MODERATOR: (MS?) That presentation was Dr. Siliciano from the United States. He spoke about how feasible it would be to replicate the HIV and how should we translate this information to (MS?). And finally, was Milly Katana from Uganda, who spoke about what is the role of the community in the fight against (MS?). So with that, I will give the floor to the speakers to summarize in a couple of minutes their presentations and then we will open the floor for open discussion. Maybe we can use the same order as the presentation this morning. Irene Fernandez.
IRENE FERNANDEZ: A very good morning to all of you. My speech focused on four areas. First was there’s growing to be quite a (MS?) in the world today and disparities are really very wide, where in the north great expense to treatment and resources. Like we have about 500,000 people on antiretroviral drugs and less than 35,000 people died of AIDS. While on the other side where we have more than two-thirds of the population, we have only 230,000 on antiretroviral drugs. In Africa alone, 2.2 million people died, and this for me is really very criminal because the access to treatment is actually denied. Denied because one, health has become a commodity through privatization of the health care services, we have now health under the control of multinational corporations and a great health insurance industry where the government has become less and less involved in providing health care services. This is being pushed through by IMS Worldwide and the World Trade Organization. The other practices of taking (MS?) drugs through the pits of that agreement, but the (MS?) increased drug pricing and, therefore, inaccessible to the drugs.
The second factor, therefore, what I’m trying to say is, how it must stop being seen as a commodity are the rights. Health must be seen as a right and, therefore, health has to be taken out of the World Trade Organization. It cannot be part of the World Trade Organization and that is the first message.
The second message is the lack of global commitment. Lack of resources comes from the lack of global commitment and this is where you see the G8 countries in default. If you go back to 1970, the Committee on the (MS?) actually reports 1.7 percent of GDP to be the quota for foreign aid. But if you look today, the United States has less than 20 percent of that target, although it will say it will increase the amount by six billion by the end of 2006.
Similarly, with the European Union the target was only half or 0.39 percent of the GDP and it should be 9.7 percent of the GDP. They focus (MS?) on Canada where it committed itself, actually inserting their funds for (MS?). So, there’s a lot of contradiction in the kind of commitment that is being giving by the G8 countries. If they had lived up to their commitments, it would be $200 billion and it would be much more than what the Global Fund required. The Global Fund required $10 billion. We got only $2 billion. So, this is really a lack of the commitment, and the lack of commitment is not because there’s no political will. The political will is directed to the war on terrorism, on issues of security, where lots of money is being spent.
So, what we are saying, the value given to life for people--for 3,000 people is so high compared to the value given to the people dying of AIDS. And so, what we are saying is, we need some more global response to bring back (MS?) and this Global Fund has already initiated the (MS?) that South Africa and Brazil have challenged the pharmaceutical drug companies in court and have won cases. And in Brazil we can see the increase in the number of people on antiretroviral drugs. This is the challenge that we have to have at the global level and which must come and that’s why we are saying if we want a global commitment, HIV/AIDS must be an agenda in any commission of development. Thank you.
MODERATOR: Thank you, Irene. (MS?). If you would like to make some comments?
UNIDENTIFIED MAN: This is a scientific meeting, but what is clear about AIDS is that science is not enough. But the virus is not the sole or even the principal issue, but rather our response to the virus. That response must be found without any respect for human dignity and human rights, and the presentations that took place during the model the nixed the issues of science, epidemiology, human rights and community engagement, were really the formula for a successful long-term approach to addressing AIDS in the world.
MODERATOR: Thank you. Then, the next--the next presentation was delivered by Professor Schwartlander and was related to resolution of the epidemic. BERNHARD, would you like to summarize, then, we’ll go to the questions.
DR. BERNHARD SCHWARTLANDER: Yeah. I would like to just make a very few points to introduce the topic. We have counted 13 million living with HIV/AIDS. Last year alone in 2001, we have five million new infections and seen more death around the globe. Really important is that 94 percent of the burden is with developing countries, and I know seven countries where HIV prevalence was more than one in five adults, a national average. Also, the news that in some places, in some cities, where HIV infections concentrated that every second or third person working on the street and out of those hardship countries in Africa carried the virus nowadays.
