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Last Updated: Friday, 4 March, 2005, 11:56 GMT
Tough challenges remain in Aids fight

By Karen Allen
BBC Health correspondent

Nearly 90 million Africans could be infected by the HIV virus in the next 20 years if more is not done to combat the epidemic, the UN has warned this week.

It estimates the next two decades could see 89 million new cases of the disease in Africa - or up to 10% of the continent's population.

A volunteer receives a vaccine shot in Bangkok
Only a small percentage of Aids funding goes into vaccine research
The statistics make grim reading and with infections continuing to rise at an alarming rate, there is no room for complacency.

The UN recommends a committed campaign against HIV/Aids - and $200bn (105bn) of investment - to stem its spread.

It is a dynamic picture and one of the biggest global challenges the international community has had to face.

Funding

Global funding for HIV/Aids has tripled in the past four years from a little over US$2bn to $6bn.

Yet it still falls far short of the UNAids estimate.

With more money now in the system, divisions are emerging about how it should best be spent.

The Bush administration in the US has committed $15 billion to fight HIV/Aids. It's an impressive sum.

But it has come in for criticism from some aid agencies for pushing programmes that use brand name anti-retroviral drugs which are more expensive than their generic counterparts.

It has also been under fire for pursuing an agenda which gives priority to projects that promote sexual abstinence over condom use.

Finding a safe effective vaccine is the holy grail in HIV/Aids research
Some commentators say this is irrelevant for women in parts of Africa, for whom the biggest risk is of getting HIV is having a partner who sleeps around.

But others argue that even money with strings attached is welcome at a time when the epidemic shows little sign of waning.

Anthony Fauci - the US government's key advisor on HIV/Aids argued at the International Aids Conference in Bangkok in July that the logic behind the Bush programme was to maintain accountability and control over how US taxpayers' money is spent.

Meanwhile UN Secretary General Kofi Annan ruffled feathers when he countered that the American unilateral approach was undermining the Global Fund - an international mechanism to raise cash for HIV/Aids work, which is struggling to meet its financial targets.

That dispute has not really been resolved but there is now a concerted international effort to co-ordinate Aids funding in a more orderly manner.

Drugs

The cost of a year's anti-retroviral treatment has fallen from around 6,000 a year to about 180, yet nine out of 10 people who need the medicines are still not getting these life-saving treatments.

Aids drugs
The price of anti-retroviral drugs has plummeted
The World Health Organisation has set an ambitious target of getting three million people onto the drugs by the end of 2005.

But there are real doubts whether this is achievable, given current funding levels. Aid agencies say that it is entirely possible to meet that deadline but what is needed is the political will to roll drugs out on a massive scale.

Access to anti-Aids drugs is spreading rapidly in many developing countries, the World Health Organization says.

Some 700,000 people in poor countries were taking the drugs by December 2004 - a 50% rise in six months, its latest report said.

Good progress had also been made in sub-Saharan Africa and parts of Asia.

But the situation was less satisfactory in eastern Europe, central Asia, North Africa and the Middle East.

WHO said major obstacles remained, including a funding gap of $2bn.

It is not simply about distributing pills.

Christian Aid is one of the charities warning that without proper investment to build hospitals and train staff, sustaining anti- retroviral treatment in the long term will be hard.

Anti-retrovirals need to be taken consistently and widespread failure to do this could lead to major drug resistance and a reduction in treatment options for infected patients.

Vaccines

Finding a safe effective vaccine is the holy grail in HIV/Aids research but is proving a difficult challenge and it is unlikely that we will see effective immunisations available before the end of the decade.

Aside from the scientific difficulties, there are also enormous financial challenges

Earlier this week, as he received his knighthood, the world's richest man Bill Gates, who has committed $260million towards an Aids vaccine said he would be surprised if there was a vaccine within a decade and said if that happened he would "eat his hat".

There are currently some 30 different Aids vaccines undergoing trials.

These experiment with different approaches, aiming either to disable the Aids virus or prevent it from entering human cells and multiplying.

Aside from the scientific difficulties of HIV vaccine research, there are also enormous financial challenges.

I would have liked to see more discussion on HIV/Aids. For us in Africa that is the greatest threat to development
Amboka Wameyo, Tanzania

IAVI, the International Aids Vaccine Initiative points out that only 1% of global research and development funding is being channelled into finding an Aids vaccine.

The British government has already indicated that it intends to push Aids vaccine research up the political agenda, backing it up with a promise of more funding.

If indeed it does deliver, it could be a lasting legacy that finally turns the tide on an unrelenting epidemic.


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