SF Gate Home Today's News Sports Entertainment Technology Live Views Traffic Weather Health Business Bay Area Travel Columnists Classifieds Conferences Search Index

AIDS Experts To Meet in Eye Of Epidemic 20% of South Africa's adults are infected Sabin Russell, Chronicle Staff Writer   Friday, July 7, 2000 The most important thing about the 13th International AIDS Conference convening Sunday is the simple fact that for the first time it is taking place in Africa. After all, more people are living with the AIDS virus today in South Africa, the conference's host country, than any nation on Earth. About half of the 15-year-olds in that country and other African nations hardest hit by the epidemic will eventually die of the disease, according to UNAIDS, the U.N. agency dealing with AIDS. ``For the symbolism alone, this is a very important meeting,'' said Dr. Anthony Fauci, the U.S. government's leading AIDS researcher who directs the National Institute of Allergy and Infectious Diseases. Fauci is one of more than 10,000 AIDS researchers, activists and journalists converging on Durban, a historic South African seaport and Indian Ocean beach resort, for the biennial meeting to report on the latest efforts to track the disease and curb its spread. When the first international conference was held in Atlanta in 1985, the global dimensions of the AIDS epidemic were only beginning to take shape. AIDS is now estimated to have killed 18 million people, most of them from the world's poorest places. The location of the weeklong International AIDS Conference has already stirred up unprecedented interest in Africa's AIDS epidemic, which has been consuming the continent without much attention from Western nations preoccupied with their own, smaller battles with the disease. ``AIDS is having an incredibly destabilizing effect on these countries,'' warns Tom Coates, director of the AIDS Research Institute at the University of California at San Francisco. Like many researchers who chart the global spread of HIV, he is hopeful that the Durban conference will prompt the United States to devote more time, attention and money to prevention efforts abroad. Durban itself has a storied past. One of the few natural harbors on the southern coast of the African continent, it became a major port and railway center for South Africa. It was from the Indian immigrant community there that Mohandas Gandhi launched his political career. STRADDLING 2 WORLDS With its unique and tragic history of apartheid, South Africa is a nation that straddles two worlds. It is both a developing country -- with its black majority population among the most impoverished in the world -- and an industrial power. It is rich in mineral resources and has a highly educated workforce. It also has advanced computer and communications systems and a strong military believed to have nuclear capability. Durban is both a gateway to South Africa and a port of entry for the AIDS virus -- a place where, after the fall of apartheid and the lifting of international sanctions 10 years ago, the world poured in, bringing with it renewed trade, immigration and HIV infection. Spared the early onslaught of AIDS -- which had been killing millions of people in other countries of sub-Saharan Africa since the 1980s -- South Africa has suddenly found itself the epicenter of a global pandemic. Twenty percent of South Africa's adult population, or 4.2 million people, are believed to be infected with HIV. The proportion of infected adults nearly doubled from two years ago, according to UNAIDS. UNAIDS estimates that one in four South African women aged 20 to 29 is infected. According to a University of Pretoria assessment, 45 percent of South Africa's mine workers are now HIV-positive. In the eastern KwaZulu-Natal province -- where Durban is situated -- the HIV infection rate has exceeded 30 percent among pregnant women, while rates as high as 60 percent have been recorded in the Messina, near the northern border with Zimbabwe. `HOPE OF AFRICA' While South Africa is seen by much of the industrialized world as the ``hope of Africa,'' its government's hesitant and conflicted response to the epidemic has both puzzled and angered AIDS researchers. Nothing has upset the world scientific community more than South African President Thabo Mbeki's flirtation with widely discredited theories that the human immunodeficiency virus is not the cause of AIDS. Without access to the costly anti- retroviral drugs that have helped suppress HIV in the United States and slowed the horrific death toll from AIDS, there is a yearning on the part of millions of Africans for a different explanation of what is happening there. ``I really wish they would find that HIV is not the cause of AIDS,'' said Winstone Zulu, an HIV-positive activist from Zambia, ``because then I would be off the hook.'' For a while, there was talk of canceling the Durban conference to protest Mbeki's stance. Renowned San Francisco AIDS clinician Dr. Paul Volberding said he is not attending the conference this year, ``in part because of Mbeki's statements.'' At a visit to San Francisco in May, however, the South African president seemed to be subtly shifting the target of his skepticism -- no longer so concerned whether HIV is the cause of AIDS, but asking more pointed questions about why HIV has struck Africa so much harder than the industrialized West. While the epidemic in Europe and the United States remains concentrated among gay men, injection drug users and their partners, in Africa it is a heterosexual epidemic. ``If there are different biological circumstances affecting Africa, it is important for us to take into account those differences,'' he said. Yesterday, the British journal Nature published a statement endorsed by more than 5,000 scientists stating unequivocally that HIV is the cause of AIDS. The so-called Durban Declaration said the evidence was ``clear-cut, exhaustive and unambiguous, meeting the highest standard of science . . . HIV causes AIDS. It is unfortunate that a few vocal people continue to deny the evidence. This position will cost countless lives.'' The release of the declaration on July 1, prior to its publication in Nature, drew a quick rebuke from the South African government. ``We have never seen this kind of intolerance and we don't want people bringing intolerance to South Africa,'' Mbeki press spokesman Parks Mankahlana told Reuters. INDECISIVE RESPONSE As it grapples with the growing epidemic, the leadership of South Africa has been criticized at home and abroad for its failure to react decisively. South Africa's health minister, Dr. Manto Tshabalala- Msimang, told American reporters in May that HIV is only one among a long list of serious health and economic