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<DIV style="FONT: 10pt arial">
<DIV style="BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A
title=RKoppenleitner@t-online.de
href="mailto:RKoppenleitner@t-online.de">RKoppenleitner</A> </DIV></DIV>
<DIV class=Section1>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">JOHANNESBURG, 22 August (PLUSNEWS) - As the 26,000
delegates who attended the 16th International AIDS Conference in Toronto,
Canada, prepared to head home on Friday, the pervading mood was one of guarded
optimism.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">The conference theme, 'Time To Deliver', set the tone
for a week of reflection on lessons learned from the past 25 years of the AIDS
epidemic. UN Special Envoy for HIV/AIDS in Africa Stephen Lewis used it as a
rallying call in his closing speech to define the needs of the next 25 years,
with a special focus on prevention.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">At the previous conference, two years ago in Bangkok,
the issue of prevention was largely eclipsed by the push for treatment access.
In Toronto there was consensus that the goal of universal access to treatment
would remain beyond reach as long as new HIV infections outpaced the ability of
governments to deliver treatment and care.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">According to UNAIDS, new HIV infections every year are
outrunning AIDS-related deaths. In Sub-Saharan Africa, for example, there were
2.7 million new infections in 2005 compared to 2 million deaths, but less than
one in five people at risk of becoming infected has access to basic prevention
services.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">Lewis echoed the view of many speakers in Toronto who
criticised abstinence-only prevention programmes as both ineffective and
dictated by the ideological bias of funders. Others argued that behaviour-based
prevention programmes could work when they were based on evidence rather than
ideology, but were overshadowed by the nearly unanimous bashing of the 'ABC'
approach - 'Abstinence, Be faithful, Condom use' - advocated by President Bush's
Emergency Fund for AIDS Relief (PEPFAR). </SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">The UN envoy added his voice to those of Bill Gates and
former US President Bill Clinton who put their considerable weight behind the
delivery of an effective female-controlled microbicide, and the rapid rollout of
male circumcision that initial data suggested could be 60 percent effective in
reducing HIV transmissions among men.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">Lewis also pointed out that existing prevention methods,
such as the use of combination antiretroviral (ARV) therapy for the prevention
of mother-to-child transmission, were being severely underutilised in the
developing world, where most countries were still giving HIV-positive pregnant
women less effective single-dose nevirapine, if anything at
all.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">"This means that hundreds of thousands of babies
continue to be born HIV-positive rather than reducing the transmission rate
virtually to zero," he said.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">Earlier in the week, delegates learned that ARV
treatment itself has a role to play in prevention. Efficacy trials of an
approach called pre-exposure prophylaxis (PREP), in which ARV drugs are
administered to prevent infection, are underway in three countries and could
produce results as early as 2007. Julio Montaner, the director of British
Columbia's AIDS Centre in Vancouver, presented a mathematical model showing that
if all identified cases of HIV were treated, prevalence would drop to virtually
zero by 2050 because treated people were much less infectious.</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">The likelihood of achieving universal access anytime
soon looks remote at current rollout rates. Lewis said the number of people on
treatment only rose by 350,000 in the last six months, bringing the total to
1.65 million of an estimated 6.5 million people in immediate need of the drugs.
</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">According to Lewis, "a huge financial crisis" threatens
closing of the treatment gap - commitments by G8 leaders in Gleneagles last year
are already unravelling and no one is sure where the billions of dollars needed
to achieve universal access, prevention and care will come
from. </SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">The focus on prevention and treatment was not popular
with everyone at the conference. Several delegates from organisations working in
Africa pointed out that ARVs and new prevention methods were beside the point
when the real drivers of the pandemic in developing countries were economic and
gender inequality. </SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">"We need to go far, far beyond the technologies that are
being highlighted here," said Stuart Gillespie of the Regional Network on
HIV/AIDS, Rural Livelihoods and Food Security (RENEWAL). "We need to go beyond
even food aid; we need to look at livelihood security."</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">On the final day of the conference, Lois Chingandu,
executive director of the Southern Africa HIV/AIDS Information Dissemination
Service (SAFAIDS), expressed disappointment that governments had not used the
conference as an opportunity to set long-term financial targets for combating
the epidemic. </SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">She told journalists that community-based organisations
and health workers were already well-positioned to deliver treatment, prevention
and care, but needed political leaders to make good on promises of "sustainable,
predictable and flexible financing that allows us to respond in our own
way".</SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN lang=EN-GB
style="FONT-SIZE: 10pt">Lewis agreed that the key to capitalising on the
cautious optimism of the conference lay at country-level. "If the next 25 years
are to link, inseparably, poverty and disease ... then it has to happen
in-country, on the ground - organised and orchestrated by the countries
themselves." </SPAN></FONT></P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
<P class=MsoNormal><FONT face=Arial size=2><SPAN
style="FONT-SIZE: 10pt"></SPAN></FONT> </P>
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