Two AIDS patients serve themselves food at an assistance center run by the Catholic charity Maryknoll on November 25.
Two centuries ago, the Spanish monarchy sent a group of orphans on a ship to its
colonies in the Americas. The children served as living vessels for the vaccine against
smallpox, the equivalent at the time of today's HIV, or AIDS virus.
Two children were vaccinated shortly before departure, and when pustules developed
on their arms, the ship's doctor would use some of the pus to inoculate two more
children, roughly every nine days.
There was no system of refrigeration to preserve the live vaccine during the long
voyage across the ocean to Spain's colonies. The experiment is considered the first
international public health operation.
Today, smallpox has been eradicated. But researchers are working hard to come up
with a vaccine of similar importance: one that will fight HIV, the AIDS virus, the
worst scourge in a century, which claims three million lives a year, the highest
rate ever.
The number of people living with HIV/AIDS-over 40 million today-is steadily climbing,
as is the number of deaths the virus causes, said Marika Fahlen, director of social
mobilization and information for the United Nations Joint HIV/AIDS Programme (UNAIDS).
Some five million people have been infected with HIV this year, said Fahlen at the
release of the annual report ''AIDS Epidemic Update 2003'' in London.
The disease appears to be unstoppable despite the barrage of efforts, which include
treatment with antiretroviral drugs, as well as prevention measures like educational
campaigns on safe sex and awareness-raising initiatives on how the virus is spread.
But the biggest hope lies in the discovery of a vaccine. Efforts towards that goal
have been under way since 1985, said José Esparza, a World Health Organization
(WHO) AIDS vaccine expert.
The provision of pharmaceuticals to people living with HIV/AIDS took on renewed momentum
through the WHO/UNAIDS strategy known as "3x5", shorthand for making the
antiretroviral "cocktail" therapy available to three million people in
2005.
Today, only 400,000 people receive the drugs, said WHO official Donald Sutherland.
Of that total, a relatively large proportion, around 70,000 live in South America,
mainly Brazil.
Esparza noted that, years ago, the Brazilian government began to furnish people living
with HIV/AIDS with antiretroviral drugs free of charge. The big challenge now is
to make these drugs available to patients in Africa, a moral commitment that the
world must assume, he said.
Science cannot continue producing wonder drugs that radically change the prognosis
for people living with HIV/AIDS in the United States and Europe, while the developing
world has virtually no access to those drugs, he argued.
Catherine Hankins, UNAIDS chief scientific adviser, points to the situation in sub-Saharan
Africa, which is dominated by a cycle of disease and death largely due to the total
lack of far-reaching prevention programs and antiretroviral treatment.
Of the 40 million people living with the disease worldwide, nearly 27 million are
in sub-Saharan Africa, amounting to between 7.5 and 8.5 percent of the adult population
on that continent.
Prevalence of the disease in that region ranges from less than one percent in Mauritania
to nearly 40 percent in hard-hit Botswana and Swaziland. But Esparza says the application
of the "3x5" strategy would renew hopes in Africa about the availability
of antiretroviral drugs and would revitalize programs for fighting HIV/AIDS in all
developing countries.
The price of these medicines today has dropped to the point that, with less than
a dollar a day, a person with AIDS can be treated with the least expensive yet appropriate
drug cocktail that the WHO recommends.
That sum is around 300 dollars a year, which is still considered high, but is a tiny
portion of the 10,000 to 15,000 dollars per person that the drugs cost just a few
years ago.
However, Esparza notes that the problem is not limited to prices, but also involves
the infrastructure needed to distribute the medicines. The treatments are complex
and require strict medical follow-up. There are many who say the African optimism
is a bit premature, he adds.
The big pharmaceutical transnationals used the same arguments in 2001 when debate
began on authorizing developing countries to produce generic versions of the drugs
in order to treat their ill, as Brazil, South Africa and India have done since.
With this panorama, Esparza says a vaccine to prevent AIDS is the best hope for definitively
controlling the epidemic.
But he admits that it is not easy, nor will a vaccine be available soon, as indicated
by the outcomes of two trials published this year.
In February, encouraging results were announced for tests involving 5,400 people
in the United States, using the first generation of what are known as the GP120 vaccines.
And a few weeks ago, reports were released for a similar trial conducted in Bangkok,
with 2,500 young men who use intravenous drugs. But the vaccine did not provide much
protection for high-risk populations.
Nevertheless, the experiments with vaccines have provided important lessons. For
one thing, they have shown that it is possible to follow the individuals taking part
in the trials for three years, even though they often live in difficult situations.
"We now know that the tests can be conducted with the highest ethical and scientific
standards," says Esparza.
But another issue is that the antibody induced by this type of vaccine does not protect
people who already have HIV, at least not for the majority of the test population.
A different kind of antibody is needed, and scientists are already trying to identify
one, said the WHO expert.
Another lesson is that in future experiments, variables of gender and race need to
be taken into account. Esparza admits that tests should include more women and more
people representing different ethnic groups.
On another front, some unpublished studies conducted in the United States show that
people of African descent produce higher levels of antibodies than people of European
descent. This phenomenon was unknown until just a year ago.
The relatively poor results of the two vaccines developed in the past three years
have prompted members of the scientific community to seek a different route.
In June, AIDS researchers proposed creating a global enterprise for a vaccine, based
on the model that was used to decipher the human genome.
The enterprise will be an alliance of research institutions, independent agencies
from developing and industrialized countries alike, both public and private sector-and
would include the WHO and UNAIDS.
The alliance, which is sponsored by the U.S.-based Bill and Melinda Gates Foundation,
is founded on the principle of a common scientific plan, says Esparza, who will leave
the WHO in the next few months to join the new project.-IPS
Facts about HIV/AIDS
Infection
ï In 2003, 5 million people are expected to contract HIV, a slight increase o ver
2002.
ï Infection rates are rising throughout sub-Saharan Africa, India and China.
ï Uganda, Thailand and Cambodia are among the only countries to have successfully
reduced their HIV prevalence rate.
ï Southern Africa, with less than 2 percent of the world's population, has about
30 percent of those living with HIV/AIDS.
Death toll
ï About 8000 people succumb to the virus every day worldwide.
ï 68 million are expected to have died by the year 2020.
ï 26 million people have already died from AIDS since 1980.
ï There are at least 40 million people living with HIV/AIDS worldwide.
Treatment:
ï In 2003, the least expensive drug regime approved by WHO cost about $300 per year.
ï In 2000, the standard drug regime in developed nations cost between $10,000 and
$12,000 per year.
ï Last year, about 800,000 people had access to anti-retroviral treatment for HIV/AIDS.
ï 500,000 of them lived in high-income nations.
ï 50,000 and 43,000 lived in sub-Saharan Africa and the Asia-Pacific region, respectively.
Cambodia and Asia
ï In Cambodia, 157,000 people live with HIV or AIDS.
ï Over 1 million people are expected to acquire HIV in the Asia and Pacific region
in 2003.
ï 7.4 million people in the region now live with the virus.
ï 500,000 of them are estimated to have died of AIDS in 2003.
Sources: UNAIDS, WHO