And the next point is that we are only in the early stages of this epidemic, which is important and we have naturally increases of HIV that we observed in various parts of the world and in the Middle East, in Asia, and the very populous nations of Asia. But also and especially in the Eastern world there, infections of just Cairo, Egypt over the past three years and that is, of course, very worrisome. We also have seen increases in (MS?) countries, increases in the drug infections, which is of course, also very worrisome because of the situation there. You know, the knowledge is available. The resources are available to do something about it and still the disease increases, which is very bad.
One other point, the epidemic is in the youngest. The youngest are at highest risk. There’s new examples around the world. Just to give you a few highlights, a third of all (MS?) is less than 20 years of age. They are in their teens. Half of them remain positive. Injecting drug users in Russia shook up the numbers of injecting drug users in very young people 20 years--less than 20 years, again, from 300 a few years ago to go to more than 10,000 really diagnosed HIV infections in drug users in the last year. And there are many other examples around the world, which you could find in a handout that we have prepared if you’re interested.
The last point is the most important. None of this has been inevitable and is inevitable in the future. We can do something about this. There are increasing numbers of good examples and South Africa has just joined a group of countries where infection rates have come down at least in the youngest age groups that we released just last month ago--a month ago, and we know that we can turn this epidemic around.
We have (MS?) analysis building up and, you know, and the analysis that was prepared for the United Nation’s Special Session last year that related to what would be needed to sort of scale up in effect with response and now taking the response to a global effort into what can we actually achieve if we are to manage those packages--a comprehensive package on care and prevention. And then the seriousness without that effective response taken up, our countries would have to expect another 45,000,000 new infections between now and the year 2010. If countries live up to their commitments that were given last year, both rich and the poor, we could eliminate (MS?) of those, which is more than 60 percent.
So the time for excuse is running out. I think the pieces of the puzzle are coming together. The commitment has been given. We now have to live up to it. We have to experience kinds of new programs in the era in the HIV/AIDS effort that we should take up now.
MODERATOR: Thank you, BERNHARD. The next presentation was given by Dr. Siliciano and he was talking about the virus replication and has broadened the prospects for eradication. Robert.
DR. ROBERT SILICIANO: Well, good morning. My presentation focused on theoretical potential of antiretroviral therapy and in particular on two questions. First, will it ever be possible to cure the infection with antiretroviral therapy alone? And second, is it possible to stop the evolution of the virus and maintain patients for life on treatment without the disease progression?
With respect to the first question, the answer appears to be no and this is because of an existence of a stable reservoir for the virus in resting memory T-Cells. This reflects the fact that the virus has taken advantage of the most fundamental aspect of the immune system, which is the immunologic memory and can establish a stable silent infection along with lympocides [sp].
In our recent studies, we’ve looked at whether if a lot of these cells decay in patients on treatment and have seen essentially no decay in patients who had optimal response to treatment over the course of five to seven years. And it looks as if it will never be possible to eradicate this reservoir with the antiretroviral therapy alone. Some other approach will be needed to deal with this reservoir. Our studies of the reservoir suggest that this is going to be very difficult to do, because these cells are essentially indistinguishable from uninfected cells. They only carry a silent form of the viral genome and it’s going to be very hard to specifically target them.
With respect to the second question, our work suggests that in patients who have responded well to therapy, there is an arrest in virus evolution. We can see, essentially, a complete halt in the evolution of the virus and this suggests that patients in principle can be maintained on therapy for life without disease progression if sufficiently nontoxic drug regiments could be developed and made available.
MODERATOR: Okay. Thanks, Robert and then final presentation was by Milly Katana from Uganda about the role of the community. Milly.
MILLY KATANA: Thank you, (MS?). My presentation this morning centered in the role of the community movement in the response to HIV. And those were the opportunities available for the community to effectively participate in the response and the requirements for the community involvement in their response. I mentioned that the best front institutions to translate scientific knowledge and based on commitment is because that life and home were indeed the communities. In a nation that’s infected and where politicians took no action on HIV, (MS?) who are already in the ground operating the much needed care and support to individuals and families throughout all of the affected with HIV.
