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Monday, 8 July, 2002, 13:21 GMT 14:21 UK
Is the world doing enough to combat Aids?

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    Young people between the ages of 15 and 24 account for half of all new cases of HIV around the world, according to a new Unicef report on the Aids epidemic.

    The report, to be published later on Tuesday, shows that nearly 6,000 young people become infected with HIV each day throughout the world.

    The charity will warn that governments must pay more attention to the needs of young people if the spread of Aids is to be halted. It will also say that many young people are simply not aware of the risks and causes of HIV.

    The global Aids problem comes under heavy scrutiny this week with the Unicef report coming just days before the start of the XIV International Aids Conference in Barcelona.

    Are governments doing enough to raise awareness about the risks of HIV? Is the world doing enough to combat the spread of Aids? What more needs to be done?

    Simon Wright of Actionaid and Dr Neff Walker of UNAids took your questions in a LIVE interactive forum.



    The first question to you Dr Walker. This is from Tom Asiago, Kenya: I now live in the USA. The effort and sacrifice made against Aids is enormous. Why can't America, the friend of Africa, give more on Aids control? Not enough effort is being made to combat Aids in Africa.

    Dr Neff Walker:

    I guess I'd have to say I agree with him. But there are good trends. If you look we have been trying to track what richer countries have given - the actual amount of money given for HIV/Aids internationally has gone up about six-fold in the last four years. It's still far from what we need and one of the things that we've tried to do as a global community, both through the UN and through other governments, is try to say what is it we need to combat Aids. When Kofi Annan announced $9.2 billion, we try to set a standard and we hope that over time we are actually building momentum to holding the richer governments, including the United States, to what we think are moral commitments to help with HIV/Aids.


    Ian, UK: Why should we be spending millions of pounds on research on Aids? The investment should be spent the things that are the biggest killers in this country - cancer and heart disease.

    A similar point from Vic, USA: I fail to see how additional funding for drugs that can't cure Aids will help. What might help is a bit of self- control and a condom.

    Simon Wright:

    Actually more money is being spent on those things in the West than is being spent on HIV/Aids. More money in some places is being spent on drugs for obesity, some lifestyle drugs - some of the things which are affecting people in rich countries because we eat too much and don't get enough exercise than looking at things that are actually killing people.

    The difference between cancer and heart disease is that they're not an epidemic which is destabilising whole regions of the world and which have the potential to lead to very serious problems which can affect us in the north as much as people in the south. When we're talking about HIV being at the levels it is, particularly in sub-Saharan Africa where we're talking about some countries, like Botswana, where 40% of the adults have HIV - that is preventable and it's tragic but it's actually very serious for the stability of the world.


    Dr Walker I think you were saying in the UN Aids report that the search for a vaccine is still some ten years away and a lot of people are very worried that this is huge amounts of money that is just being poured into this black hole.

    Dr Neff Walker:

    I don't like to think of it as a black hole. I think there's two ways to view it: one is the moral commitment that we have as a human race to actually try to prevent death and suffering for people. I think the amount of money we need for HIV/Aids is not that great on the global scale. As my colleague mentioned, the amount of money spent on obesity control or on heart disease or other things dwarfs the amount of money we're talking about that would be required to turn HIV/Aids around. So I don't really see it as a problem - the amount of money is not a small amount but on a global scale it's not very significant.


    AMS, UK: If there are over 43 million diagnosed cases of HIV/Aids in Africa, there must be millions of undiagnosed cases. Shouldn't the percentages be worked out so that young people can be hit hard with the stark facts?

    Dr Neff Walker:

    In most of the richer countries the numbers of people living with HIV/Aids are based on reported cases. But in low and medium income countries, these are estimates - they're based on prevalent surveys that are done either in pregnant women to represent the general population or they're done in groups that are high risk. So when we say there's 40 million globally, this doesn't mean registered cases - that's based on the surveys we've done and extrapolated to the population. So the 40 million is supposed to represent the total number of people infected and I think we are sending the right message about the scale of the epidemic.


    Julie, UK: The issue is not about supplying the Third World with drugs - it's surely got to be about educating the Third World on ways to avoid Aids. It would be much better to spend the money on condoms and how to use them.

    Should we be concentrating all our resources on prevention rather than the search for a cure?

    Simon Wright:

    We have to balance it. We probably are spending more money on prevention than we are on treatment and care at the moment and there are some good arguments for concentrating on prevention - it's obviously better than cure. We can't cure Aids anyway, we have some very expensive, very complex drugs which in rich countries where we've got a very high level of health resources, they seem to be allowing people with HIV to live quite long and fulfilled lives, so it seems at the moment. So we are balancing that.

    But you have to remember in parts of sub-Saharan Africa, we're talking about areas that don't have basic painkillers or basic very simple drugs to treat opportunistic infections - the kind of infections that people with HIV are very vulnerable to. So we need to balance this. There is a very strong argument as well for not just concentrating on one or the other. If you look at both together. Why, if I were living in Kenya, why should I want to know whether I've got HIV if there's no help for me, if I'm not going to get any benefits from knowing that I have the virus - it might be better for me not to know, perhaps try and put to the back of my mind and not think about it. So we have to do both.


    Saima, UK: Over time I believe people are becoming less and less moral and that there are more problems in society developing. Educating people to use condoms is like giving a wig to a cancer patient. You need to deal with the cause of the problem and this should be about changing people's behaviour.

