The 13th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA), the biggest regional forum on the continent's AIDS problem, opened in Nairobi on Sunday afternoon.

Under the theme "Access to Care: Challenges," around 6,000 participants from Africa and other parts of the world would share experiences on challenges faced in accessing care to the HIV/AIDS infected and come up with strategies to improve the situation during the six-day conference.

ICASA brought together scientists, social and political leaders and other people who share their experiences and current trends in the management of HIV/AIDS and sexually transmitted infections (STIs) from an African perspective.

On Sunday afternoon, the Joint United Nations Program on HIV/AIDS (UNAIDS) issued here a report entitled "Accelerating Action Against AIDS in Africa," indicating that despite increased political attention, Africa's AIDS fight remains only half funded.

While an increasing number of leaders of African and donor nations are demonstrating a greater willingness to address HIV/AIDS in Africa, the total funding anticipated is only half of what will be needed to effectively confront the epidemic on the continent in 2005, said the UNAIDS report.

The report also said that limited treatment access and gender disparities fuel AIDS in Africa.

Previously on Saturday the International Women's AIDS Run, Kenya's largest ever mass-participation road race, was held to celebrate the opening of ICASA and the strength that African women bring to the struggle against the HIV/AIDS pandemic.

Africa is home to only 10 percent of the world's population and yet more than 70 percent of the people infected with HIV/AIDS live in Africa.

At least 60 million Africans have been directly impacted by HIV/AIDS: 30 million people are living with the deadly virus, more than 15 million have died from it, and more than 11 million have lost at least one parent to the epidemic.

Access to HIV/AIDS care: global priority and challenges　　

According to the United Nations, increased access to comprehensive HIV care and support, including antiretroviral medicines and treatment for HIV-related opportunistic infections, is a global priority.

As drug prices drop and health systems improve, significant progress is being made in these areas, but treatment and care are not yet reaching the vast majority of people in need.

A top priority:

• AIDS-related care is a vital and powerful investment that directly benefits people living with HIV/AIDS, reduces the social and economic impact of the epidemic, and boosts prevention efforts.
• The Declaration of Commitment, adopted at the United Nations General Assembly Special Session on HIV/AIDS in June 2001, highlights treatment and care, including access to antiretroviral medicines, as an essential element in the response to the epidemic.

Prices drop:

• In early 2000, the price of Highly Active Antiretroviral Therapy (HAART, also referred to as triple therapy) for one patient for a year was US$10,000-12,000. By the end of 2000, prices had dropped to US$500-800 per person per year for first-line antiretroviral treatment in low-income countries. As of May 2003, the least expensive brand name combination recommended by the World Health Organization for low-income countries was approximately US$675 per person per year and the least expensive generic combination recommended by the WHO was just under US$300 per person per year.
• Still, only a fraction of those in need were receiving antiretroviral treatment at the end of 2002, about 800,000 people worldwide, 500,000 of whom live in high-income countries. In sub-Saharan Africa, where about 2.4 million died of AIDS in 2002, only about 50,000 people were getting treatment. In Asia and the Pacific, where an estimated 485,000 people died of AIDS in 2002, only 43,000 people were receiving treatment.
• For middle-income countries with relatively low HIV prevalence, significantly lower price levels can have an immediate impact; many of these countries already have the health infrastructures and capacities to deliver medicines if they are priced affordably.
• Even with greatly reduced drug prices, in low-income countries with high AIDS prevalence, significant external financing is needed to provide antiretroviral to all those in need. Substantial international financing for provision of comprehensive HIV care, including antiretroviral treatment, is now available from multilateral sources such as the Global Fund to Fight AIDS, TB and Malaria and the World Bank, as well as from bilateral donors.

