REPORTER: Keeping with tradition, the conference began with a small demonstration. The primary sessions began with a lecture on the association of human rights and HIV.

FEMALE SPEAKER: The G8 countries are (MS?) in default. In the 1970s, the activity of (MS?) agreed that 9.7% of GDP should be foreign aid for the rich nations. But if we look at what that is today, it is indeed very worrying. The country that makes the most noise, that vetoes constantly on the issue of human rights, is the country that is the least committed. And you can see from what that commitment is of the United States.

For me, there is a formidable political will at the global level causing billions of dollars to be immobilized overnight, to arrange the horrendous deaths of 3,000 people, and the war on terrorism continues with even greater zeal. Tell me why? Tell me why -- so much value was given to those 3,000 lives?

[Applause]

Why so little thought and political will for the millions dying of AIDS? Why is the war against terrorism so sacrosent, but the war against AIDS (MS?) and weak? It therefore demands from us a resolution for a new paradigm shift where health can no longer be a commodity, but health must become a right. And it is this paradigm shift that must be recognized, because, unless and until we put health as a right, recognizes health care as the responsibility of a nation, and that health must come out of the World Trade Organization.

REPORTER: Dr. Bernard Swartzlander(MS?) of the World Health Organization told the delegates the current direction of the epidemic.

DR. BERNARD SWARTZLANDER: The HIV virus is present in almost every country in the world and no longer can any society consider itself immune to the virus. And once HIV is in a country, is in a region, it can quickly spread across the map –- just look at Eastern Europe.

A decade ago, less than half a generation, very few HIV infections had been reported anywhere in Eastern Europe. Only Poland and Romania had isolated pockets of HIV infections. And in a very short few years, Eastern Europe now has more people living with HIV/AIDS than all of Western Europe combined.

Indonesia, the world’s most populous country, is another example of just how suddenly an HIV epidemic can take off. Similar trends are being seen in parts of China and India -- the two countries where we’ve seen relatively low prevalence the epidemic is slowly but steadily taking hold. We just heard this from the previous speaker as well. The populations of these two countries are so large that they could determine the future cause of the global epidemic alone.

The world’s richest countries are not immune from growing epidemics either. In the last two years, increasingly worrisome reports have come from major cities from almost all developed countries. HIV incidence is increasing, especially among certain groups, such as young men who have sex with men, among women, and in some ethnic cultural communities.

They are beginning to comprehend how the loss of workers stands to undermine the key sectors of society. In 2020, more than 25% of the workforce in some countries may be lost to AIDS, and you’re always hearing these trends. Some hard-hit countries with prevalence as high as 40% among soldiers. In Kenya, AIDS accounts for up to three out of every four deaths in the police force. And health workers are being affected in high numbers everywhere as it is illustrated on this slide on the right side of the chart. This is a double blow, you know? Who cares for the carer?

One of the most worrying trends of all is that nearly half of all infections that are happening in the world are among teenagers or young adults aged between 15 and 24 years of age. There was over 2 million new infections in young people in 2001 alone.

Nearly a third of all adults living with HIV/AIDS today, 11.8 million, are young people, and almost two-thirds of these are young women and girls. And in some cities in Eastern Subsuharan Africa, for every infected boy there are up to five young girls.

REPORTER: Dr. Robert Cicelono(MS?) of John Hopkins University describes the latest research on the long-term effectiveness of drugs developed to kill HIV.

DR. ROBERT CICELONO: Will it ever be possible to cure HIV infections with antiretroviral therapy alone? And if not, will it be possible to maintain patients on therapy for life without these progressions? This leads us to conclude that the Layton(MS?) Reservoir in resting memory CD4 cells guarantees lifetime persistence of the virus and makes the disease intrinsically incurable with anti-retroviral therapy alone. Now, I realize that this is a difficult conclusion to hear, but in order to provide the best treatment for all of those persons living with HIV, we have to understand the limitations of this therapy. And there are some important treatment implications here.

First, early initiation of aggressive therapy, with a goal of eradication, is not likely to be successful. Nor is intensification of therapy with a goal of eradicating this reservoir. Because of the stability of this reservoir and the cumulative long-term toxicity of drug regimens, some experts are now suggesting that therapy should not be initiated until later stages of the disease, for example when CD4 counts has fallen to 300. Now, in addition to these treatment implications, I would also like to point out that the intrinsic incurability of the infection with antiretroviral drugs is as powerful an argument for prevention efforts as we are likely to have.

Now, this will require the development of available, affordable and non-toxic drug regimens. In addition, there is a very exciting possibility that the development of strategies for enhancing HIV-specific immune responses will allow patients to come off treatment and control viremia on their own, which is an idea that’s been pioneered by Bruce Walker.

These things will not be easy, but with the tremendous amount of goodwill and expertise and commitment, so evident at this conference, I think this is a goal that can be achieved.

MALE SPEAKER: The new classes of drugs that are coming out are clearly going to be extremely important, particularly to people who have developed resistance to the existing classes of drugs. But they will not help with the problem of viral reservoirs, that even if you have treatments that stop every new cell from being infected from the moment therapy is started, the cells that already are infected will persist essentially for life and will make the infection intrinsically incurable with antiretroviral therapy alone. You will need some way to specifically target this reservoir.