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Year In Review: AIDS

By Bob Roehr

The international story dominated media coverage of the AIDS epidemic this year, thanks in part to a surprise announcement by George W. Bush in his State of the Union address on January 28. He proposed the Emergency Plan for AIDS Relief, a combination of prevention and therapy that will treat at least two million people.
The President asked Congress to commit 15 billion dollars over the next five years, including nearly ten billion dollars in new money, to turn the tide against AIDS in the most affected nations in Africa and the Caribbean.
AIDS advocates warmly applauded the commitment, but by the end of the year some were complaining that not enough money was being spent now, while too much was deferred until later. There also was a growing acknowledgement that the greatest barrier to treating more Africans is the very limited numbers of trained medical personnel in those nations, and the difficulty of rapidly increasing that capacity.
Domestic advocates are growing increasingly frustrated that not enough attention or resources are being given to problems here at home. Terje Anderson, executive director of the National Association of People With AIDS (NAPWA), was careful to praise political leaders for their international initiative. But he questioned the administration s commitment to abstinence only prevention programs and its willingness to devote more dollars to care.
Prevention activities continue to be a flashpoint of contention. The CDC announced a program shift that many interpreted as away from a community-based approach to more of a medical model focusing on those already infected.
With these two shifts we are putting our already vulnerable communities at even more risk for HIV, Ed Tepporn, a program coordinator of the Asian & Pacific Islander American Health Forum, told the CDC prevention conference in Atlanta at the end of July. The thousands of community activists and service providers in the room exploded with applause.
Community organizations will be forced to close down, leaving our communities who are already underserved even more so, he said. We are being asked to make HIV testing part of medical care. Well that s a load of bull, when 42 million people do not have access to medical care. And people of color are among those most impacted by HIV.
Another source of frustration has been the assault that social and congressional conservatives have made on community prevention activities and research. Agencies from coast to coast have been audited in detail, programs have been told to exclude sexual content, and some researchers have complained of a McCarthy-like atmosphere surrounding any studies that deal with sex.
Yet the CDC continues to point to rising cases of syphilis and sexually transmitted diseases among gay and bisexual men as reason to fear that the number of new HIV infections also is increasing, even while they restrict honest and explicit messages that have been proven to work among their targeted communities.
Neither the administration nor Congress seems inclined to appropriate the money necessary for services for the growing caseload as more people learn their serostatus and therapy is keeping more of them alive. The problem is most visible with the AIDS Drug Assistance Program (ADAP), where ten states already have waiting lists to join, and California is likely to cap entry to their program in January.
The recently passed Medicare reform also threatens to throw as many as 50,000 PWAs off the rolls unless changes are made.
We need a similar commitment to the domestic agenda that the Bush administration and Congress have made internationally, said Marsha Martin, executive director of the AIDS Action Council. If we act like AIDS is over, it won t be.
The pipeline of drugs in development continues to offer new options that are easier to use, have fewer side effects, and better resistance profiles. The big news was FDA approval of Fuzeon (T-20) in March after a long and difficult development process. It is the first in a new class of drugs known as entry inhibitors.
Fuzeon also registered two other not so encouraging firsts; it must be injected twice a day and it carries a $20,000 a year price tag, several times the cost of any other anti-HIV drugs. Its use is pretty much restricted to those who have run through all of their other options, and even then, fewer people are using it than the company had projected.
Progress in developing a vaccine to prevent HIV infection continues to be bogged down.

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