Prediction of 68 million dead

Barcelona--The statistics were sobering as the biennial 14th International AIDS Conference got under way here July 7.

More than 20 million people have died of AIDS and some 40 million more are HIV-infected. By the year 2020, another 68 million may be dead, says UNAIDS, the Joint United Nations Programme on HIV and AIDS. The drugs that keep HIV from progressing to AIDS are mostly unavailable around the world. Only about 700,000 of the 40 million people infected are believed to have access to an antiretroviral cocktail. That’s less than 2 percent.

The problem is, for the most part, cost. Drug companies charge $12,000 to $15,000 a year per person for treatment--far beyond the means of everyone except the wealthy and people with full access to First World health-care systems.

Under pressure, some companies have lowered the price of their AIDS drugs in some Third World nations, but not enough that people can afford them. An exception is Brazil, which ignores international patents and produces generic AIDS drugs.

"We are only at the beginning of the AIDS epidemic," said UNAIDS Director Peter Piot. "Collectively, we have grossly, grossly underestimated how bad this was going to be . . . It’s frightening. It is by far the biggest epidemic that humanity has known in absolute terms."

As the conference got under way, therapeutic vaccines and entry inhibitors were generating some buzz.

Therapeutic vaccines are given to people who are already infected to stimulate their immune systems to battle HIV.

Entry inhibitors will be the next class of anti-HIV drug to arrive on the market, joining the protease inhibitors and reverse transcriptase inhibitors now available. Entry inhibitors, which must be injected, work earlier in the infection process than other drugs, thwarting HIV’s attempt to attach to an immune-system cell in the first place.

T-20 is expected to be the first entry inhibitor to become generally available, probably in less than a year.

Just prior to the opening of the conference July 7, several hundred protesters calling themselves ATTN (AIDS Therapeutic Treatment Now) marched on the conference site.

A flyer said their demand was "antiretroviral treatment for 2 million people living with and dying from HIV/AIDS before the 2004 International AIDS Conference in Bangkok."

This could be achieved, they said, via drastic reductions in the prices of AIDS drugs or by lifting laws that prevent generic copying of the drugs.

The organization also is demanding lower prices in the developed world, where health-care costs continually increase significantly faster than the inflation rate due, in large part, to the price of pharmaceuticals.

ATTN was created by the Network of AIDS Communities of South Africa, the Uganda Business Coalition on HIV/AIDS, the AIDS Healthcare Foundation of Los Angeles and the foundation’s Global Immunity project.

The opening plenary session was unremarkable except for the speech by Spanish Minister of Health and Consumer Affairs Celia Villalobos. No one heard what she said because several hundred Spanish delegates screamed and blew whistles throughout her entire address.

They were upset at reports that some Third World delegates experienced major complications in securing visas to attend the conference, and that Spain has only budgeted for 21 percent of its promised 50 million euro ($51 million) contribution to the worldwide fight against AIDS. Other speakers included the city council president, the mayor of Barcelona, the president of Catalonia (the autonomous region in which Barcelona is located), Her Royal Highness Infanta Elena (the king’s daughter) and various international AIDS officials.

In the U.S., said a spokesman for the Washington, D.C. lobby group AIDS Action, one of the biggest AIDS-related problems nowadays is barebacking--gay men deliberately not using condoms during casual sexual encounters.

"There is the whole notion that AIDS is over in the United States, that it’s not a problem any more," AIDS Action’s Scott Brawley said in an interview after the opening plenary.

"Prevention messages are not working. We do have gay men barebacking. We have risk groups sharing needles again. We’ve got heterosexuals that have no idea what’s going on. We have a whole generation of people under the age of 30 that don’t remember the AIDS epidemic, that think it’s nothing more than, ‘Hell, you take a couple of pills and you’ll be fine.’ "

Brawley said he did not really have any good ideas on how to stop gay men from barebacking.

"My honest response, as a gay man, is that things are going to have to get worse again before they’ll ever get better," he said. "Resistant HIV, an explosion of HIV, something that may go wrong with the medications. You never know when medications will fail."

The conference runs until July 12, when the closing plenary session will be addressed by former U.S. president Bill Clinton, who is the advisory board chair of the International AIDS Trust, and former South African president Nelson Mandela, who is honorary co-chair of the International AIDS Trust.