Seven Questions: Fighting AIDS

FOREIGN POLICY: In 2001, the international community set a series of targets in the fight against AIDS. Part of the high-level meeting last week was to review progress. How did we do?

CB: There has been progress in some countries, but it hasnt been sufficient at all. The political commitment in many countries has increased. Five years ago, Russia was facing one of the worlds fastest-growing epidemics and wouldnt even acknowledge that it had an AIDS problem. Now, [President Vladimir] Putin talks publicly about AIDS and has committed more than $100 million domestically. Similarly, five years ago, countries like China and India were in complete denial. Now they are actively working to address the disease.

But when it comes to the hardest-hit African countries, the picture is very mixed. In some age groups, the infection rates are going down slightly, but not by much. There has been no breakthrough reducing infection rates. We still have about 5 million new infections every year. There has been only moderate progress in putting people on treatment. We are always two steps behind this epidemic. It has outpaced all the efforts that leaders have made.

FP: India has overtaken South Africa as the country with the greatest number of infections. How is it dealing with the epidemic?

CB: The debate about absolute numbers is largely irrelevant. Both countries have too many people being infected. But there is no room for complacency in India. They have to recognize that they have an epidemic on their doorstep.

It is important to remember that there are very distinct epidemics in India. There are pockets of high infection rates in the general population in the southeast, in Tamil Nadu. Then there is an epidemic among IV drug users in the northeastern states. Those are two completely different epidemics. Then you have another epidemic in Maharashtra in the west where an increasing number of truck drivers are being infected. [Truck drivers] were the engine of the African epidemic 15 years ago. But to say that the whole Indian subcontinent is on the tipping point is not true. Indian officials could correctly point out that there are a number of states where the infection rate is perhaps 0.1 percent.

FP: What is the more difficult challenge in the years ahead: getting treatment to those who need it or preventing the spread of the disease?

CB: It shouldnt be an either/or question. The secretary- general has said that prevention makes treatment affordable and treatment makes prevention possible. That is exactly right. Unless we succeed in prevention, treatment will never be affordable. If we continue to add 5 million new infections each year, it will be extremely difficult to finance treatment. But if we dont offer treatment, people will not come forward for testing and counseling and we wont overcome the stigma. So we need both.

But the greatest challenge is perhaps the fatigue among the international community. There is the perception now that weve done a lot and the resources have increased, so we can move on. That would be a disaster.

FP: More people are on antiretroviral drugs than ever before. Has there been more cooperation from the pharmaceutical industry in providing drugs at a lower cost?

CB: Prices have come down over the past five years. Many pharmaceutical companies have agreed to charge much lower prices in developing countries than in developed countries. But we also need new drugs and R D. You cant treat people forever with the same drugs because they will become resistant. And we still need more funding for treatment. This is lifelong treatment. The kind of limited investment weve made so far will never put more than 1.5 million people on treatment, which is what we have now.

FP: It was reported last week that in U.N. negotiations over the meetings final declaration, there was disagreement about how to refer to high-risk groups. Why?

CB: There is enormous cultural diversity in the United Nations. For some countries, it is no problem at all to talk about sex, homosexual relationships, sex workers, or drug users. For others, it is not easy. A hard-won compromise was achieved in 2001. Unfortunately, it was not possible to build on that compromise this year. Some countries wanted to move backward and even take formulations out of the declaration that were uncontroversial in 2001. This years document isnt as strong as the one in 2001. You wonder a little bit what has happened in the meantime. Why do we have to go over this same debate again and again?

FP: Whats the progress on an HIV/AIDS vaccine?

CB: That is a disappointing story. I have been working with HIV/AIDS for 18 years and when I started, we talked about a vaccine that might come in the next three years. Every year, we heard that in five years well have a vaccine. It is 2006, and we still hear maybe five years. A lot of progress has been made in the research [area], but we still seem to be far away from an effective vaccine. We desperately need onetheres no doubt about thatbut its not an area that I would describe as making good progress over the last few years.

FP: In this years U.N. Report on the Global AIDS Epidemic, the percentage of young people who could correctly identify ways of preventing HIV transmission didnt top half in any country. In some countries, just 7 percent of young people polled could identify prevention methods. How do we remedy those statistics?

CB: These numbers are those that cause me some of the greatest concern. It is shocking that 25 years after the start of this epidemic, the number of young people who can correctly identify ways to prevent transmission is so low. Some countries will start a nationwide information campaign and the rate of young people who can respond correctly goes up. But then two years later, the politicians say OK, thats been successful, and it stops. We are talking about young people; a new generation enters that age group every year. That doesnt just apply to Africa and Asia, but to the United States and Europe. It is a major concern for all countries.

Dr. Christoph Benn is director of external relations at the Global Fund to Fight AIDS, Tuberculosis and Malaria.