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Bleak AIDS Conference Reports Deliver a Global Reality Check

Disease: The meeting closes with daunting projections on the epidemic's spread and the efficacy and cost of new treatments.


BARCELONA, Spain — Frustration was palpable in the hallways and meeting rooms here as the 14th International AIDS Conference drew to a close amid protests against drug companies and Western governments, dire forecasts about the epidemic's toll and limited prospects for new treatments.

Activists decried what they see as greedy pharmaceutical manufacturers and miserly governments, particularly those of the United States and the European Union. Conferees listened to bleak projections of 25 million AIDS orphans by 2010, another 45 million people infected with HIV in the same period, and in some nations, average life expectancies dropping below 30 years.

Meanwhile, in the six days of the meeting, 50,000 people died of AIDS around the world and another 84,000 were infected with HIV, the virus that causes AIDS.

Scientifically, researchers heard little of promise. Pre-approval clinical trials of a new class of drugs called fusion inhibitors suggest that they will be a valuable addition to the AIDS arsenal, but the first such drug, called T-20, will probably cost at least $12,000 per year per patient. Other potential new classes of drugs are still five to six years away.

The first major trial of an AIDS vaccine is nearing an end and an even larger trial sponsored by the U.S. and Thailand is scheduled to begin, but few experts believe that either vaccine will halt the spread of the disease. Meanwhile, a Harvard researcher reported on a patient who had developed apparent immunity to one strain of HIV, only to become infected by a second--a finding that suggests that any vaccine may provide only limited protection.

"In some ways, it's like the morning after the Northridge earthquake--the worst is yet to come," said Lee Klosinski of AIDS Project Los Angeles.

The meeting, which concluded Friday, was "a reality check" on how the world is progressing in the battle against AIDS, said Dr. Seth F. Berkley, president of the International AIDS Vaccine Initiative, and the world is not passing the test. Developments in Barcelona, he said, were "a splash of cold water."

Former President Clinton echoed that sentiment, calling AIDS "an epidemic that will not turn, the worst thing since the bubonic plague killed a quarter of Europe in the 14th century."

Clinton noted the mood of the more than 15,000 conferees, the most ever, and said: "All these numbers are overwhelming, and there have been no medical breakthroughs, and I know a lot of you are worn down. And if you are HIV-positive, you might be feeling a little frightened."

But the situation is not hopeless, he added. "I would like to say that there is a greater level of understanding and support in the political leadership of the world ... than I have ever seen."

That understanding led to the creation last year of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The fund's head, Richard Feachem, hopes to have 3 million people in the developing world receiving HIV drugs by 2005--compared with only about 230,000 now--but reaching that goal will require a minimum of $10 billion per year. Government donations for the first year are still less than $3 billion, however.

The U.S. has received by far the most criticism for its effort. America has contributed $500 million, but it is not clear whether that sum is for one year or several.

U.S. Secretary of Health and Human Services Tommy G. Thompson was booed loudly when he attempted to make a speech here Tuesday. That address, which no one was able to hear, noted that the United States had donated nearly a quarter of the money received by the fund so far, more than any other nation.

But Mogha Smith, chairman of the British charity Oxfam, said that the $118 million donated by the Netherlands and the $58 million from Sweden are a much more significant contribution when viewed as a percentage of those countries' gross national products. On that basis, those commitments are five times that of the United States.

An AIDS activist from South Africa, Zackie Achmat, made his own plea for help. Appearing by videotape because he is too sick to travel, Achmat said, "Just because we are poor, just because we are black, just because we live in environments and continents that are far from you, does not mean that our lives should be valued any less."

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