In the News

Plague on the Poor: How AIDS Divides the World


IF HIV were just a bug that people were fighting against, it would be hard enough. But it is difficult not to think of the human immunodeficiency virus as an intelligent and calculating enemy: “This is one of the smartest viruses that people have ever seen,” says Lisa Price, the policy manager for the Terence Higgins Trust, the best-known British AIDS charity. “It changes all the time.”

In the time it took to read that paragraph, three more people became infected with HIV. The virus’s spread is not slowing; both deaths and new infections reached record levels last year, at 3 million and 5 million respectively, more than 20 years after it was first identified among US homosexuals in 1981, and neither a cure nor a vaccine is in sight.

Instead – because HIV exploits the tiniest weakness in the body’s defences and mutates to confound attempts to kill it – every time the world’s scientists and politicians think they understand how to tackle the virus, they discover that it is more complicated still.

Some people thought that HIV only affected homosexuals; they were wrong. Some scientists suggested that HIV did not cause AIDS. They were wrong too, though some people have stuck with that line – most notably South Africa’s president, Thabo Mbeki, who insists he has never known anyone who has died of AIDS. (In a sense he is right – it is the opportunistic infections that HIV enables which kill you. Most people with full-blown AIDS die of pneumonia.)

The disease has has set First and Third World governments at odds over the anti-retroviral drugs needed to treat it and has even split the Catholic Church over the Vatican’s insistence that condoms spread, rather than restrict the spread of, HIV.

While the World Health Organisation unveils a scheme today for the annual World AIDS Day that it calls “3 in 5” – aiming to provide the latest anti- retroviral drugs to 3 million people by the end of 2005 – the UN secretary- general, Kofi Annan, has spoken of his frustration at trying to get the healthy to help the sick.

The statistics are numbing. More than 42 million people are infected with HIV worldwide, of whom 26.6 million live in sub-Saharan Africa. The largest number of infections is in South Africa, where about five million, or one in 10 citizens, is HIV-positive. And a combination of unprotected sex and drug abuse is fuelling an explosion of the epidemic around the world. And since you started reading this article, 20 people have become infected with HIV.

Yet in the West, being HIV-positive is no longer the death sentence that it was in 1983, when doctors had little chance of preventing the infection turning into full-blown AIDS, at which point a patient would typically live for less than a year.

Now, modern drugs mean HIV has become a disease that one can live with. The drugs bring unpleasant side-effects, such as nausea, occasional hallucinations and, in some cases, a strange redistribution of fat around the body. But you can live with them, for years – perhaps indefinitely.

In Africa, those treatments have been too rarely available. The WHO estimates that 4.2 million people need anti-retrovirals in sub-Saharan Africa; but only 50,000 get supplies.

Mr Annan thinks many political leaders do not care enough to fight the disease, which has killed 28 million people since it was first reported.

“I am not winning the war because I don’t think the leaders of the world are engaged enough,” he said. “I feel angry, I feel distressed, I feel helpless. What is lacking is political will.”

Only one thing – the use of condoms – dramatically reduces the spread of HIV. (Needle swapping programs for intravenous drug users also work, but on a smaller scale.) And only one thing – anti-retroviral drugs (often called “triple-therapy cocktails”) – makes it possible to live with HIV.

Given those facts, you might expect the world’s leaders to focus on them. You’d be wrong. And since you started reading this article, 30 people have become infected with HIV.

Catholics for a Free Choice, a pressure group, said yesterday it would begin an advertising campaign against the policies of the church – which has millions of followers in Aid-hit countries – saying “Good Catholics Use Condoms” as “a direct challenge to the cardinals and bishops who recently claimed that condoms were helping to spread HIV/AIDS”.

The Vatican supported that bizarre claim in October, saying that condoms had tiny holes which allowed the virus to pass through – so that to use them would encourage its spread. The WHO angrily called the advice “incorrect” and “dangerous”; Catholics for a Free Choice called the Vatican’s policy “a disaster”.

The lack of availability of treatments for those who are infected could be called a disaster too – though it has not resulted from any dogma. Instead, it grows from a fundamental dispute between the giant pharmaceuticals companies, the only organisations able to rapidly and effectively research new therapies, and the governments of the countries which need them. Western governments have tried to please both sides, and generally failed.

The drug companies want to price the drugs to fund the expensive research needed to develop the next generation – and perhaps find a chink in HIV’s armour that might lead to a vaccine, or a cure.

But African countries cannot afford those prices, and have sought ways around the companies’ patents to make generic versions of the drugs – exactly the same chemicals, but without the brand name. That led to threats of trade wars.

Former US president Bill Clinton set up a deal in October for four drug- makers in South Africa and India to sell generic versions of anti-retroviral treatments for a quarter of the price of the patented version.

Dr Bernard Pecoul of the medical charity Medecins Sans Frontieres said: “One pill, twice a day at this reduced price is exactly what is needed to rapidly expand the numbers of people receiving anti-retroviral treatment in developing countries. With that announcement, the WHO’s 3 by 5′ objective becomes much more feasible.”

Feasible, yes. But will it happen – and by the time it does, will even more people need the treatment?

Meanwhile, the search for better treatments goes on. “We’ve been saying that a vaccine is five to 10 years away for 15 years,” said Ms Price. “But it is looking more realistic that we will (have one) in the next five years.” And since you began reading this article, more than 40 people have been infected with HIV – and more than 20 have died from AIDS.

This article first appeared in the 1 December 2003 edition of The Independent.

Catholics for Choice