For scientists (and journalists like myself) who have pursued the complex issues of the international AIDS pandemic, addressing the crisis is extremely challenging. No one imagined that from such obscure beginnings a pandemic as devastating as HIV/AIDS would arise, in just two decades killing more than 25 million people and infecting another 40 million. Unfortunately, despite brilliant approaches and advancements in antiretroviral research and roll-out, the virus is still winning.

AIDS is a complex medical syndrome ultimately resulting in premature, painful death, and it is inextricably intertwined with social issues such as stigmatization, discrimination, sex, fear, ignorance, and denial. First emerging among marginalized groups - homosexual men, prostitutes and injection-drug users - the very presence of AIDS triggered immediate stigmatization. Anyone infected, anywhere, regardless of the circumstances through which the disease was contracted, was branded a social pariah.

When I ran into Maura Elaripe Mea, an HIV-positive woman from the impoverished Pacific country of Papua New Guinea (PNG) at the conference in Sydney, Mea said that the combination of stigma and discrimination remains, creating huge burdens in the lives of HIV-positive people. A nurse by profession, Mea was diagnosed in 1997. She was one of the first women to come out publicly in PNG. She represents the growing face of the disease in the region: about 40 percent of the 8.5 million people infected are female. She nearly died in December 2002 but survived after being given antiretroviral drugs. Now as President of Women Affected by HIV/AIDS in PNG, Mea describes the ways she is trying to help other HIV positive people.

"I went through a very difficult time. In the face of my struggle and the struggle of so many other positive people having to deal with HIV, I took the step of talking openly about HIV, to try and break down some of the barriers."

Mea laments, "Despite all efforts in advocating [for the] sexual and reproductive rights of all women, I am still struggling at times to be heard."

She urges people to "stop being afraid of us and discriminating [against] us and allow us to work ourselves out of the poverty that HIV so often brings."

She also urges government and nongovernmental organizations to make antiretroviral therapy widely available and accessible, not only in PNG but in all other countries where HIV infection rates are high. "We need governments to agree to urgent action to make sure we all have affordable access to medicines and medical tests," Mea says.

During the conference, although no single researcher captured the headlines with a startling breakthrough on AIDS, it was clear that important advances in scientific research are being made. There were presentations of 978 abstracts on vaccine studies, current and promising HIV prevention technologies, better generic pediatric antiretrovirals, biomedical prevention strategies such as microbicides and pre-exposure prophylaxis.



But what were the most salient issues discussed during the conference?
And where do we go from here?

International AIDS Society President Dr. Pedro Cahn set the stage and tone in a dramatic and forceful address, saying that even though HIV is a preventable and treatable condition, there are still 1,000 people newly infected every day, and three million deaths are caused by HIV every year.

"Science has given us the tools to prevent and treat HIV effectively. The fact that we have not yet translated this science into practice is a shameful failure," Cahn said.

Large-scale, global efforts have recently begun to expand the availability of ARVs (antiretrovirals) to the poorer countries of the world. New, less toxic ARVs are being developed to overcome viral resistance. And although millions of people in the developing world who need the drugs don't receive them, access to ARVs has steadily improved.

According to Dr Michel Kazatchkine of the Global Fund to Fight AIDS, TB and Malaria, over 2.2 million individuals are now taking potent antiretroviral therapy in poorer countries. He contrasted this to 2001, when the first IAS conference was held: only 200,000 or so patients in resource-limited countries were taking effective HIV treatment then. The number of people taking therapy today was, he said, beyond his "wildest expectations" just six years ago.

In addition, Dr. Annette Sohn, Assistant Professor in the Division of Pediatric Infectious Diseases at the University of California, San Francisco, commented on the plight of children with HIV/AIDS. She said there are 2.3 million children living with the disease. As many as 780,000 children are in need of antiretroviral treatment; only 115,000 children are receiving it. Although there has been a 50% increase in coverage over the last year, only 15% of the children in need of ARVs are receiving them.

One of the most interesting findings in recent research is that circumcised men are up to 60% less likely to contract HIV. The World Health Organization and UNAIDS now recommend male circumcision as a disease prevention method.

Epidemiologist Dr. Robert Bailey from the School of Public Health at the University of Illinois in Chicago said that studies in Africa have found that male circumcision could avert 2 million new infections and 300,000 deaths in sub-Saharan Africa over the next ten years if implemented.

Bailey said male circumcision may, in fact, be the oldest surgical procedure known to humankind, dating back to at least 2300 BC in Egypt. Today, about 67% of men in Africa are circumcised, but only 30% of men worldwide have had the procedure - mostly in countries where it is common because of religious or health reasons.

In Asia and the Pacific region, countries such as Papua New Guinea, Cambodia and Thailand have high HIV prevalence and low male circumcision. In contrast, HIV prevalence is low in countries like Pakistan, Bangladesh, Indonesia and the Philippines where most men are circumcised.

The four-day conference concluded with the reiteration of the "Sydney Declaration" urging national governments, bilateral, multilateral and private donors to allocate ten percent of HIV funding to medical and operational research, to ensure that treatment reaches those in the world's poorest nations. To date, over 2,000 scientists, clinicians, policy-makers and community leaders from around the world have signed the declaration.

The declaration states, "Research was essential to ensure that effective prevention and treatment programs were developed and delivered. Without such funding, we will fail to maintain a sustained and effective response to the AIDS pandemic."

During the conference, the Australian government committed one billion dollars over the next three years to address the pandemic.

In the end, I share the sentiments of Dr. Anthony Fauci of the US National Institutes for Health who points out that although advances today in the understanding of HIV should be "celebrated", the next 25 years will determine how the world's response to HIV is judged. How well we address the pandemic as scientists, health care workers, journalists and human beings will say a lot about our future and will define our ultimate achievement in the fight against HIV/AIDS.



About the Author
Imelda Visaya-Abaño, began her journalism career in 1998 as a reporter at the Philippine Daily Inquirer, the leading daily newspaper in the Philippines. Her areas of interest are women and children's issues, science, environment, health, agriculture and education.

In 2002, Ms. Abaño was honored as the Asian Winner of the Global REUTERS-IUCN Media Awards on Environmental Reporting.

Ms. Abaño vows to continue serving her community through balanced news and fearless views. She believes in better journalism for better communities.