    Simon Wright:

    I agree that behaviour change is an important part of it. I think it is probably important to say first of all that HIV is always this subject on which people can hang their own political, moral or personal religious views and that's often been a huge problem with HIV that we don't just sit and talk openly about the facts. Sex is difficult to talk about anyway but it goes on - everybody does it - few people are planning to live the rest of their lives without sex so we shouldn't be talking in unrealistic ways.

    What we also need to do is take a step back from looking just at individual behaviour and try and think about the things that make people in a society more vulnerable to HIV. So if you live in a society where perhaps there has been a lot of conflict, a lot of social disruption, where maybe you don't carry a strong sense of what you want to do or where you want to be in ten years time - well then avoiding a virus, which is really only going to have an effect on you in eight or nine years' time isn't going to be a priority. So we need to look at the social factors - that's poverty, discrimination - discrimination against women in particular and power imbalances - and the wider global inequalities - we need to address all of those.


    John, UK: Just wait until Aids is the top killer in the West and then there might be some government action.

    Do you think he's being overly cynical there?

    Dr Neff Walker:

    Truthfully I don't think he is. I think that's the way it is for all countries. You see epidemics starting, they don't respond until they see the impact in their own societies. I think it happened in the West that we were slow to respond to HIV/Aids in the 1980s when the Aids epidemic started out among gay men. I don't think he's cynical - I think he's correct.


    Mick, Scotland, UK: Attacking the so called "greedy drug companies" does no good. They spend 13 years and half a billion dollars to bring a new drug to market. They have to make back that money somehow. If there was no profit to be made, they would simply stop drug research and we'd all be dying of diseases. The disease is ridiculously easy not to catch in the first place, as opposed to cancers and drug resistant bacterial infections, which should be much better funded.

    There has been criticism that the drugs companies are actually out to make money out of this.

    Simon Wright:

    Certainly and we do want drug companies to carry on doing the kind of research they've been doing. But don't be under any illusion, they're making plenty of profits from their sales in Europe and in North America and in Australia in particular for HIV. So they are recouping those research costs and that's right, that's a good system to work. The problem is that those drugs are prohibitively expensive for people in poorer countries. So there is no market there. So at the moment they're not making any money - none of the research costs are recouped from selling in Asia or in sub-Saharan Africa or in Latin America.

    The issue now - and this is a big debate that has been going on for a couple of years about international trade law - is do we let those countries that are having very high level epidemics that perhaps could produce cheaper versions of the drugs locally or perhaps could buy them cheaper from different routes that aren't approved by the companies - do we allow them to do that? Under international law they are allowed to but in practice we're not really encouraging them to and we've got to face up to that.


    Dr Walker, we've had a number of e-mails about that subject. Isn't that one area where it's shown that actually if governments worked together they can actually make a difference?

    Dr Neff Walker:

    In terms of working together to drive the prices down?



    Dr Neff Walker:

    Absolutely. You see that in the West we've been paying over $10,000 where now there are several countries - like in Brazil - they're paying a little over a $1,000 a year for triple therapy. Some countries are paying between $300 and $500 a year. I think there's been great movement and again as my colleague pointed out, in selling drugs in these poor countries, doesn't affect the profit margin at all because the drug companies are recouping their cost in the markets they currently have with the high prices.


    Sarah, UK: Why not make some adverts as hard hitting as the drink driving and seatbelt campaigns of recent years? Surely that would make some people sit up and take notice.

    We should be trying much harder, especially in the developed world, to educate people about this because we all remember those campaigns from ten years ago - the icebergs etc. - but we don't see anything like that now.

    Simon Wright:

    Yes and obviously Actionaid is particularly involved in North America, the UK and in Europe in trying to raise awareness. So that we think that the British public need to wake up to what's going on in developing countries. We have a responsibility for that. So we're working very hard on it. How you do it is always the subject of enormous debate.

    The icebergs that we had in the late 80s and remembered by everyone because they were dramatic. But there was a huge debate about whether they got to the people who really needed the information and chances are they probably didn't - they scared a lot of people who weren't at particular risk while at the time we weren't funding any prevention work with gay men who remain in Europe the group of people most at risk of getting the virus - we just stopped doing that work completely and concentrated on these icebergs. Also perhaps fear isn't always a great motivator - it's not a good long-term motivator - perhaps hope is better. Perhaps if we can give people a better sense of their future, a better commitment to themselves and to their community and that's going to take a lot of changes - but perhaps if we can do that that would be a much better motivator.


    Humphrey Lupyani, Zambia: There is nothing more that can be done than to continue educating people about Aids. Knowledge is always a better weapon to deadly infections. I suggest that the government or the world at large introduce a learning schedule within schools concentrating on Aids as a subject matter.

    So a sort of global fight on this with everybody getting the same message. Do you think that's realistic?

    Dr Neff Walker:

    I do think it's realistic because the nice thing about introducing things to a school education - you can reach a large number of people and the kind of critical people - the youth - fairly easily. Of course where it falls apart is then in lots of poor countries - huge percentages of youth don't continue education beyond age 12. So one of the issues is how do we expand out and reach those who are not in school for very long or live in rural areas. But certainly I think that's one of the commitments we have is to try to expand knowledge about HIV/Aids and how to protect yourself to all youth globally - it can be done.

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