As the AIDS epidemic continues its devas tating march across the globe, the most effective strategies to slow its spread are unlikely to emerge from new discoveries in the laboratory.
Instead, political leaders must acknowledge and act swiftly on the crises in their own countries.
That was one of the key messages to emerge from the 14th International AIDS Conference July 7-12 in Barcelona, said Dr. Larry Corey, principal investigator of the HIV Vaccine Trials Network.
"The epidemic continues unabated and is alive and well almost everywhere we look," said Corey, who heads Infectious Diseases in the Clinical Research Division.
"While there are a handful of individual countries - Uganda, Thailand and Senegal, for example - that have managed to keep their epidemics at stable levels, there were five million new cases of HIV infection worldwide last year.
"We already have lots of tools that can be used to control the infection. The feeling now is that the impediment to significant progress isn't the science but the political process."
Corey was one of more than 17,000 scientists, government officials, activists and others involved in AIDS research and policy from more than 190 countries who attended the conference to hear the latest research on the disease and its impact.
Other network staff at Fred Hutchinson who attended the meeting included Dr. Judith Wasserheit, director, and Steven Wakefield, associate director for community relations and education.
Wasserheit said the need for stronger governmental leadership was expressed most emphatically by Dr. Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS, who intimated that political leaders who are unwilling to address the epidemic ought to be replaced.
"We're learning lessons about the importance of political leadership from countries like Uganda and Thailand, which have had some success at slowing the spread of the disease," she said.
"In those countries, the efforts are led by the most senior levels of the government. In Thailand, even the royal family has been involved."
Other developments from the meeting:
HIV/AIDS treatment issues
Obstacles to effective treatment differ signifi- cantly around the world. In the Southern Hemisphere, where few of those infected have access to effective anti-viral drugs, the challenge is to make therapies affordable and accessible.
In contrast, in the United States and Western Europe, where many with AIDS receive drug treatment, prolonging survival is a major issue. Only now, with a population of patients who have survived with the disease for 15 to 20 years, are the long-term health complications of prolonged therapy becoming apparent.
Vaccine development continues to be one of the best hopes for prevention, Wasserheit said, and much enthusiasm for the effort was expressed at the meeting.
"The general sense is, we need to push hard on this, because without a vaccine, the pandemic, which is the most devastating to ever hit the globe, is not going to be controllable.
Wasserheit said that rather than focusing solely on the development of new drugs to prevent HIV transmission, the emphasis now is to take existing therapies and find ways to deliver them in resource-limited settings.
For example, Dr. Glenda Gray of South Africa, one of the principal investigators with the network, discussed results of a randomized, controlled trial that showed that a single dose of nevirapine is equal to six weeks of zidovudine in reducing post-partum, mother-to-child transmission of HIV.
Infection in the United States
HIV infection continues to spread in the United States, particularly among disad vantaged African-Americans in the Southeast and along the Eastern seaboard.
"We are seeing exactly what has happened with other infectious diseases for which we have some interventions," Wasserheit said.
"The educated and affluent get access to the intervention first. This pushes the disease back into subpopulations that are harder to reach, the ones that have less access to services."
The same has been seen with tuberculosis and other sexually transmitted diseases, cases in which the spread of disease is related to social conditions.
"We need to make special efforts to provide care and services to those populations who are now most in need and hardest to reach," she said. "We have not conquered the disease in many communities in this country."
Solidarity between researchers and activists
Wakefield noted new collaboration be tween scientists and AIDS activists. "We're seeing much more of more a link between these two groups in an outcry toward wealthier nations to take on more responsibility for battling the epidemic," he said.