Changing future course of AIDS epidemic

London - Success in stemming the continued growth of the AIDS epidemic during the next 25 years will require an aggressive crash program - including international cooperation to design and implement socially relevant education and prevention programs, promote ongoing vaccine research, and develop and distribute effective vaginal and rectal microbicides, according to Marcus A. Conant, M.D.

Dr. Conant is clinical professor of dermatology, University of California, San Francisco.

"AIDS is a global pandemic, and while there have been some important scientific advances in this field, ignorance, denial, religious fundamentalism and the U.S. government have all presented significant barriers to developing programs that might be effective for containing the epidemic. Unless new strategies are implemented, the outlook for containing the spread of HIV infection is bleak," Dr. Conant tells Dermatology Times. He spoke on the topic at the annual meeting of the European Academy of Dermatology and Venereology (EADV), calling upon the EADV to take a leadership role in this effort.

Grim statistics

He notes there are now approximately 60 million people who are HIV-infected, while each day, 16,000 individuals become newly infected and 8,000 die from their disease. Populations that were previously at low risk for becoming HIV-positive are now becoming infected at rapidly rising rates. For example, in both Russia and China there are now about 1 million people who are HIV-positive, and it is expected that four years from now, 10 million people in China will be infected with HIV.

HIV infection is also spreading quickly in the eastern European countries that were previously behind the Iron Curtain. Intravenous drug users are the main risk group in those latter countries, and those individuals are a teeming source for further infection spread since they comprise sexually active heterosexuals and homosexuals.

"As HIV infection rates continue to increase in more and more countries and with the wage earners in society representing those predominantly affected, the impact of the disease will also be felt in the area of global trade," Dr. Conant notes.

Scientific advances, modest impact

Progress has been made in the area of science. HIV researchers have been successful in defining the natural history of the virus, its structure and function, and have also developed "amazing" antiretroviral drugs to contain it. More new drugs can be expected in the future and researchers will continue to look for conserved epitopes for vaccine development.

However, antiretroviral drugs are often unaffordable, and modulating vaccines that are being tested to reduce the rate of disease progression won't eliminate the epidemic. Importantly, there is no sterilizing vaccine on the horizon nor any solid reason to believe one will ever be available.

"Consider that we still have no vaccine for malaria, tuberculosis or leprosy, and there is nothing that promises we will have a vaccine for HIV," Dr. Conant says.

Societal failures

Dr. Conant believes that failure to stem the AIDS epidemic lies mainly in the inadequate response of society where the primary barriers have been ignorance, denial, religious fundamentalism and the U.S. government.

"Society has denied the reality of the epidemic, blamed its victims and relied on archaic paradigms to try to contain it," Dr. Conant contends.

He notes that so far, governments have spent inordinate amounts of money on education and prevention programs that are ineffective even in highly developed nations. As an example, Dr. Conant cites the reliance of the Bush administration's "ABC" policy to stop the spread of AIDS - "ABC" denoting Abstinence, Being faithful, and, for those who cannot abide by the first two rules, using Condoms.