World 'woefully unprepared' to spread Aids treatments

The big buzz at the world’s largest Aids conference is that microbicides to help women protect themselves from HIV might be available in several years. Yet Aids experts warned yesterday the world is woefully unprepared to ensure widespread access to such treatments.

Promising tests for new HIV prevention approaches are nearly complete, yet many financial and ethical obstacles could delay or even derail completion of critical trials.

More than 40 million people worldwide today are living with the virus that can lead to Aids . An estimated 25 million people have died of Aids since the first cases of HIV were reported 25 years ago.

Testing of microbicides that could protect impoverished women who have little say over their health and bodies in sub-Saharan Africa, for example, will be complete by the end of next year. A topical microbicide to block HIV transmission could be available by 2010.

Recent studies in Africa suggest men can cut the risk of getting HIV from an infected partner by some 60% if he is circumcised; HIV-positive men also appear about one-third less likely to spread the virus if they have been circumcised.

Other hopeful approaches include cervical diaphragms, antiretroviral drugs such as tenofovir, the suppression of herpes – which boosts HIV risk up to three times – and the relentless search for an HIV vaccine.

“Very soon, we could have new, highly effective ways to prevent many of the 4 million new HIV infections that occur every year,” said Helene Gayle, co-chair of the Global HIV Prevention Working Group as well as the 16th International Aids Conference under way in Toronto. “But these tools will have little impact in the real world unless we take immediate steps to complete current trials, mount new ones, and reach people most in need.”

The Working Group, in a report released at the conference yesterday, noted that fewer than one in five people at high risk for HIV infection today have access to effective prevention, a rate deemed too low to have a significant impact on the course of the epidemic.

“The development of effective new HIV prevention approaches could help millions avoid crippling illness and death,” said David Serwadda, director of the Institute of Public Health in Kampala, Uganda, and co-chair of the Working Group. “But unless we prepare now to make new, lifesaving tools accessible in developing countries, this scientific triumph will turn into a moral failure.”

The report made three recommendations to prepare for the roll out of the new HIV prevention methods which have already proven effective in clinical trials: Major new donor funding; more trained health care providers; and efforts to better develop education campaigns to emphasise the importance of using simple, cheap prevention such as condoms.

Gayle noted a trial for tenofovir – a generic drug already used to treat Ais and now being tested as a preventative pill – was cut short prematurely in Cameroon and Nigeria over concerns about whether the women in the study who became infected would receive treatment for Aids.

“When we talk about the ethical considerations, there’s a whole range of issues, but one that comes up most strongly is what’s the ethical responsibility to treat,” she said. ”Most people do feel that there’s a strong obligation to treat people who are getting positive during the trials. But what’s our obligation to treat those people who aren’t participants?”

She said these ethical dilemmas that sideline clinical trials, compounded by lack of funding and the stigma still associated with HIV/Aids were major obstacles to treatment.

Former US President Bill Clinton, attending the second day of the week-long conference that has drawn more than 30,000 researchers, activists and health care workers from 132 countries, said developed nations must meet their commitments to the Global Fund to Fight Aids , TB and Malaria.

The lead funding agency for Aids faces a 500-million-dollar shortfall this year – despite a recent pledge of half-a-billion dollars from the Gates – and another 1.4 billion dollars next year.

“We know how to overcome Aids ; we know how to prevent more needless deaths,” Clinton said. “While more money is necessary, it is nowhere near sufficient. Every single wasted dollar puts a life at risk.”

Clinton also lamented the lack of health care workers as another roadblock to ending Aids.

“All over the world there are people whose health is better in wealthy countries because of people who left their own countries to go where they could earn more money with their great gifts,” he said. “Our foundation is working hard to reverse this.”

He said the Clinton Foundation is training 1,000 nurses in Kenya who would be folded into the public health system there.

The World Health Organisation launched an initiative on the sidelines of the summit yesterday to address the lack of health care workers. It said more than four million workers were needed to fill gaps in 57 countries, mostly in sub-Saharan Africa and Asia.

“The shortage of health workers is devastating public health systems, particularly in the developing world, and it is one of the most significant challenges we face in preventing and treating HIV,” said Dr Anarfi Asamoa-Baah, assistant director-general of WHO.

The WHO estimates it will cost 72 billion dollars over five years to implement the plan, which pledges to provide guidance and technical assistance to train health workers, offer financial incentives and improve the workplace environment.