Our information is that communities (MS?) when either agencies have switched budgets with the communities boldly with our bare hands with minimal resources to implement the activities which it remains to help the lives of the people infected and affected with HIV. I mentioned that now that we are moving into action, one of the key words of the commodities is advocacy for results and with this world advocacy for AIDS competence policies, the fact remains the (MS?) should be (MS?) of commitment and the tide which that has created therein.
And also, I addressed the stigma of discrimination, which is still realized in different forms and in different parts of the world. And I particularly mentioned that the re-culmination of HIV-related drug assistance, especially men having sex with men in Asian countries are being familiarized and this has communities willing to address, because we all stick together for this is to drive it really underground and the world that intended to familiarize people. Instead, these people are being (MS?) communities, which the world was supposed to protect.
And I also talked about the environment where more opportunities are available for the community (MS?), and one of these was the basic infrastructure in the countries with--poorest countries have some minimal resources in terms of human resources that seems we have accumulated over the years. And we’re not (MS?), especially in the Asian countries, which we need to (MS?) and drive our prevention agenda.
And as far as the defining (MS?), I mentioned that we need to as a commission and all over, not only the community level, and that the communities and everybody else needs to be part of the transformation focus and we should stop talking about content for change. We need to be part of the change process ourselves.
And I also mentioned that at the end of the day, we are indeed all communities, everybody inside of a community. And as I say that, we all have a role to play, indeed everybody has a role to play and that the biggest challenge that is facing us as communities is to do things differently this time around. Thank you.
MODERATOR: (MS?). Feel free to ask questions. Yes, please? Is there a microphone for him? Just a minute.
FRED SANDERS: Thank you. I’m Fred Sanders from the South African Medical Journal. I’d like to ask Dr. Siliciano, when you talk about stopping the evolution of the virus, does this mean that with effective ARP, if the virus does replicate, there are not going to be mutations?
DR. ROBERT SILICIANO: What it means is that with effective therapy we see a little bit of virus in the plasma, but that virus is archival nature. It looks as if it’s just being released from some state or reservoir and is not going through additional cycles of replication. And what you need to get evolution is for the virus to go through additional cycles of replication. We don’t think that is happening at least in some patients who have responded very well to the drug.
MODERATOR: Next question, please?
JIM RICHER [sp]: Hello. My name is Jim Richer and I’m with the official World Trade and the newspaper of the conference. This question is for Dr. Schwartlander. You mentioned the collateral damage that’s caused by HIV/AIDS in your section of your talk on the widening--the widening track. You talked also about a new era and a new paradigm. I wonder if you could just elaborate a bit more on what sort of collateral damage you’ve measured and effectively all we--do you view this in widening this--the widening track is actually accelerating. We’re in a new era, track-like for a better--and what does that indicate?
DR. BERNHARD SCHWARTLANDER: [Excuse me.] Well, the first part of the question, what is this impact--whether this impact is in those countries that are hardest hit by the epidemic right now and it’s quite traumatic. It’s beginning to show because the people have started--beginning to start--to volume in large numbers in the absence of new (MS?) treatment and therapy. It means that an increasing number of families--the family heads are dying. Children have to grow up with or through support of their families. There’s a very much increasing number of babies. The estimate stands right now at 13.3 million, but it’s targeted to increase to more than 25 million babies in years to come. And those are children who lost their mother, their father or both parents to HIV/AIDS.
And the (MS?) are showing in the early active sections of societies of most people in the (MS?) sector, in rural sectors basically, which is also very traumatic and let me just highlight two sectors because they’re both median indications as to the future of the society. One is the education factor and more than a million pupils have lost their teachers in Africa due to HIV/AIDS last year and in the year that followed. It’s very difficult to keep education habits which are already low at that level right now without new (MS?).
The other example of impact is, you know, is in the health sector. Doctors are dying. Nurses are dying, which of course, is a very special situation where, you know, the care is actually problematic, which makes it very difficult to cope with the disease in these countries to cater to people who need it.
I see a kind of shift in the paradigm for many reasons. One, I think we have accumulated a large amount of knowledge from how to prevent the disease. There is country after country where we at least have in parts of those societies an example that it works well. We have interested communities, which of course, is not at the level that it should be. There is an increase in resources, again, far from being perfect but there’s a start.
