AIDS Researchers Meet at Ground Zero

For the first time since the world’s scientific community began international meetings to examine the AIDS epidemic some 17 years ago, the group is convening in a country, South Africa, ravaged by this modern day plague.

Recent meetings have been held in cities such as Yokohama, Vancouver and Geneva, in industrialized countries where the AIDS problem is real but largely hidden in inner-city ghettos.

But the 12,000 researchers and activists convene their scientific sessions today in a region, sub-Saharan Africa, where nearly three-quarters of the world’s 34 million people infected by the AIDS virus live, where 11 million children have been orphaned by the disease, and where treatment is virtually nonexistent.

“The continued gap between the haves and the have-nots is going to hit people in the face in a way we are [normally] sheltered from,” said Dr. Helene Gayle, director of the National Center for HIV, STD and TB Prevention at the U.S. Centers for Disease Control and Prevention.

“The world is finally recognizing that this is where the center of the epidemic now is,” says Karen Bennett, spokeswoman for the XIII International AIDS Congress.

That location is expected to change the tenor of the conference. The last two congresses focused primarily on drugs to fight HIV infection. In Vancouver four years ago, researchers reported for the first time that cocktails of antibiotics including the then-new protease inhibitors could suppress HIV infections, and researchers were almost giddy with anticipation.

Two years ago in Geneva, it was becoming clear that the drug regimens could provide long-term benefits, but that they were unlikely to eradicate the virus from victims’ bodies. Side effects of the drugs were becoming apparent, and patients were having difficulty taking the large numbers of pills required each day.

But this year’s meeting is taking place in a region where use of anti-AIDS drugs is virtually nonexistent. Big pharmaceutical companies will still present refinements of their drug trials and new information about side effects, but most companies are scaling back on their participation at the accompanying exposition and some, like Chiron Corp., are simply not attending at all.

“Complicated, expensive medicines cannot . . . be the answer in the developing world,” said Dr. Harold Kessler of Rush-Presbyterian-St. Luke’s Medical Center in Chicago.

And the meeting is taking place amid unusual controversy.

Several hundred delegates, critical of South African President Thabo Mbeki’s apparent support for a widely discredited theory that HIV has nothing to do with AIDS, walked out Sunday during his speech.

Meanwhile, area AIDS activist groups are planning a number of marches and demonstrations--so many, in fact, that the conference chairman felt compelled to send a letter to all 12,000 potential delegates to assure them that their personal safety was not in question.

On Sunday, the Treatment Action Campaign, a South African umbrella organization backed by 230 AIDS groups around the world, staged a 2,000-person march to demand that pharmaceutical companies make AIDS drugs more widely available to developing countries. The march was led by Winnie Madikizela-Mandela, the ex-wife of former South African President Nelson Mandela.

“If we could struggle against HIV with the same commitment as our struggle against apartheid, we can turn back the tide,” she said. “If we could give the same attention to the struggle against HIV as we did for the bid for the [soccer] World Cup, we could save many lives.”

At least five major pharmaceutical companies earlier this year pledged to sell anti-AIDS medications in Africa at sharply reduced prices, and Friday a German company offered to give away the drug nevirapine, which could be used to prevent mother-to-child transmission of HIV. But negotiations for those drug sales have bogged down, especially because there is no health infrastructure in most of the countries to distribute the drugs.

Even an 80% reduction in the cost of the drugs--which now sell for about $15,000 per year or more in Western countries--still leaves them well beyond the reach of health care systems that now spend less than $5 per year per person.

To combat that problem, Dr. Peter Piot, head of UNAIDS, called Saturday for the developed world to contribute $3 billion annually to fight the disease--10 times more than is now donated. Experts noted that $3 billion is about how much Western nations spend each day for health care.

“It’s an unprecedented crisis that requires unprecedented responses,” Piot said.

Another unlikely controversy that has enmeshed the conference is the question of whether HIV actually causes AIDS--a proposition that was settled in the minds of most scientists years ago.

South African President Mbeki is a well-known Internet surfer, and a few months ago he stumbled across one of the many World Wide Web sites run by the so-called “denialists,” a very small group of researchers spearheaded by Peter Duesberg and David Rasnick of UC San Francisco.

The denialists believe--contrary to overwhelming evidence--that HIV is a mere “passenger virus” that has nothing to do with AIDS, and that the symptoms of the disease are caused by the highly toxic drugs used in its treatment, by drug abuse and addiction, and by the infectious diseases rampant in the regions where AIDS is also endemic.

Mbeki, however, bought in to their arguments--perhaps because of what Gayle calls “intellectual curiosity.” In May, he appointed a committee to examine the AIDS epidemic in his country and nearly half of the committee members were denialists.

He has also refused to supply the AIDS drug AZT to pregnant women to prevent mother-to-child transmission, contending that it is too expensive and too toxic.

Activists in South Africa have criticized Mbeki harshly, charging that his efforts are misguided and exacerbate the immense challenges involved in fighting the war against AIDS.

Last week, on the eve of the conference, more than 5,000 scientists published the so-called Durban Declaration in the journal Nature, a firm and clear statement that AIDS is, in fact, caused by HIV. Some viewed it as a slap in Mbeki’s face, and a South African government spokesman said it was destined for the “dustbin.”

“We know more about HIV than any other virus that has ever been studied,” says Dr. Anthony Fauci, head of the U.S. National Institute of Allergy and Infectious Diseases, who believes the controversy will eventually blow away.

The researchers canceled a news conference scheduled for Sunday afternoon in which that statement was to be reiterated. Many clearly hoped that Mbeki would defuse the issue in his welcoming statement Sunday evening, but that did not happen.

Instead, he argued that poverty is the greatest problem facing Africa and defended his stance. “As I listened and hear the whole story about our own country, it seemed to me that we could not blame everything on a single virus,” he said.

“Some in our common world consider the questions that I and the rest of our government have raised around the HIV/AIDS issue . . . as akin to grave criminal and genocidal conduct,” he said. “I believe that we should speak to one another honestly and frankly, with sufficient tolerance to respect everybody’s point of view, with sufficient tolerance to allow all voices to be heard.”

Many delegates responded by walking out of the convention.

“Every South African hoped for a firmer acknowledgment for the links between HIV and AIDS,” Dr. Alan Whiteside of the University of Natal in Durban told Associated Press after the session.

Today, the scientists get down to the serious business of the conference, but few expect much new scientifically to emerge. “We are in an era of incremental changes, not an era of bold new major discoveries,” Gayle said.

Dr. Salim Abdool-Karim of South Africa’s Medical Research Council, head of the scientific program, was blunter: “There are going to be no major medical breakthroughs here.”