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Discord lingers as AIDS gathering wraps up

With its theme of "Access for all," the focus of this year's International AIDS Conference was supposed to be on access to treatment for millions of people around the world.

But that agenda was derailed by friction between the major financiers of the fight against AIDS, discord that dominated many conference sessions. Still, the massive Bangkok gathering ended yesterday with a renewed recognition of the importance of targeting drug users, gay men and poor women to stop the spread of the disease.

And the long-running debate about the value of HIV prevention versus treatment seems finally to have been laid to rest, with even the United States endorsing condom use and "harm reduction" for injection drug users, such as clean-needle programs. The fight over the use of generic drugs was also a major theme, but definitive evidence was presented that the much cheaper generics are as safe and effective as their brand-name equivalents.

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Many hardcore AIDS-funding activists were encouraged by the results.

"I haven't felt this good for a long time," enthused Paul Davis, director of U.S. government relations for the lobby group Health Gap.

"All the debates that raged for years have been absolutely settled. There are the squeaking gasps of a dying opposition, but all the political debates about use of condoms and harm reduction and . . . are we going to use affordable generic drugs or expensive [brand-name]drugs . . . all this stuff is settled."

Yet there were no major announcements from the scientists and researchers at the six-day gathering that drew more than 19,000 people to the Thai capital.

"There was no breakthrough," said Winstone Zulu, Zambia's most prominent AIDS activist. "No vaccine, no new drugs, and everywhere people are clamouring for treatment. It's what I expected. But it's still a disappointment."

The initial focus of the gathering was to be the push to provide anti-retroviral drugs to people with AIDS in developing countries, particularly the World Health Organization's initiative to treat three million people by 2005.

But the discord between the three big players on the global scene, who cumulatively have billions to spend on the disease in coming months -- UNAIDS; the Global Fund to Fight AIDS, TB and Malaria; and the new United States initiative on AIDS -- took over many policy sessions.

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Canada's Stephen Lewis, who serves as UN special envoy for HIV-AIDS in Africa, said he was distressed by the feuding between the heads of the big agencies.

"There is such tension between the major players, and such evidence of an ill-concealed animosity, that one hopes that there will be, at some point when it's all over, a coming together of people to resolve the differences . . . because it cannot possibly do any good, it can only do damage," he said.

But Mr. Lewis was heartened by the excitement over research into microbicides, a gel or cream a woman could apply to her vagina to prevent HIV infection from semen without having to inform her partner. It bodes well for women in Africa, where 75 per cent of infected people between the ages of 15 and 24 are female, he said.

"The microbicide issue seems to have gripped the imagination of the conference, and if I was to point to one phenomenon that could lead to something terribly important, it would be microbicides," he said.

Sonia Gandhi of India, whose appearance signified the new awareness of the spread of the epidemic in her country (where an estimated five million people are infected), told delegates at the closing ceremony that she was deeply affected by her own exchanges with people living with AIDS.

"I have seen the terrible emotional toll HIV/AIDS extracts quite apart from its cruel physical ravages," she said. "I have seen people who have lost their jobs, who are ostracized by their communities, who can no longer hope to raise and bear healthy children."

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But the most compelling speaker was Graca Machel, wife of former South African president Nelson Mandela, and a former education minister in Mozambique.

"We have the scientific and technical capability to [defeat AIDS] the resources exist," she said. "There is no reason why we have to continue to lose lives because of our inaction and our incompetence. Bangkok has to be the end of promises made, promises broken."

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