And I also think it’s a very important to say for the first time treatment--effective treatment has been represented from my colleague, is individual (MS?). For the first time there is hope for societies and is really important for the first time I think we can count on one of the most important constituencies on the side HIV/AIDS, which is most people who are living with HIV/AIDS because we have something to offer. We can help them to get out of the closet and feel--you know, (MS?) stigma and we can count on them to help us to prevent further infections and help others.
MODERATOR: (MS?).
UNIDENTIFIED MAN: This is a question for Dr. Katana. You mentioned that pharmaceuticals should be left out of the WTO. Could you sketch a little more what kind of involves (MS?) then, and what do you think about pharmaceutical companies, specifically about pharmaceutical companies that are in the--involved in the access programs that are being supported by WHO for instance?
MILLY KATANA: (MS?) taken out of the World Trade Organization. (MS?) of drugs under the TIPS Agreement, and I would think when that it done, then how it is seen as a commodity, but how is basic rights is a fundamental right and, therefore, it cannot be focused on trade. And so, it has to come out of the World Trade Organization. It has to have what--it has to come back to the responsibility and accountability of governments. And in this context, then raise concern and interest should go back to the World Health Organization and we UNAIDS as a factor, as a force that should set the example, not the World Trade Organization. And that’s what I mean.
If you’re looking at the drug companies and the private structure, now overall better efforts have been made after the meeting in Durban, that prompted we would have to look into accessibility and affordability. But my concern is overall the drug pricing should still come down and the target seems to be $50 as the private structure. But this is still not possible for many countries, particularly in Africa where your cities are only less than a dollar a day. So, even if the Global Fund is able to provide some money, all accessibility to treatment, it doesn’t resolve the problem. The root must be that countries must be allowed to produce their own drugs, generic drugs, and that means taking in of drugs must not be a factor. So, which the most successful in Brazil, in South Africa where it has actually arrested the increase in infection and saved lives. So, that is the direction that I’m discussing.
MODERATOR: Thank you. There is a question here in the front, please?
UNIDENTIFIED MAN: (MS?). You have in the United States a question of, especially for Milly Katana, a year ago at the (MS?) the Declaration of Commitment insisted that civil society, grassroots organization and the community be involved in project conception from the start. And in your talk this morning, you said that community groups don’t find themselves at the conception tables let alone as part of the projects to be funded. Where is community leverage to change this and is it perhaps intended to be first with the funders that they must insist that the community be involved?
MILLY KATANA: Thank you very much. Yes, I mentioned that in the morning that this proposal of the Global Fund where we showed that (MS?), we showed that communities finally arrived themselves as being the association signing papers as country (MS?) for problems that respond to HIV/AIDS. I do not have a specific answer to your question, but I also make an appeal to all of us to realize the central role of communities have to play and want to dare us to ensure that the policy makers indeed engage the communities not only in implementation, but planning the evaluation and (MS?) of this program. And we take this out as part of the concept of making the requirements of the Global Fund’s focus. But you know, as board members, we cannot be in every country to hear what happened, so at the end of the day only (MS?). And in particular, the media has a big role because where we cannot reach the media can reach.
UNIDENTIFIED MAN: (MS?) I’d like to ask Dr. Siliciano whether his skepticism about the long-term ability of antiretrovirals to actually cure, exclusively extend to the new classes that are coming out, drugs such as (MS?) that we’ve heard about this morning and whether he has any particular comments about that drug that he’d like to make?
DR. ROBERT SILICIANO: Good question. The new classes of drugs that are coming out are clearly going to break--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 and that is because the virus in these reservoirs is persisting in a latent form. It’s not replicating and, therefore, it’s not affected by drugs that are a target actively replicating virus. And so, it doesn’t actually matter what step in the virus lifecycle you include it, none of those things will actually affect this reservoir once it’s established and that’s the problem.
UNIDENTIFIED MAN: I have another question for Dr. Siliciano. Talking about resistance and the principal emerging resistant is transient for HIV, is it possible and introductions to the drug treatments? That situation being, do you know that patients with that role in the new drugs and the new treatments are changing, maybe because you have noted that you’ve witnessed resistance strains. And you know that maybe (MS?) in recent years, so that there are some new implications there are more HIV resistance to drug treatment. So, when do you (MS?)?