Challenges:

• Along with prices, other challenges to expanding access to treatment include mobilizing sustainable financing for bringing medicines and diagnostics to low- and middle-income countries, and strengthening health facilities and human resource capacity in the health field so that the medicines can be prescribed and used safely.
• In Africa, where some two-thirds of the world's HIV-positive people live, health-care systems were already weak and under-financed before the advent of AIDS. They are now buckling under the added strain of millions of new patients. In many places, facilities for diagnosis are inadequate and drug supplies are erratic, even for HIV-related conditions that are easy to diagnose and inexpensive to treat.
• Proper prescription and monitoring of compliance with drug regimens are essential for the benefit of patients and for reducing the serious risk of drug resistance.
• To develop and disseminate information on sources and prices of medicines, initiatives such as the partnership between the UNAIDS Secretariat, UNICEF, the WHO and Medicines Sans Frontiers have been established. This has resulted in regular pricing reports based on surveys of more than 200 pharmaceutical manufacturers in 40 countries worldwide.
• Comprehensive care and support must include a range of services, including voluntary HIV counseling and testing so that people can know their HIV status and deal effectively with it. Comprehensive care must include psychological support to help people cope with the implications of having a life-threatening disease. It also requires social support to help HIV-positive people, their families and their communities cope with the economic and social consequences of AIDS.
• The role of communities and community organizations -- especially those involving people living with HIV/AIDS -- is especially important. Their work promotes social solidarity with HIV-affected individuals and their families, provides them with emotional support, and helps protect people living with HIV/AIDS against discrimination and the violations of their rights. Often, it is community activism that helps prompt governments to devote more resources to the AIDS response and spurs companies to lower drug prices.
• Increasingly in the hardest hit countries, the private sector is playing a role in providing access to HIV/AIDS treatment and care, including antiretroviral, for their employees and in providing support for the communities affected by HIV/AIDS from which they draw their workforce.
• Access will remain uneven and compromised until countries are able to afford AIDS-related medicines and diagnostic equipment, as well as equip their health systems with the necessary infrastructure and adequately trained staff. 
  

Recent advances in war on HIV/AIDS　　

Following are major recent advances in the war on HIV/AIDS.　

As the mutation and combination of HIV sub-types is turning out to be the biggest challenge to the war on HIV/AIDS, the World Health Organization has established the Global HIV Drugs Resistance Surveillance Network to assist countries in monitoring the emergence of HIV drugs resistance.　　

Recent scientific advances have resulted in the development of various antiretroviral drugs (ARVs) that reduce the amount of the HIV virus in the body. There have been more than 19 different types of ARVs targeting different HIV sub-types, with others still under research and development.　　

With new developments, a single tablet is sufficient for a whole day dosage. In the past, the three times a day dosage of the ARVs was proving challenging to many people. 　　

Good nutrition especially the use of supplements has been found to boost the immunity of those affected, staving off opportunistic infections.

Herbal medicine has been found to play a role in HIV/AIDS management. Scientists at the University of Nairobi and the Kenya Medical Research Institute are working closely with herbalists.　　

The ability to understand how the virus behaves has made it possible for the development of anti-HIV vaccines. Over 30 HIV vaccines based on various HIV sub-types have been tested without much success. Currently, an estimated 25 HIV vaccines are on trial worldwide.　　

In Africa, Kenya, Uganda, South Africa and Botswana are carrying out vaccine trials. Rwanda, Cameroon, Senegal and Nigeria are other countries earmarked for vaccine trials.　　

Kenya and British scientists are conducting studies on an HIV vaccine that will elicit killer T-cells, a type of anti-bodies, in the body to prevent the virus from infecting a person. Initial results show that the vaccine, based on HIV sub-type A, is safe and able to induce the immune system to elicit the required killer T-cells.　　

Aidsvax, a vaccine developed by VaxGen, a US company, is the only AIDS vaccine that has gone through the last and final phase three human trials, which were to determine its efficacy. The same company is undertaking phase three trials in Thailand on another vaccine designed to prevent the infection of HIV sub-type A/E.

(Xinhua News Agency September 22, 2003)