December 1, 2004
Tough challenges remain in AIDS fight
BBC

By the time World Aids day has run its course an estimated 14,000 more people in the world will have become infected with HIV. Nearly 40 million people globally are living with the Aids virus and within two years, six million more are expected to die.

By Karen Allen
BBC Health correspondent

By the time World Aids day has run its course an estimated 14,000 more people in the world will have become infected with HIV.

Nearly 40 million people globally are living with the Aids virus and within two years, six million more are expected to die.

The statistics make grim reading and with infections continuing to rise at an alarming rate, there is no room for complacency.

It is a dynamic picture and one of the biggest global challenges the international community has had to face.

Funding

Global funding for HIV/Aids has tripled in the past four years from a little over US$2bn to $6bn.

Yet it still falls far short of the $20bn UNAids estimates will be needed by 2007, just to stop the epidemic getting worse.

With more money now in the system, divisions are emerging about how it should best be spent.

The Bush administration in the US has committed $15 billion to fight HIV/Aids. It's an impressive sum.

But it has come in for criticism from some aid agencies for pushing programmes that use brand name anti-retroviral drugs which are more expensive than their generic counterparts.

It has also been under fire for pursuing an agenda which gives priority to projects that promote sexual abstinence over condom use.

Some commentators say this is irrelevant for women in parts of Africa, for whom the biggest risk is of getting HIV is having a partner who sleeps around.

But others argue that even money with strings attached is welcome at a time when the epidemic shows little sign of waning.

Anthony Fauci - the US government's key advisor on HIV/Aids argued at the International Aids Conference in Bangkok that the logic behind the Bush programme was to maintain accountability and control over how US taxpayers' money is spent.

Meanwhile UN Secretary General Kofi Annan ruffled feathers when he countered that the American unilateral approach was undermining the Global Fund - an international mechanism to raise cash for HIV/Aids work, which is struggling to meet its financial targets.

That dispute has not really been resolved but there is now a concerted international effort to co-ordinate Aids funding in a more orderly manner.

This is likely to be a key theme taken up by the British government when it assumes the presidency of the G8 and EU next year.

Drugs

The cost of a year's anti-retroviral treatment has fallen from around £6,000 a year to £180, yet nine out of 10 people who need the medicines are still not getting these life-saving treatments.

The World Health Organisation has set an ambitious target of getting three million people onto the drugs by the end of 2005.

But there are real doubts whether this is achievable, given current funding levels. Aid agencies say that it is entirely possible to meet that deadline but what is needed is the political will to roll drugs out on a massive scale.

However, it is not simply about distributing pills.

Christian Aid is one of the charities warning that without proper investment to build hospitals and train staff, sustaining anti- retroviral treatment in the long term will be hard.

Anti-retrovirals need to be taken consistently and widespread failure to do this could lead to major drug resistance and a reduction in treatment options for infected patients.

Vaccines

Finding a safe effective vaccine is the holy grail in HIV/Aids research but is proving a difficult challenge and it is unlikely that we will see effective immunisations available before the end of the decade.

There are currently some 30 different Aids vaccines undergoing trials.

These experiment with different approaches, aiming either to disable the Aids virus or prevent it from entering human cells and multiplying.

Aside from the scientific difficulties of HIV vaccine research, there are also enormous financial challenges.

IAVI, the International Aids Vaccine Initiative points out that only 1% of global research and development funding is being channelled into finding an Aids vaccine.

The G8 have promised to set up a Global HIV Vaccine Enterprise, a consortium to fast-track Aids vaccine research and pool information and cash.

The British government has already indicated that it intends to push Aids vaccine research up the political agenda, backing it up with a promise of more funding.

If indeed it does deliver, it could be a lasting legacy that finally turns the tide on an unrelenting epidemic.

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