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Experts See Hope, Concerns In Confronting AIDS

AIDS Experts See Hope, Concerns in Confronting Virus

On the eve of World AIDS Day, President Bush renewed his pledge to fight the global HIV/AIDS pandemic.

"The pandemic of HIV/AIDS can be defeated," he said November 30, through international cooperative efforts such as his President's Emergency Plan for AIDS Relief (PEPFAR). "We continue to fund research and develop new methods of treatment and prevention," he said, referring to PEPFAR's five-year, $15 billion commitment to fight the disease.

World AIDS Day also gives health professionals and public health advocates a chance to send a message, and in 2007 the message from AIDS experts was blunt.

"We are losing the fight against AIDS," Dr. Ward Cates, president of Family Health International and a leading epidemiologist, said at a November 28 briefing at the U.S. Capitol building. He acknowledged significant successes in treatment with anti-retroviral drugs of the human immunodeficiency virus (HIV), which causes AIDS. But he cited annual HIV/AIDS infection statistics -- 2.5 million worldwide -- saying more must be done to contain the disease.

"We have to reverse this. We need prevention now," he said.

Cates was one of several experts who spoke at the function sponsored by the Global Health Council (GHC), the African Union Mission to the United States, Family Health International (FHI) and the Pan American Health Organization (PAHO).

There was consensus on the need for better preventive measures. Amalia Del Riego, PAHO project manager, emphasized the importance of hindering mother-to-child transmission. She said there is a huge gap between need and prevention in Latin American and Caribbean countries. Domestic violence and sexual abuse of young people are contributing factors to the spread of AIDS there, as elsewhere, she added.

Africa remains the continent most ravaged by HIV/AIDS. Dr. Robert Einterz of Indiana University described a successful partnership with Moi University in Kenya that tackles the multifaceted problem at all community levels. The Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH), funded by PEPFAR and private philanthropy, centers on a teaching referral hospital. "Kenyans do the work," Einterz said, who is a consultant there. "We've treated over 60,000 individuals now in 26 sites," rural and urban.

The AMPATH approach has developed over time to include a farm to help patients with nutritional needs, after they found that many people on anti-retroviral drugs failed to thrive because they were on the verge of starvation. He said that after six months or so, "they get healthy enough to go back to do their farming."

U.S. Assistant Global AIDS Coordinator Michele Moloney-Kitts agreed that "while we have a lot of success to claim around the world," prevention of mother-to-child transmission must be improved, as must outreach activities. "We are still operating at a hospital level ... reaching out to communities is an ongoing challenge," she said.

"HIV/AIDS is really a disease of inequality, it is not necessarily a disease of poverty, although it does make poor people poorer," Moloney-Kitts said. "[A]ddressing gender issues and the inequality of women throughout all our interventions is hugely important."

Numerous U.S. government agencies participate in international partnership programs with governments and the private sector, but the United States Agency for International Development (USAID) and the National Institutes of Health take the lead in strategies against AIDS.

Dr. S. Ken Yamashita, USAID's director of the Office of HIV/AIDS in the Bureau for Global Health, told USINFO, "We want to make sure that the technical content of these programs has the highest level of expertise and best possible impact."

He said that the infection rate is grim -- "for every one person that goes on treatment, six become infected." He added, "It's not so much that we are losing the war on prevention. It's unless we deal with prevention, we will eventually lose the war on AIDS."

That said, research on new prevention technologies goes on apace and the landscape changes quickly. Changing risky sexual behavior is still the key to prevention, the experts say. Peer outreach is an essential tool in prevention.

"The international theme is 'keep the promise,'" Yamashita said, "and it's the promise that we will remain engaged ... that we'll do everything we can. The promise of making sure we are good partners."


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