By Xiong Lei

One could not ignore the striking disparities in global anti-AIDS efforts when 24,000 top-notch medical researchers, patients, activists and government officials gathered at the week-long 16th International AIDS Conference in Toronto last week.

There is the disparity in survival rates of people living with HIV/AIDS in rich and poor countries, for instance.

The UNAIDS data indicate that "in low- and middle-income countries, mortality rates for 15-49-year-olds living with HIV are now up to 20 times greater than death rates for people living with HIV in industrialized countries." In low- and middle-income countries, HIV-infected individuals in their forties experience annual death rates of 90-200 per 1000.

"We have high-level commitments; we have financial resources; and we also have antiretrovirals," said Frika Iskandar, a 25-year-old Indonesian who has been HIV positive since age 18. "But we can't deliver to those who need it the most people who are far away from the capital or major cities."

Here, human rights seem to pale in front of intellectual property rights UNAIDS and many developing countries have found it hard to get the giant pharmaceuticals that manufacture antiretrovirals to make their drugs affordable to people in low- and middle-income countries who need them.

Even Sofia Gruskin, associate professor of health and human rights and director of the program on international health and human rights at the United States' Harvard School of Public Health, said human rights "is no solution" to the issue.

There have been international programs to address the dilemma HIV-positive people have faced in poor countries, with increased funding to facilitate their access to appropriate treatment. Still, four-fifths of the over 6 million people living with HIV/AIDS who are in need of medication in these countries cannot get it, according to UNAIDS.

So Iskandar, now advisor of a regional network of people living with HIV/AIDS, asked the international gathering in Toronto "why most of the money does not reach communities."

The Indonesian, who happened to be born in the year when AIDS was discovered, is among the lucky few who only takes three pills a day, a simpler packaging of antiretrovirals. As Peter Piot, executive director of UNAIDS, frankly noted, "Most active pioneers of the fight against AIDS should benefit first from treatment." While antiretroviral therapy is not for everybody, the majority of HIV-positive people in developing countries who have access to medication, if any, have to put up with the conventional regimen of at least nine pills a day.

Aside from disparities in the survival rate and accessibility to treatment, the disparity in distribution of resources is also stunning. Billions of dollars have been thrown into the research and development of antiretrovials, without any resulting cure to end the epidemic. Then came projects on prevention methods, such as male and female condoms, microbicides and vaccines, with no certain effect for the latter two.

In all these research efforts, said Pam Barnes, president and chief executive officer of the Elizabeth Glaser Pediatric AIDS Foundation, "children have been grossly neglected in the world's response to AIDS," although everyday 1,800 children become newly infected with HIV and half a million kids will die this year alone.

"The special needs of children when it comes to care and treatment are still being ignored," she said. "If we continue to treat children as small adults, we can seriously jeopardize their health." The youngest children cannot swallow pills. But "many HIV/AIDS medicines still have not been tested for children."

Also neglected is the simple truth poor nutrition compromises the human immune system and causes vulnerability with HIV. Yet resources available to food security and nutrition are scarce compared to those allocated to AIDS medication and prevention, observed Dr. Gabriel Rugalema, senior officer of HIV/AIDS and Food Security at the Food and Agriculture Organization of the United Nations.

"Hungry people cannot eat medication," said Rugalema. Complaining that his program has a very small budget, he said, "It's difficult to argue these cases, as AIDS is still seen as a medical problem rather than a nutrition problem."

But it is obvious that when infected with HIV, people with good nutrition can survive longer than those with malnutrition.

Also apparent is the disparity in research between developed and developing countries, as the former have dominated the research in medication and prevention technologies. Although more medical scientists from developing countries have been involved in international programs of AIDS research in recent years, they are far from getting an equal footing with their counterparts from developed countries.

Even if they are heavily engaged in critical clinical trials, developing countries "are very weak" in sharing benefits such as patent rights, said Dr Pontiano Kaleebu, assistant director of the Viral Institute of Uganda.

AIDS has a singular amount of global attention and resources. No other disease has ever prompted the United Nations to set up a special office and ignited 16 international conferences to deal with it.

This is because AIDS was not known to exist 25 years ago and has killed so many people so quickly, said Helence Gayle, co-chair of the Toronto International AIDS Conference and president of International AIDS Society that initiated the biannual event in 1985.

Gayle acknowledged that more and more people have realized that one cannot solve the problem by dealing with AIDS alone. "That's why the conference has become more inclusive by incorporating topics of poverty elimination, tuberculosis, malaria, etc into its programs," she said.

That justifies that one cannot ignore these disparities in the global fight against AIDS. Otherwise, I doubt if those wonderful programs can get anywhere.

The author is a council member of China Society for Human Rights Studies.

(China Daily August 24, 2006)