DR. ROBERT SILICIANO: Well, the problem is that any treatment for HIV infection that doesn’t completely suppress viral replication leads to the development of resistance. And typically, any single drug treatment or dual drug treatment that doesn’t completely suppress viral replication will almost inevitably lead to the evolution of resistance and that’s the problem. Once resistance has evolved in a given infected individual, that resistant virus can be stored in this reservoir that we’ve discussed and it will be there for life. This reservoir gives the virus a way to remember any kind of mistakes that are made in treatment, and by mistakes I mean any form of treatment that doesn’t completely suppress viral replication. Once you suppress viral replication down to the limit of detection, then what we see is that the evolution of a drug resistant virus is essentially halted.
ANGILENE [sp]: My name is Angilene. I’m from Malaysia. The panel is showing some very convincing data on the default--the measure of default. And I’m to know that year after year we talk about (MS?) resources (MS?) to eliminate this problem. What can we do? What can we do? What can this conference do to make sure that defaulters actually live up to their commitments?
MILLY KATANA: I think this is where the global response has come in, and this is where I think the people of the north have to have a more proactive role in really questioning the countries that have made the commitment. One, in terms of their own leadership and challenging that leadership into really living up to their commitment. Second, people have to get into partnership to ensure that those commitments are lived up to, which will require actually monitoring and recognizing what is happening at the community level. That partnership has to evolve globally. And thirdly, is that we need to conscientiously evaluate, for example, the Global Fund NPAD (New Partnership for African Development) and all other development strategies that actually finger or create this default.
LARRY ALTMAN [sp]: Hello. Larry Altman here at Times. Well, in the past you--if I recall then on plenary sessions or at least spoken, given hope for the cure for AIDS and that you could eradicate the virus. If I believe correctly you did that in Geneva? Maybe I’m in error from memory. If in fact, what has happened that would make you change your view?
DR. ROBERT SILICIANO: Well, when we initially discovered this reservoir, we weren’t sure whether it would eventually decay or not. And now, that we’ve had a chance to follow patients for longer periods of time, it’s become very clear that the reservoir is not decaying. The main question was whether the reservoir would decay with treatments that completely stopped the virus replication. There was some suggestion that in patients who have--who are on part but don’t have a complete suppression of viral replication, the reservoir will persist. But in patients in whom there is complete arrest of viral replication that the reservoir would eventually decay.
We now think that that’s not going to happen, that the virus persists due to the intrinsic stability of this memory T-Cell compartment, and that even if you have treatments that stop every new cell from being infected from the moment therapy is started, the cells that are already 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 and the problem is that that is going to be very difficult because of the nature of the reservoir.
UNIDENTIFIED WOMAN: Hello? I have a question for Dr. Siliciano. It’s about super-infection, and new infection between people who are both HIV positive. Do you think it works? Is it really happening, super-infection, or what do you think about it?
DR. ROBERT SILICIANO: The question is related to super-infection, people--people who are already infected being infected with new viruses. It’s something that probably does occur in the evidence (MS?) in the form of the existence of re-combinant forms of HIV where two very different strains appear to have recombined with each other. That can only happen if there’s infection by both strains in the same person and, in fact, in the same cell. So, it probably can happen, but in our experience it’s not very common. Definitive significance is really not clear, except that it can lead to the--this recombination between the strains, which produces new forms of the virus and that greatly complicates the development of vaccines.
UNIDENTIFIED WOMAN: Dr. BERNHARD, can we extend the agenda on developments? If there is (MS?) vaccine and antiretrovirals global (MS?) these drugs, but given that the current drugs are now (MS?), is there any plans for any ideas, any theories about when say the new drugs are to be made available to poor people and stop the cross-mutation virus?
DR. BERNHARD SCHWARTLANDER: If I understood the question right, you said you asked for other aid, sort of short-term plans to make drugs more available to poor people. This desire is patterned by discussions that you have heard and other things, and I can only start to answer. Maybe my colleagues can chip in. I think there are a number of very encouraging developments where resources that were different from previously. There are new resources now specifically made available for treatment of patients, which was different in previous years and I would just give you two examples. I think that it’s just in proportion of the money that the Global Fund has actually been allocated to treatment. Clearly, that is not enough yet, but it’s a start.
