Gateses Urge Speed on HIV-Preventive Drugs

By David Brown
Washington Post Staff Writer
Monday, August 14, 2006

TORONTO, Aug. 13 -- The two people who control the world's biggest charity opened the 16th International AIDS Conference here Sunday with a call for science and industry to redouble efforts to develop microbicides or pills that prevent sexual transmission of the human immunodeficiency virus.

The exhortation by Bill and Melinda Gates arises from three conclusions about the AIDS epidemic that are likely to be themes of this largest-ever gathering of scientists and advocates.

The first is that there won't be an AIDS vaccine soon. The second is that AIDS treatment, finally being brought to people in poor countries, will eventually become an intolerable drain on the world's resources if the rate of new HIV infections is not reduced. The third is that a prevention strategy controlled by women -- and usable without the knowledge or permission of men -- is essential.

"We want to call on everyone here and around the world to help speed up what we hope will be the next big breakthrough in the fight against AIDS," Bill Gates told delegates in the cavernous Rogers Centre, home of the Toronto Blue Jays baseball team. "This could mark a turning point in the epidemic, and we have to make it an urgent priority."

The foundation Gates and his wife run has invested $110 million in recent years in research on vaginal microbicides that would prevent HIV infection during intercourse. At a news conference earlier Sunday, they said they would increase their investment in that field, and in the use of antiretroviral drugs as before-sex pills, but they did not give details.

Clinical experiments of microbicides are underway in several African countries and India. Studies of two AIDS drugs, tenofovir and emtricitabine, for "pre-exposure prophylaxis" are now being done in Thailand, Botswana and Peru.

The Bill and Melinda Gates Foundation has spent about $2 billion addressing the global AIDS epidemic. Last week it gave $500 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Geneva-based organization that pays for prevention and treatment programs in about 130 countries.

This year's AIDS conference comes 25 years after the identification of the first AIDS cases in Los Angeles and New York.

About 24,000 people will attend the week-long meeting, which is held every other year. That is twice the number of people at the conference in Durban, South Africa, in 2000, which most observers agree was the moment when rich countries and pharmaceutical companies seriously began to commit themselves to bringing life-extending anti-retroviral therapy to the developing world.

Nascent success in that effort -- 1.4 million people in poor countries are now on AIDS treatment, out of more than 6 million who need it immediately -- is leading to worries about the future as the call goes out to speed the process even more.

"It is time to move from crisis management to long-term, sustainable response," said Peter Piot, the Belgian physician who heads the United Nations' AIDS program. "Twenty, 30, 40 years from now, that [treatment] need will still be there. Who will pay for that? Where will the drugs come from?"

Unlike many scientific meetings, this conference includes thousands of activists and patients among the delegates. One of the speakers at the opening ceremonies was Frika Chia Iskandar, a 24-year-old Indonesian woman who is HIV-positive.

She reminded her listeners there are mundane obstacles to treatment that might not occur to them -- such as the inability of many rural patients to pay the bus fare to get to clinics where they can then get free drugs.

"When we talk about access to treatment, it is not just pills," she said.

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