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A global alliance against AIDS

Koichiro Matsuura
AIDS is clearly a tragedy. But is it a fatality? This is far from obvious. Admittedly, the AIDS epidemic has spread throughout the world uninterruptedly for over a quarter of a century. The death toll has already reached twenty million. In 2003 alone, three million people died of the disease and five million were infected, i.e. a new infection every six seconds.
We currently possess no effective vaccine against AIDS, whether preventive or therapeutic. However, the patients are in the South and the treatment is in the North. In the most affected countries, AIDS undermines the very possibility of combating the disease, since by decimating the general population it destroys the political, economic, educational and social elites who could take the lead in fighting the menace.
Does this mean that we should abandon the struggle? Of course not. The first priority is universal access to treatment. Tuberculosis and Malaria have recently stressed that access to treatment is a global emergency. Along with their partners, UNAIDS have launched the "3 by 5" initiative aimed at treating 3 million people by the end of 2005. This initiative must be supported. The fight against AIDS cannot simply be based on the individual relationship between doctor and patient: it calls for the conclusion of a genuine global contract.
We need to be conscious of the scale of the challenge. Being unaware of their disease most infected people are not receiving treatment and continue to transmit the virus. The conclusion is clear: if we wish all those infected to submit to testing, we must be able to offer them treatment from the start of their infection.
It follows that treatment must be made universally available. This implies not only a widespread movement of solidarity to extend the use of combination therapies, but also the development of new forms of treatment. The second priority then is the development of research. As underlined at UNESCO by Luc Montagnier and Jim Yong Kim, Director of the HIV/AIDS Department at WHO, research must progress and come up with inexpensive and well-tolerated forms of treatment to tackle the disease directly or to be used in association with combination therapies. What is needed is to treat not only the infection but also the host condition of the disease, which is immuno-depression. Simplified therapeutic schemes have already been devised by WHO and have yielded results.
In view of the failure so far to come up with a preventive vaccine, it is furthermore clear that research should be directed primarily towards the development of a therapeutic vaccine that could be used in association with existing treatments. Leading researchers are of the view that such a vaccine could be developed within a reasonable time span. "If the vaccine proved effective", Luc Montagnier told us, "immu-
nised patients would control their viral infection when the combination therapy was ended, thus preventing the virus from reappearing immediately". A vaccination policy of this kind would obviously call for the setting up of local structures for treating infected individuals and for monitoring those who had been vaccinated.
A third priority is to reduce the spread of AIDS, which affects 5 million people annually. This is a major challenge for humanity, which can only be met by stepping up prevention work. Obviously, prevention is the most urgently needed and economical solution and in the absence of a vaccine, the most effective. However, prevention on its own is often powerless, particularly when women are not truly free to choose the nature of their relationships and the means of protecting themselves. As Luc Montagnier pointed out, prevention on its own comes up against the economic barrier of poverty and the political obstacles of chaos and civil war that beset many failed states.
Prevention and treatment have often mistakenly been viewed as independent and rival strategies. In reality, treatment, prevention, education and information should go hand in hand, so that medication and knowledge reach the population at large simultaneously. Combating AIDS effectively, controlling it and ultimately - why not? -overcoming it thus require policies and political will. Some countries have pointed the way and infection rates have fallen in Brazil, Thailand, Senegal, Uganda and the Dominican Republic. Such policies must naturally be adapted to national realities and local cultures. At the same time, local communities must combat cultural practices and prejudices that have a dramatic impact on health, in particular discrimination directed against the sick and against women, who are often treated as outcasts.
The diversity of situations confronting AIDS should not therefore be viewed in wholly negative terms: for this does not only reflect inequalities of income or development and differences of social custom or climatic conditions but also the diversity of AIDS prevention, education, information and treatment policies. Rich countries are not the only ones to have successfully checked the epidemic. There are a great many other countries where the prevalence among the adult population is less than 1 per cent and the figure is barely higher on a worldwide scale. The diversity of situations is in the end a source of hope: it indicates that political will, where it exists, is not slow to bring its rewards. We are today witnessing its emergence on a global scale, including within the G8. For AIDS is not the destiny of humanity: it is the mirror of its shortcomings. Together, we can curb the progress of the disease.