Another example is that the World Bank has a program based (MS?) that was started and more than a year then that program and initially this program did not include treatments, you know, following negotiation with the countries. But the World Bank has taken the decision to retrospectively and retroactively change those decisions and make sure that countries can actually include as part of their loans and as resources for treatment, which is very important. So, there are first steps. Clearly, it is not enough and we all have to push to make more resources flow to also bring the prices down further. They’re still too expensive for most people living in countries to pay for themselves, but there are starting points that you have to build from, a median.
MILLY KATANA: Communities affected with HIV and as front-liners we are advocating for association based models of treatment, which will combinize the weaknesses and infrastructure and build on what is available within the community, themselves, the peer counseling that we are talking about. At the minimum, of course, of generically produced drugs, which we cannot sell now as low as $300 per annum per patient. So, with infrastructure of the community groups, we can get the counseling across at various low costs. We hope we are able to prevent this kind of approach, which will be able to reach more poor people who need the drugs more.
DR. BERNHARD SCHWARTLANDER: Just to (MS?). In this conference, there are several presentations that do presently demonstrate that (MS?) in very poor segments is feasible. There is some infrastructure can be used and some (MS?) can be done using a very simple (MS?). So, I think it is feasible and this has been successful and there are a few presentations during the conference, including (MS?) in the Late Breaker sessions, but I invite you to take a look at it.
UNIDENTIFIED MAN: Robert, yesterday a U.S. company announced that they would have a vaccine within the next five years that would hit this strain in the United States. Given the resistance of this virus and the way that this virus replicates and the fact that there’s been no cure or a vaccine for any retrovirus, what would be your opinion on the vaccine in five years?
MODERATOR: Just before addressing the question, vaccine is going to be the topic, or one of the topics of tomorrow’s plenary and so that position will be addressed much more widely and much more specifically, and to invite you to ask the same question tomorrow. But anyhow, if you would like to ask the question.
DR. ROBERT SILICIANO: Yeah, I think it’s probably better to consider this tomorrow, but my comment would be that what is really dramatic when you look at the evolution of the virus worldwide and particularly the evolution of the embryo protein--the outside coat protein which is what you would need to develop a vaccine that raised antibodies that neutralize the virus, is that it is diversifying at a terrific rate making the development of a vaccine that would develop broadly and neutralizing antibodies very, very difficult.
If we don’t have those antibodies, we have to rely on other components of the immune system, for example, cidatoxic [sp] T-Cells, which have been shown in studies in the SID model to be able to not prevent infection, but to prevent the disease after infection occurs by lowering the viral set points. I think that’s one very possible scenario is that we will have a vaccine that won’t prevent infection, but will put people in a situation where their immune response controls the virus better. I think it’s going to be harder to develop a vaccine that totally prevents infection, because to do that you really need to target this embryo protein, which is diversifying at a terrific rate.
UNIDENTIFIED WOMAN: Dr. Siliciano, you mentioned today that people with long-term care could stop the replication of a virus provided that you found nontoxic drugs. Myself, having taken the drugs for almost nine years and experienced quite a bit of the side effects, I’m wondering about how third world countries are going to feel if those drugs are not developed and we intent that they will be?
DR. ROBERT SILICIANO: Well, I think that the hope is that we now have drugs that are powerful enough to stop the evolution of the virus. So, we’ve already--we’ve already gotten far enough to really stop the virus in its tracks, if the drugs are given correctly. The problem is, those same drugs are quite toxic and the hope is that by modifications of those drugs or development of new classes of drugs, we will be able to produce regiments that have the same potency, antiviral potency that are more easily tolerated, and I think that’s a very real possibility. We’ve already gotten to the point of having drugs that are powerful enough when used in combination and it’s a matter of fine tuning them and overcoming the problem--understanding the problems of toxicity and overcoming them.
UNIDENTIFIED MAN: (MS?). My main question for the panel is (MS?). And my question is, how is this achievable and how--especially if it’s left in the government to actually do to treat that, to make it to achieve the target and what the governments are planning to do as of now? And what should others do in governments and what other recommendations (MS?) to be actually achieved?
