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Rich, Poor Far Apart in AIDS Fight

July 3, 1998

GENEVA (AP) _ ``Bridging the gap,″ read signs draped everywhere at the 12th World AIDS Conference. But by meeting’s end Friday, the message to many seemed just the opposite: The chasm between the haves and the have-nots in the global epidemic is only widening.

Around the world, nearly 34 million people are infected with HIV, and that number is growing: Since the international meeting began Monday, about 100,000 more have contracted the virus, which causes AIDS.

Perhaps 4 percent of those infected live in the United States, Western Europe and a few other affluent nations, where patients routinely get powerful _ and expensive _ AIDS medicines that can keep the virus in check. For everyone else, the benefits of recent medical breakthroughs are an ever distant dream.

``Medical advances present us with a painful paradox,″ said Anna Luisa Liguori, who works with the MacArthur Foundation in Mexico. ``The greater the advances in clinical research, the greater the gap between those who can afford the best treatment and those who can afford no treatment at all.″

Treating just one HIV-infected person with the standard three-drug regimen costs $10,000 or more. According to one estimate at the meeting, making this protocol available worldwide would cost $36.5 billion, two-thirds of that expense coming in Africa.

``Bridge the gap?″ asked Dodji Mathey of Togo. ``I don’t think so. It is not possible for the new medicines to ever get to Africa. We are too poor.″

Among the meeting’s 13,371 attendees, less than a quarter were _ like Mathey _ from the parts of the world where children routinely die for lack of basic antibiotics and clean drinking water.

In Mathey’s tiny West African country, 9 percent of adults are infected with HIV. In some nations on the continent, the figure approaches 30 percent.

With no effective AIDS vaccine close to development, the only way to stop the epidemic in poorer nations is to prevent the spread of the infection. The primary approach is to make condoms cheap and abundant and to persuade people to use them.

Mathey paid his own way to the conference to present data on a program he runs in Lome, the capital of Togo. It educates scooter taxi drivers to urge their passengers to use condoms. But he could not pull together the $20,000 in Geneva that he needs to sustain his campaign.

In at least one area, though, the benefits of AIDS drug research may make its way to the world’s poorest. Giving AZT to infected women during pregnancy helps keep them from passing HIV to their babies during birth.

Studies at the conference show that $50 worth of the medicine cuts this risk in half. During the meeting, the United Nations’ AIDS program said it would start a pilot project to provide AZT to about 30,000 women in poor countries in Asia, Africa and South America.

There are some 1,600 cases of mother-to-child transmission daily, almost entirely in the developing world. Even if a baby is born free of HIV, there is still a 10 percent chance that an infected mother could pass the virus to the child during breast feeding.

Just over 40 percent of the speakers at the conference were from poor countries, and they were featured prominently in the program. However, during closing ceremonies Friday, Dr. Richard Horton, editor of the British journal The Lancet, chastised attendees for sometimes failing to sit through their talks.

``Why is it that whenever speakers from a developing country rose to speak about these issues, the halls began to bleed delegates?″ he asked. ``Why should any government bother to listen if you don’t?″

At the next world AIDS meeting, in 2000, the contrast between haves and have-nots is likely to be even more striking: It will be held in South Africa.

Dr. Hoosen Coovadia, the chairman of that meeting, to be held in Durban, said that at the city’s largely black King Edward VIII Hospital, about 40 percent of the patients have HIV. None of them receive virus-fighting medicines.

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