The high-profile International AIDS Conference, held for the first time at ground zero of the epidemic, ended Friday as it began, dominated as much by questions of money and political will as of medicine.
More than 12,000 people from around the world came together for a week to look for solutions to an epidemic that now infects 34 million people on the planet, 95 percent of them in the poorest regions, especially sub-Saharan Africa.
"The challenge is to move from rhetoric to action, and action at an unprecedented intensity and scale," said Nelson Mandela, South Africa's former president, referring to his country's often criticized response to the epidemic.
While some of those at the conference spoke of cutting-edge research into new drugs, like ones that have changed AIDS into a manageable disease in wealthy countries, most of the attention was on the much more basic need to prevent the explosive spread of the virus in countries with the fewest resources.
Dr. Peter Piot, head of UNAIDS, said Africa alone needs $3 billion a year -- 10 times what is being spent now -- to offer the most basic AIDS prevention and care.
In general, experts know how to stop AIDS: Educate people about how the disease spreads. Promote condom use. Discourage promiscuity. Control other sexually transmitted diseases. Treat pregnant women.
Many at the meeting spoke of the need of wealthy governments and pharmaceutical companies to understand the complexity and urgency of the epidemic -- to comprehend that AIDS is the worst infectious disease threat in recorded history, as Dr. Roy M. Anderson of Oxford University described it.
"This meeting has really underscored the need fr global solidarity on HIV/AIDS," said Dr. Ronald Valdiserri, deputy AIDS chief at the U.S. Centers for Disease Control and Prevention. "It is the first conference in which I have perceived such a compelling sense of urgency. The heat is on. There is no way to ignore the catastrophe that is taking place around the world."
However, another theme of the week was the need for those at greatest risk to help themselves, for governments in the poorest countries to acknowledge AIDS' threat to their people and to do something about it.
"What came out of the conference is a need for African governments to commit more of the little resources we have to this fight," said Kojo Lokko of the Ghana Social Marketing Foundation. "We keep talking about how poor African countries are, but we can do better than we have. It's not enough to say that somebody from far away should come save us."
Many believe the ultimate solution to the epidemic is development of a vaccine. However, no significant breakthroughs in this area were reported at the meeting, and experts believe an even modestly effective AIDS vaccine is several years away.
Behind this shift is a belief that widespread availability of AIDS drugs could substantially slow the epidemic as well as help those already infected. AIDS drugs lower the amount of virus in semen and other fluids, and this makes virus carriers much less likely to infect others.
One area where drugs could make a difference is stopping the spread of HIV from infected mothers to their baies. Research this week confirmed that just one dose of the drug nevirapine during labor can substantially lower transmission, although the virus that spreads after birth through breast-feeding wipes out much of the benefit. In one notable announcement of the conference, nevirapine's maker, Boehringer Ingelheim, said it will offer the drug free to infected pregnant women in developing countries.
The international AIDS meeting will be held next in 2002 in Barcelona, Spain, and in 2004 in Toronto.
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