An unlikely brew of sex-education workers, scientists,
performance artists, politicians and concerned citizens from across
the globe flooded the streets of Bangkok, Thailand last week in an
effort to combat the AIDS epidemic that is plaguing parts of the
world.
The occasion was the 15th biennial International AIDS
Conference, and it turned Bangkok into a global village where more
than 15,000 delegates from 160 countries met to talk about
HIV/AIDS
At the conference, scientists, policy-makers, activists and
HIV/AIDS victims from all over the world ““ along with
UCLA’s own AIDS Institute ““ gathered to discuss the
state of the AIDS epidemic and to compare approaches to eradicating
it.
“We’re doing a really good job of treating AIDS, but
not of preventing it, as you can see from the growing numbers of
infections,” said Edwin Bayrd, executive director of
UCLA’s AIDS Institute and Bangkok conference attendee in a
phone interview from Bangkok.
An estimated 5 million people became infected with HIV in 2003
alone. For this reason, scientists and policy-makers are ever more
forcefully stressing the importance of international cooperation in
containing AIDS, sharing their latest developments on HIV vaccines
and cheaper, more effective treatments.
But the problems with solving the worldwide AIDS crisis go
beyond answering these pressing scientific questions.
Unlike many other virus epidemics, HIV/AIDS carries stereotypes
that make it difficult for people to see the virus as their common
enemy, leading policy-makers to neglect populations that are at the
highest risks of infection, Bayrd said.
Current treatments may be effective, said Bayrd. But many
developing countries such as South Africa and Cambodia don’t
have the money for access to the expensive drugs used to treat
AIDS. Others refuse to acknowledge that they have an AIDS problem
at all.
“There is still a huge stigma attached to it,” said
Dr. Kathie Ferbas, a faculty member of the AIDS Institute who does
research on developing an AIDS vaccine.
“There are places in the world where you can’t even
mention it, where people have to die alone without
treatment.” she added.
Women are particularly at risk, continued Ferbas, because in
many places in the world they do not have the power to abstain from
sex or compel their partners to use condoms.
Talk at the international conference was just as concerned with
the sociopolitical problems surrounding AIDS as it was with the
scientific problems, featuring presentations on subjects ranging
from women’s concerns about hypothetical HIV vaccines to
improvements in condom use among sex workers.
The theme of the conference was “Access for All,”
which highlights the importance of international cooperation in the
AIDS fight.
But the political climate was touchy, as different countries
extended criticism to others for the ways in which they deal with
their respective HIV/AIDS patients.
“It’s always a little confrontational,” Bayrd
said.
The United States was especially in hot water last week, as
people criticized it for contributing to the huge majority of its
AIDS research and treatment money to countries who follow its lead
in promoting an abstinence-first approach to preventing HIV
infection.
But Bayrd and others say abstinence is not a feasible
solution.
“This may be in line with American ideology, but this
prevention strategy is not in line with scientific evidence,”
said Thomas Coates, professor of infectious diseases at the David
Geffen School of Medicine and a UCLA AIDS Institute executive
committee member.
Thailand itself, home to this year’s conference, has what
Bayrd considers to be a good system of prevention education ““
one which requires mandatory HIV-testing and education through the
military, an institution to which every male citizen must
participate. Still, many complain that Thailand has no
needle-exchange program that would encourage intravenous drug users
not to share or reuse needles.
“The government is basically saying, “˜If
you’re a needle-user, you can just go die,” Bayrd
said.
Criticisms abound, but attendees say there is also a lot of
positive sharing of ideas at the conference, especially regarding
ways in which to promote infection-prevention education across the
globe.
Ferbas describes some of the horrifying consequences that a lack
of prevention education can lead to.
“There are people in Africa who think that you can’t
get AIDS from having sex with a virgin, so there are 4-year-old
girls being raped,” she said.
One surprising method of education to which people are
increasingly turning is art. This trend is apparent by the number
of activists that portrayed their messages in creative ways to both
the pleasure and consternation of viewers around the conference
areas in Bangkok.
“This is the first conference I’ve attended
that’s had this much focus on the role art can play in
heightening awareness about AIDS prevention ““ especially in
the Third World,” Bayrd, a veteran delegate of the biennial
international AIDS conferences, said.
Bayrd spoke about the work people have done in India to promote
AIDS education through unusual media such as puppeteering, cultural
theatre, and scroll painting, a traditional Indian art form.
“When you think of AIDS prevention, you think of doctors
and nurses and school health programs and posters and television
announcements,” Bayrd said. “You don’t think of
scroll painters and puppeteers.”
These methods might not be very effective for audiences of
first-world countries, Bayrd admits; but they can be extremely
effective in places where people don’t have easy access to
television or health care information.
In an age where HIV/AIDS drugs cost between $15,000 and $18,000
per person per year ““ perhaps even as high as $40,000 with
the addition of the newest medication ““ “access for
all” is still a pipe dream, Bayrd said.
“How do you provide drugs to countries that can’t
pay for them?” he added. “How do you fairly deal with
American patent laws? They’d like to get their research and
development cost back and make a profit.”
Some countries offer treatment for a fraction of the cost that
U.S. pharmaceutical companies charge.
India’s pharmaceutical company Cipla Ltd. is sharing its
latest development: a single pill that combines three of the
antiretroviral drugs and must be taken only two times per day. It
will cost each AIDS victim $132 per year.
“That’s a reasonable amount for an American to pay
to sponsor a child in a Third World country,” Bayrd said.
UCLA’s AIDS Institute is also contributing to breaking
down the boundaries between nations.
In addition to sponsoring artists from India who integrate AIDS
infection prevention messages into their pieces, the institute has
also compiled articles on the status of the epidemic from experts
on HIV in every Asian country except North Korea.
They gave a copy of the report to each of the 15,000 delegates
to the conference last week, so that all attendees went home with a
summary of the current status of efforts in prevention, education
and treatment for AIDS in every country in Asia, Bayrd said.
AIDS is a difficult disease to combat because it does not appear
to have the potential for being eradicated with vaccinations,
researchers say.
The HIV virus that makes people sick with AIDS can mutate
rapidly. As a result, it takes different forms in every part of the
world ““ and sometimes even within a single individual, Ferbas
said.
Microbicides ““ a substance which is applied to the vaginal
and rectal areas in order to kill microbes such as HIV and other
STDs ““ is a more hopeful alternative for reducing the numbers
of possible transmitters of the disease, said Ian McGowan,
associate professor at the School of Medicine.
“(A microbicide) would prevent a tremendous number of
infections,” Bayrd said. “You don’t have to kill
all the HIV in order to prevent infection.”
Microbicides could also help women to prevent infection in
places where they are unable to abstain from sex.
“If you could incorporate HIV drugs into a gel, you could
get it into the hands of women, most of whom are powerless to
prevent themselves from being infected,” Bayrd said.
“Women can be empowered by using microbicides,”
Ferbas said. “And as a woman and a mother, this is very
important to me.”
But though scientists believe they can develop microbicides long
before they could have an effective vaccine, the first microbicides
will not be available for five to 10 years, McGowan said.
“Until that time, we should focus on education, condom
use, behavior modification where necessary,” McGowan said.
But, he added, “It’s always going to be a
challenge.”
“I wish that we were able to say that we could paint a
less gloomy picture,” Bayrd said. “But that’s the
general sense of the conference itself, that unless a
multi-national, multi-ethnic, multibillion dollar effort is made,
it’s going to get much worse.”