DR. BERNHARD SCHWARTLANDER: Certainly, I can’t answer both parts of this question by myself. First of all, as you have mentioned, (MS?) extends for getting the treatment to the people. We have some very ambitious goals, which is officials, you know, seeing from their incumbent officers, we’re going to have--we’re going to make sure and we’re going to help to make sure in partnership with other such three million people who need care, they’ll have care by 2005, and that is about 50 percent of all that who will need it. Obviously, that number needs to be increased over time much further. And what we can do to advance that, of course, is to one, show the evidence that it can be done and how it can be done under different circumstances to help guide the response at the country level.
We have just come out a few weeks ago with guidelines that show how a treatment can be done in a very simplified way, can from a very complex treatment in a individual patient to occupations’ treatment, very heavy lab monitoring that we had the best Western countries and rich countries over the past five years with very good success. But obviously the next step and the most important step was to make sure that these treatments are sort of de-complexed, demystified and we are--and with those treatment guidelines that we have published right now, it is possible to deliver treatment basically on the street level hospitals without necessarily having very, you know, highly trained skilled health workers. And obviously, this is one of the major elements to, you know, bring the drugs to the people.
The second element that has been done at the World Health Organization with its Committee on the Essential Drugs has put antiretrovirals on the list of essential drugs, which certainly is also a component to help guiding countries in their national programs and national plans to include these drugs on the list to help them in their negotiations with pharmaceuticals, both on e-resource companies and drug generics to make sure that these drugs are available at the country level, at the community level, that they can be used.
MILLY KATANA: The only key--key factor here would be, if we want to classify such treatments, but we have learned from the experience of South Africa and how the communities have been organized with their support micronisms. But what is concerned is also that (MS?) about Asia, it’s very worrying because there needs to be a greater political modelization into really changing the current status quo in reworking the national health policies. And as--that within the whole development agenda, that HIV/AIDS becomes an integral part, a major factor, and this is not happening if you look in the Asian countries. It’s still seen as purely a health factor. And whereas in AIDS, one interesting old area of existing treatment which gives a cause for a whole reorganization of the health sector. Second, is that it is a development issue and if you look at the mandatory testing that is given to various groups like migrant workers, like sect workers, drug users, it again increases stigmatization. And therefore, this issue is meant to be completely addressed within the whole agenda of ensuring access to care and treatment.
DR. ROBERT SILICIANO: Let me add at last, while the conditions in the countries where these treatments need to be carried out are a key, a second key is making sure that the resources are indeed there to be able to carry this out and there are a number of actions that need to be taken if the goal of three million people under treatment is going to be reached by the year 2005.
One of those is a continued decline in the price of antiretrovirals. We have seen a dramatic decline in the past 18 months of close to 95 percent from the prices that were in effect by the--at the end of year 2002 prices available today. We’re going to need to see another reduction of about 90 percent over the next three years if that’s going to be a reality, because ultimately if this is going to depend entirely on the resources that are coming from affluent nations, it would be very difficult to maintain it over time. So, a reduction by 90 percent bringing the cost of drug therapy to $30 to $50 per year will be a truly sustainable approach.
But secondly, those external resources are vital and the Global Health Advocacy Community is committed to putting pressure on--political pressure on the United States, the European arena and the developed specific countries to no longer view this as a secondary issue, which deserves a little bit of attention and resources but not nearly enough to turn the tide. Over the next three years, we’re going to need to see resources going up from $2 billion a year to $10 billion a year and we’re committed to making sure that that happens.
MODERATOR: Okay, we can stand for two or a couple of questions more, if any? (MS?)
UNIDENTIFIED WOMAN: This may be like a liberal (MS?) question, but would it be proper for a very famous person to get a global involvement--like I know, Clinton now after this conference or any other celebrity who could be your spokesman worldwide, who is even known in a little village in Africa or India? There is nobody around. I don’t know.
MODERATOR: This conference is a very (MS?) and every single delegate of 15 (MS?) who are here in Barcelona. You can choose any single one of them as the “man” of the conference.
UNIDENTIFIED MAN: If you want, I can email it to you and give you certain copies.