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Friday, 14 July, 2000, 11:34 GMT 12:34 UK
World's attention focused on HIV menace
By BBC Health Correspondent Karen Allen
Before the XIII International Aids Conference had even begun it was clear that this was going to be a controversial meeting - not least because of its location.
In South Africa 4.2m people are infected with HIV/Aids, but some of its political leaders refuse even to recognise that there is a link between the virus and the disease.
The conference opened against a backdrop of dismay amongst many in the scientific community angry that the South African government had re-ignited an old debate about the links between HIV and Aids.
It had given credence to dissident scientific views that Aids was a result of poverty and it had been slow to deal with issues of access to drugs and HIV prevention.
Just days before the conference began 5,000 scientists across the world signed the "Durban Declaration" stressing the urgency of the Aids situation in South Africa where there are now 1500 new infections every day.
So there was little surprise that when President Thabo Mbeki's made his opening address he was on the defensive.
His assertion that "there is no substance to the allegation that there is any hesitation on the part of our government to confront the challenge of HIV/Aids" drew much criticism - and in the days that followed it diverted attention away from the scientific debate.
The harshest criticism came from Mr Justice Edwin Cameron - an eminent supreme court judge who himself has the HIV virus.
However, unlike many other South Africans, has access to the potent anti-retroviral drugs now so widely used in the richer world.
He described the government's failure to come to grips with the Aids epidemic as "irresponsibility that bordered on criminality".
He also argued that until the government addressed the inequities of drug distribution, few people would be prepared to come forward to be tested for HIV/Aids.
Indeed the theme of the conference was "break the silence".
But the strong feeling that emerged from delegates was that this task will be made all the more difficult to achieve without firm political leadership from the South African government.
Stoned to death
It was a sad irony that little more than 10 miles away from where the 11,000 delegates conducted their debates, a young woman named Gugu Dlamini admitted publicly that she had the virus - in a township where talk of this kind is still taboo.
Unlike the judge she was stoned to death within days of making her statement.
That was just two years ago - a visit to Kwamancinza township with a police escort revealed that not much has changed.
During the course of the conference there was little announced in the way of new treatments, but exciting new research into preventing transmission of the virus from mother to child.
Doctors from the Chris Hani Baragwanath Hospital in Soweto have shown than a single dose of the drug Nevirapine to a pregnant woman during labour - then another dose to her and her baby after birth - could reduce the risk of mother to child transmission by up to half if the mother does not breastfeed.
Yet the vast majority of women in South Africa who test HIV positive do not have access to this drug and probably won't do for some time.
This despite a gesture by its makers to provide it free to the poorest countries over the next five years.
The lack of HIV testing across South Africa is the reason given by Dr Nono Simelela - the director of the country's HIV/Aids programme - for Nevirapine not being freely available.
But unless widespread testing is introduced as a matter of urgency, the numbers of youngsters with the virus could rise exponentially.
For many of the worst affected countries in Africa drug prices are not the only obstacle to getting treatment - many pharmaceutical firms have agreed to drop prices.
Instead it is deficiencies in infrastructure - not only hospitals and laboratories but also access to clean water and regular food.
People with HIV need to follow complicated drug regimes, and without the infrastructure to test and monitor the presence of the disease these Aids drugs are rendered useless.
It is in this field that the big pharmaceutical giants can expect to be lobbied in the future to provide contribution and know how to set up detection systems to deal with the virus.
In the absence of any major medical breakthroughs in treatments for those already infected with the virus, the announcement of new vaccine trails was the most promising development at the conference.
Indeed the BBC's Nine O Clock news broke the story just days before the talks were about to begin, that the first ever human trials of a vaccine specifically intended for Africa would commence in Oxford next month.
If these are a success it could form the blueprint for further vaccines in the future.
For a continent like Sub Saharan Africa where 70% of the world's HIV/Aids infections can be found, a vaccine offers the only real long term hope.
By the time the conference finishes an extra 7,500 people in South Africa will have been newly infected with HIV.
If this high profile meeting has achieved anything it is that it has focused the world's attention on the sheer enormity of the Aids epidemic - and the need for urgent action on a global scale.
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