By Liz Kresse
August 5, 2002

The 14th International AIDS Conference, held in Barcelona, Spain July 7-12, provided more sobering evidence of the continued impact of the AIDS epidemic worldwide while at the same time offering some glimmers of hope for the future. About 17,000 participants from 124 countries attended the conference, which was the largest AIDS conference ever held. Following are highlights of the conference.

HIV/AIDS in the United States

Epidemiological data released by the U.S. Centers for Disease Control and Prevention (CDC) indicate that the number of new HIV/AIDS cases in the U.S. has stabilized in recent years. However, among certain populations, particularly African Americans, cases are on the rise. A majority of those newly infected are African-American, and 75 percent of people who are infected through heterosexual sex are black, half of them women. Further, 90 percent of young gay black men who have the AIDS virus do not know it.

HIV/AIDS Abroad

Worldwide, there will be 45 million new infections by 2010, according to information released at the conference, with most cases occurring in the developing world. China, India, Russia, and Indonesia are witnessing AIDS explosions. Further, life expectancy in 51 countries, mostly in Africa, but also Asia, Latin America and the Caribbean, will drop within a decade because of the AIDS epidemic. One study predicts that in less than a decade, many southern African countries will have average life expectancies of about 30 years; in Botswana, the figure will be 27 years of age. Another major report released at the meeting provided alarming projections on the growing number of AIDS orphans in the developing world. Current estimates suggest that 13.4 million children in the developing world have lost one or both parents due to AIDS; that number is expected to double by the end of this decade. The social costs of this demographic development are "high and long term" and "will require radically scaled-up national, regional, and community responses for at least two decades," according to the report.

Treatment Developments

Researchers announced the development of yet another new drug—known as T-20—which can diminish levels of the virus in HIV-infected patients. This is significant for patients who have exhausted available treatment options because they have developed resistance to existing therapies. However, the cost of adding T-20 to an antiretroviral AIDS cocktail could be more than $10,000 a year. Other research provided evidence that HIV-infected people might be able to delay triple antiretroviral therapy longer than previously thought without damaging their health by waiting until their CD4-cell count—an indicator of immune system resistance—has dropped to 200 rather than to 350, the current federal government recommendation. This can save the average patient a year and a half of taking drugs—many which have unpleasant side effects—and provides important insight to health planners in developing countries who face an extreeme shortage of antiretroviral drugs.

Bridging the Gap Between Rich and Poor Nations

A major theme sounded at the conference concerned the marked inequities in access to treatment and prevention that exist between developed and developing countries. The gap has begun to be bridged by such recent developments as a 90 percent decline in the price of AIDS drugs sold in the developing world and a meeting of the United National General Assembly in 2001 that set targets for increases in prevention services and decreases in disease transmission by 2015. Perhaps most important is the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the three diseases that have the greatest impact on health in the developing world. The fund collects money from governments, foundations, and individuals, and currently has $2.1 billion in pledges. However, this amount falls short of the $10 billion a year that experts say is required to better control the epidemic worldwide. The expectation is that rich countries should do more to meet that challenge. To that end, former President Bill Clinton, who addressed the conference, called on the current administration to increase its contribution to global AIDS programs and suggested that the US increase its contribution from about $1 billion currently to $2.5 billion a year saying, "if we don't do it, we will be spending far, far more than that to clean up the mess." Also attending the meeting was Health and Human Services Secretary Tommy Thompson, who was drowned out during his address by activists who were angry that the Bush administration had not pledged more money to fight the global epidemic.