World AIDS Day highlights challenges 20 years on

PARIS, France — As World AIDS Day is marked today, the fight against the disease remains stymied by inadequate treatment in poor countries and setbacks in finding an effective vaccine, experts said.

To be sure, there have been plenty of advances over the past two decades. While 33 million people have the human immunodeficiency virus (HIV) virus that causes AIDS, more are enjoying healthier, longer lives, thanks to powerful new medications.

Organizers of World AIDS Day —built around the themes of leadership, self-responsibility and activism —are calling on governments to follow through on promises of universal treatment, prevention, care and support.

“We have effective treatments. We have no other choice than to offer them to all those who need them,” said Jean-Francois Delfraissy, head of the French National Research Agency on AIDS and viral hepatitis (ANRS).

But affordable and effective treatment remains a rarity in Africa, home to most HIV-positive people, making prospects of universal access to medication remote in the near future.

In poorer countries, the choice may eventually be between treating millions of HIV-positive patients or offering more expensive treatment to some 500,000 people who are resistant to mainstream therapies, Delfraissy said.

Even in wealthier nations like France, where 5,200 new HIV-positive cases were registered last year, thousands of others remain unaware they are infected.

“Don’t let AIDS pick up speed!” urged the French association AIDES, which plans to install a huge counter on the Paris opera house showing the lag between new infections and treatment.

On Friday, the United Nations urged countries to focus on the roots of the epidemic and draw on a panoply of tried-and-tested tools to help HIV from spreading among people most at risk.

“There is no single magic bullet for HIV prevention,” said outgoing UNAIDS executive director Peter Piot.

Hopes for such a magic bullet were shattered last year, when scientists were forced to abandon two advanced clinical trials of an AIDS vaccine by pharmaceutical company Merck, after they appeared to actually heighten the risk of infection.

But AIDS research was given a boost in October when the 2008 Nobel Medicine Prize was bestowed to a pair of scientists who discovered HIV.

Researchers have also discovered new molecules and have launched tests on new triple treatments that have proved effective for patients no longer responding to other therapies.

Meanwhile, research on finding an effective AIDS shot continues. US scientists recently discovered a gene that may pave the way for a vaccine.

Delfraissy, of ANRS, also predicts a revival in basic research to find molecules capable of attacking the virus at a stage where it has not yet been detected.

Scientists are also interested in the cases of some HIV-positive people who never develop full-blown AIDS.

“We have an impressive arsenal,” said Father Pierre-Marie Girard, who heads the infectious disease unit for the Saint Antoine Hospital in Paris.

One mark of success, he said, is those with HIV today talk of living and aging well with the virus — with hopes of enjoying the same lifespan as those without.

Migrant workers at risk

The growing number of people crossing boundaries in South-East Asia searching for economic opportunity puts millions at risk to HIV infection with little or no protection or access to services, according to a United Nations report.

A country-by-country assessment of HIV and mobility in the 10 Association of Southeast Asian Nations (ASEAN) countries revealed that, despite their contributions to national economies, migrants lack legal and social rights and generally have no access to HIV/AIDS medical and information services.

“Migrant workers are a vital force to national economies in South-East Asia, yet when it comes to protecting their rights and ensuring HIV prevention and treatment, they are often among the forgotten,” said UN Development Program (UNDP) Director for Asia and the Pacific Ajay Chhibber.

High-risk behavior and HIV infection rates are significantly higher among migrants than in the general population, the joint UN-ASEAN report noted.

The report also indicated that HIV infection rates for migrant fishermen in Thailand were as high as nine percent, and at least 30 percent of people living with HIV in the Philippines and Laos were returning migrants.

According to the report, national AIDS programs and their services do not cover most migrants. It said that in Thailand, for example, registered migrants have access to health services with subsidized medical costs, but anti-retroviral (ARV) treatment is not included.

If migrants are found to be HIV-positive through routine testing in Malaysia, Singapore, and Brunei, they are repatriated.

Although Indonesia has shown a commitment to addressing HIV vulnerability among mobile populations with their inclusion in national HIV prevention, care and treatment strategies and with policies prohibiting mandatory HIV testing during recruitment processes, limited HIV infection rate data exist for these populations.

Cambodia, Indonesia, Laos, Philippines and Vietnam have also made attempts to tackle the risk faced by migrants by developing “pre-departure training” on HIV prevention for outbound migrant workers, but the report concludes that this has been largely ineffective as the courses are offered too late in the moving process and are too short in duration.

The report makes a number of recommendations to policymakers as they respond to the challenge of the growing numbers of migrant populations who are at greater risk to HIV than people who stay in their home countries.

The report’s recommendations include developing gender-sensitive epidemiological data, strengthening cooperation to ensure a continuation of services for migrants, coordinating cross-border HIV efforts, allocating adequate financial and human resources to address migrant needs, and reinforcing policies and commitments on HIV/AIDS. – Pia Lee-Brago