Pubdate: Wed, 23 Aug 2006
Source: New Straits Times (Malaysia)
Copyright: 2006 NST Online
Contact:  http://www.nst.com.my/
Details: http://www.mapinc.org/media/3734
Author:  Adeeba Kamarulzaman
Note:  The writer is president of the Malaysian AIDS Council and head 
of infectious diseases, University Malaya Medical Centre
Bookmark: http://www.mapinc.org/women.htm (Women)
Bookmark: http://www.mapinc.org/find?137 (Needle Exchange)
Bookmark: http://www.mapinc.org/rehab.htm (Treatment)

IT TAKES COURAGE TO TURN THE TIDE OF HIV/AIDS

The 16th World AIDS Conference focused on prevention. ADEEBA 
KAMARULZAMAN calls for Malaysians to pay attention to sex education 
in fighting the disease.

THE just concluded 16th World AIDS Conference in Toronto, Canada, is 
a biennial gathering of scientists, activists, community leaders, 
politicians and people living with HIV/AIDS.

This year's theme -- "Time to Deliver" -- was meant to underscore the 
urgency with which prevention and treatment programmes need to be put 
into place, 25 years after the epidemic began.

In Malaysia, this becomes even more relevant given the findings from 
a local study reported in the NST on Aug 18 of the high degree of 
sexual promiscuity, coupled with low levels of knowledge surrounding 
HIV/AIDS, among local tertiary students.

These findings, while shocking, are hardly surprising. It tells us 
that we can no longer afford to be squeamish discussing sexuality and 
reproductive health with the young and that comprehensive sex 
education in schools, particularly in institutions of higher 
learning, must be urgently implemented.

Research shows that comprehensive sex education programmes do delay 
the onset of intercourse, reduce risk-taking behaviour, and lead to 
reductions in pregnancy and HIV, or the acquisition of a 
sexually-transmitted infection.

In the absence of a new wonder drug or vaccine, prevention has to be 
the mainstay of the fight against the epidemic.

This was the focus of this year's conference. A call to make proven 
effective measures such as education, voluntary counselling and 
testing, condoms and provision of drug-substitution therapy and 
needle exchange for drug users more widely available was echoed by 
many speakers, who urged putting aside ideology and cultural and 
religious barriers in order to save lives. The effectiveness of male 
circumcision in preventing HIV transmission, as demonstrated in 
several large studies, also received a lot of attention.

But perhaps one of the most promising and exciting developments in 
preventive research is the development of microbicides, vaginal gels 
and creams that can potentially block HIV transmission to women. 
Globally, women have now become the face of HIV/AIDS making up almost 
half of reported HIV cases. In parts of sub-Saharan Africa, one in 
every two women is infected with HIV. In Malaysia, one in every eight 
new reported cases is a woman.

Given that in many parts of the world, women are unable to negotiate 
for their rights, including that of insisting that their male 
partners wear condoms, in the face of HIV, research into these 
potentially life-saving measures is all the more urgent. There are 
currently five microbicides in late-stage development with results of 
clinical studies expected to be out late next year.

Many at the conference were asking, "Time to deliver what?", given 
that the search for a cure or vaccine remains elusive. Although 
complete eradication of the virus with a magic bullet remains many 
years away, advances in treatment mean that what was once a disease 
where death was a certainty can now be successfully managed with a 
combination of drugs.

Despite lower costs of treatment through importation of generic 
medications and direct price negotiations with pharmaceutical 
companies, only a fraction of the 25 million people infected with HIV 
are receiving treatment. Ensuring that more people receive these 
live-saving medications should be a priority for most affected nations.

Each World AIDS Conference in recent years has been linked and 
remembered for achieving a certain milestone. The Vancouver 
conference in 1996 marked the introduction of treatment that has 
dramatically saved the lives of millions worldwide. The Durban 2000 
conference was the catalyst for better access to treatment, which 
should no longer be the privilege of patients living in the wealthy 
West alone. Perhaps this year's conference will be remembered by the 
leadership, passion and commitment shown by the two Bills, as they 
came to be known.

Bill and Melinda Gates and former United States president Bill 
Clinton have decided to devote their lives to the fight against 
HIV/AIDS, believing it to be the most catastrophic disease ever to hit mankind.

While the Gates and their foundation focus on preventive efforts, 
especially microbicides, Clinton has made getting treatment and the 
associated laboratory tests required to monitor treatment his 
priority through supporting development of laboratory capacities and 
negotiations for cheaper medications on behalf of countries.

Having had the opportunity to witness these leaders at the 
conference, what impressed me most was that they are not just lending 
their names to the cause nor just giving money away without personal 
involvement. The two Bills and Melinda's up-to-date knowledge, 
including research developments and insight into the personal, public 
health and economic implications of this disease, would put many of 
us scientists and others to shame.

Speaking at the opening ceremony, Melinda reminded us all that 
HIV/AIDS was frequently transmitted through activities that society 
found difficult to discuss, and that the stigma and discrimination 
made this disease difficult to fight despite a large amount of 
knowledge on what worked.

She recalled that in their visits to many countries, to which their 
foundation has links with, they are often eagerly greeted by the 
countries' leaders.

But they will often shy away when the couple asks to visit sex 
workers or other HIV programmes.

Both she and her husband made an impassioned plea at the opening 
ceremony for the empowerment of women and that prejudice, stigma and 
discrimination be put aside and for society to consider every life, 
be it that of a child, sex worker, nurse or drug user, as one worth saving.

Although Bill and Melinda and Clinton may not be able to solve all of 
the problems around HIV/AIDS, it is hoped that their drive and 
commitment will inspire others in similar positions of influence and 
power to act. None of us has anywhere near the bank balance nor the 
power of these three individuals, but each of us could contribute 
towards the fight against HIV/AIDS, which is destroying the lives of 
thousands of Malaysians and their families.

It could start as simply as trying to understand more about the 
disease, which will help to drive the fear, stigma and discrimination 
that continues to pervade society, and which in turn hinder effective 
prevention programmes and deter many HIV-infected persons from coming 
forward for life-saving treatment. It could start by going back to 
the true teachings of all our different religions on the dignity and 
worth of every human being that is to be cherished, nurtured and saved.

It is time that we combined this with scientific knowledge that could 
guide our policies surrounding sex education, HIV testing, condom 
promotion and clean needles, so that these measures are viewed as 
effective public health tools that can save lives. The sooner we as a 
society come to terms with that and act, the sooner we could turn the 
tide of the HIV/AIDS epidemic in this country.