Global AIDS conference finds the issue is cash

Money — or rather the lack of it — was at the heart of discussions at the 14th International AIDS conference in Barcelona from 7 to 12 July. Speaker after speaker denounced the polarization between HIV prevention and HIV treatment campaigns, and emphasized that prevention and treatment were complementary strategies.

There was widespread consensus that antiretroviral drugs should be introduced into poor countries, but much debate about why this was not happening and where the money should come from to ensure that it did.

"Antiretroviral treatment has slashed mortality in high income countries," said UNAIDS Executive Director Peter Piot at the opening ceremony. "Brazil has shown it can be done elsewhere. So why are only 30 000 Africans getting antiretroviral treatment, when a hundred times that number need it?"

Bernhard Schwartlander, WHO's Director of HIV/AIDS, echoed Piot later in the week: "As we all know, since 1995, highly active antiretroviral therapy (HAART) has resulted in dramatic reductions in morbidity and mortality and greatly improved the quality of life.

"There is no longer any reason to believe that this should not be possible in the poorer nations as well. Even if we do not close this unconscionable gap between the treated and the untreated, between the rich and the poor, we can prolong life for millions more."

But where was the money to come from to close this gap, and what was the best way to get the cheapest antiretroviral drugs?

The Global Fund to fight AIDS, TB and Malaria — a new tool in the AIDS war since the last international AIDS conference (in 2000 in Durban, South Africa) — was the focus of much attention as the most obvious source of money.

Richard Feachem, the Fund's new Executive Director, vowed to make it a "modern, effective tool for delivering maximum impact with funds provided by donors".

The fund's initial grants would already increase sixfold the number of Africans able to get antiretrovirals, said Feachem, and already US$ 616 million was committed to be disbursed worldwide over the next two years.

But he acknowledged that, "to succeed, the amount of money spent must be dramatically increased".

"Many billions more will be required quickly to implement the high-quality proposals that we anticipate receiving during the next 12 months," said Feachem. "Without rapid and substantial increases in financial support for the Global Fund, it will not be possible to support the most worthy of these plans."

US Health Secretary Tommy Thompson was shouted down by Act Up and other activists when he tried to explain to the conference why his country had not contributed more to the Fund. Rwanda contributed ten times more in terms of a percentage of its GNP than the US, activists pointed out.

Thompson countered that his government had already dedicated more money to AIDS than the previous administration, and was spending US$ 1 billion on fighting the disease this year alone.

But at the close of the conference, former US President Bill Clinton said that, in order to pay its fair share of the US$ 10 billion needed annually to fight AIDS, the US contribution of US$ 800 million to the Fund would need to be increased by almost US$ 2 billion.

This amounted to "less than two months of the Afghan war and less than 3% of the requested increases for defence in the current [US] budget", said Clinton.

"We cannot lose the war on AIDS and win our battles to reduce poverty, promote stability, advance democracy and increase peace and prosperity," said Clinton. "That is why I said it was a security threat when I was President. That is why every citizen on our small planet has a personal interest in ending AIDS."

Also at the closing ceremony, former South African President Nelson Mandela called on "all institutions, public and private, to make rapid and real progress" to ensure that all those who needed antiretroviral treatment had access to it.

Mandela said that in a world where the treatment was available and antiretrovirals could return people with AIDS to good health, it was unacceptable that parents should die and leave their children orphaned.

The issue of generic antiretroviral drugs was repeatedly raised by speakers and delegates as a way of lowering treatment costs.

Children's rights advocate — and Mandela's wife — Graca Machel put the position clearly when she called on pharmaceutical companies to release their patents "so generic antiretroviral drugs can be available to the millions of poor people who need them".

"We know they are there to make money and I don't question that, but if you sell your medicines to 30 million people rather than three million, you will still make money."

Kerry Cullinan, Barcelona

World Health Organization Genebra - Genebra - Switzerland