problems facing his country. ``People with AIDS expect you to drop everything for AIDS,'' she remarked. ``As my daughter said to me, `You are the minister of health, not the minister of AIDS.' '' Nevertheless, Tshabalala-Msimang has taken the lead in pressuring the global pharmaceutical industry to provide low-cost access to modern drugs. At a recent conference, she reasserted her government's right to make or purchase generic version of AIDS drugs by issuing ``compulsory'' licenses to patent holders and shopping the world market for the cheapest products. The conference itself is unlikely to yield any major scientific breakthroughs. Because of the highly politicized environment of the international AIDS conclaves -- the program is a magnet for global activists and sometimes disruptive protests -- the most important research findings are saved for other gatherings, such as the Conference on Retroviruses and Opportunistic Infections, held last February in San Francisco. But as a forum for discussing the impact of AIDS in the developing world, the Durban conference will be unparalleled. Dr. Peter Piot, executive director of UNAIDS, said the world is only now beginning to grasp the devastating impact AIDS will have on the social fabric of struggling nations. Last week Piot released a dire prediction of an entire generation of Sub-Saharan Africans taken out by AIDS -- most notably in countries such as South Africa, Zimbabwe and Botswana. ``The probability that you die from AIDS when you are 15 today is over 50 percent in these countries,'' Piot said. ``We are going into societies where there are more people in their 60s and 70s than there are in their 40s and 30s. This is unheard of.'' AIDS ORPHANS Durban will focus the world's attention on the growing problem of AIDS orphans. A total of 13.2 million children under the age of 15 have lost either their mother or both parents to AIDS, according to Piot. There will be many debates and demonstrations in Durban about the lack of access Africans have to the anti-retroviral drugs used by HIV-infected Americans and Europeans. At a cost of at least $12,000 a year, the triple drug combinations are hopelessly out of reach for millions of Africans, where total health spending is a fraction of that in the West. In the United States, for example, per capita health spending is $4,187. In South Africa, it is $268. In Cameroon, it is $31. Inevitably, a medical conference on AIDS in Africa will focus on the frustrating search for a vaccine. ``Some of the realities will come into focus when people go to Africa,'' said Dr. Donald Francis, president of VaxGen Inc., a Brisbane firm that is now conducting advanced trials of an AIDS vaccine. It is similar to one that blocked HIV in chimps. Final evaluation of the trials is still three years away. As a public health worker in Africa in the 1970s, Francis played a role in the successful campaign to wipe out smallpox, and he was among the first to identify AIDS as a global threat. ``The cost of treating AIDS in Uganda at current prices for anti-retroviral drugs is 12 times that nation's gross national product,'' he noted. ``If they reduce prices by 80 percent, it's still more than twice the country's GNP.'' Francis believes economics like that will force policymakers to pay more attention to prevention strategies, including vaccines. ``Those of us who have worked over there know that life is really tough in most of the world. You have to recognize that, and then do the best that you can,'' he said. 5 STEPS TO CONQUER A KILLER The 13th International AIDS Conference in Durban presents an opportunity for Western nations to respond to Africa's AIDS epidemic. On the basis of interviews with doctors, scientists, epidemiologists and economists, here are five realistic steps that, with Western assistance, could help bring Africa's HIV epidemic under control. PROVIDE HIV TESTING AND COUNSELING People who know they are infected with the AIDS virus tend to change their behavior. They are more likely to use condoms and less likely to infect others. But in Africa, fewer than 10 percent of those who are infected with HIV know it. AIDS tests cost only a few dollars each, still out of reach for most African governments. With help from abroad, HIV testing and counseling could become commonplace. With readily available testing, AIDS education and condom distribution programs would become more effective. TREAT SEXUALLY TRANSMITTED DISEASES Sexually transmitted diseases such as syphilis and herpes are a major risk factor for the transmission of HIV. Offering antibiotics and antiviral drugs to treat these conditions will not only alleviate the suffering they cause, but could also reduce HIV infection rates. PROMOTE MALE CIRCUMCISION A growing body of evidence is convincing AIDS researchers that lack of male circumcision may play a huge role in the spread of HIV among heterosexuals. In Nigeria, where there is a tradition of circumcision, the HIV rate is 4 percent. In Botswana, where it is not practiced, the adult infection rate is 36 percent. Proponents say male circumcision, with appropriate counseling on the continued need for safe sex, could cut HIV transmission by 50 percent or more. Under sterile conditions, male circumcision is a safe, low-cost (under $6) and permanent medical intervention that could prevent millions of HIV infections. PROVIDE DRUGS TO CUT MOTHER-TO-CHILD TRANSMISSION Roughly 30 percent of infants born to HIV-infected mothers contract the virus at birth. Short courses of the drug AZT costing about $800 during and after birth have reduced mother-to-child transmission in the United States to under 5 percent. Less expensive, lower-dose regimes tested in Thailand show the potential to cut the transmission rate at least in half. A single dose of the antiviral drug nevirapine for mother and child bettered the Thailand results at a cost of only $4 per infant, compared with $60 for AZT. OFFER DEBT RELIEF AIDS, like many other diseases on the African continent, remains overwhelmingly a disease of poverty. As long as African nations must function under extreme financial constraints, they will not be able to build the roads, water systems and hospitals needed to treat the epidemic. South African president Thabo Mbeki is expected to ask the world's leading industrial powers for $100 billion in debt relief to free up money to battle Africa's health problems. It is a big number. So is the number of HIV infections in the developing world. E-mail Sabin Russell at russells@sfgate.com.   · Printer-friendly version · Email this article to a friend

Feedback

©2000 San Francisco Chronicle   Page A1 Sections North Bay Datebook San Francisco Commentary Sports News Peninsula Contra Costa East Bay Business