1. Kennedy, Maureen Shawn MA, RN

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At the 15th International AIDS Conference, held in July, a logo depicting three elephants symbolized not only the location of the conference-Thailand-but its theme as well: "Access for All," to education, information, and medication.


According to the 2004 Report on the Global AIDS Epidemic, published by the Joint United Nations Programme on HIV/AIDS (UNAIDS), almost 5 million people worldwide became infected with HIV in 2003, the greatest number since the beginning of the epidemic in 1981. About 3 million of the newly infected live in sub-Saharan Africa, where AIDS has already caused about 20 million deaths, and an estimated 38 million people live with HIV.

FIGURE. Thai childre... - Click to enlarge in new windowFIGURE. Thai children infected with HIV attended a special function in Bangkok, Thailand, prior to the 15

Perhaps the most sobering information brought to light at the conference was that the populations most vulnerable to the disease are women and youths. Nearly half of the people living with HIV are women; in sub-Saharan Africa, women account for almost 60% of HIV cases. Youths and young adults (15 to 24 years of age) represent 28% of all cases and account for half of all new infections. The likelihood of infection is even higher among young women and girls: about 62% of young people with HIV are female; in sub-Saharan Africa, about 75% are.


The sex trade spurs the spread.

The conference put into question the long-held belief in the effectiveness of the "ABC strategy"-abstinence, being faithful, and condom use. While all three measures are recommended, the fact remains that for women who lack social and economic power, negotiating the frequency of sex and the use of condoms often isn't possible. And while many choose to be faithful to their partners, there is no guarantee that their partners are equally diligent. The trafficking of women and girls for the sex trade is another risk factor: according to the UNAIDS report, some 28,000 to 30,000 children-half of whom are 10 to 14 years old-are prostitutes in South Africa. Vietnam and Mexico have widespread trafficking of girls from rural areas into large cities and tourist resorts, and thousands of girls are trafficked for sex throughout Italy, France, the Netherlands, Switzerland, and the United Kingdom.


Other groups remaining at high risk are men who have sex with men (in countries where the practice is stigmatized, as well as in developed nations where risky behaviors are increasing), intravenous drug users, sex workers, and prisoners.


Prevention must be comprehensive, the conference concluded, necessitating an array of measures. Examples include informing people about AIDS (in India, for instance, 30% of women have never heard of AIDS or HIV); discouraging risky behaviors (particularly among youths); promoting condom use along with abstinence and fidelity to one's partner; establishing voluntary testing and counseling centers; preventing transmission of the virus from pregnant mothers to their infants; ensuring the safety of blood supplies; stepping up anti-retroviral treatment (only 7% of those who need such medications in developing countries receive them); caring for orphans; countering the stigma associated with AIDS; and improving the social, legal, and economic situation of women and girls.


Only 50 delegates from the United States were present, down from 236 at the 2002 International AIDS Conference in Barcelona, Spain. Government spokespeople have stated that cost considerations drove the decision to limit the number of American delegates attending the conference, but some delegates disagreed. Catherine DeAngelis, editor-in-chief at the Journal of the American Medical Association (JAMA), offered the example of a scientist who coauthored a paper in JAMA but was not allowed by the U.S. government to attend, even though the journal was willing to pay for his trip. "It's an incredible example of political pettiness," she told the BBC. "It is antiintellectual."


At the 2002 AIDS Conference, protesters booed the U.S. secretary of health and human services, Tommy Thompson, as he tried to deliver a speech; it has been suggested that barring U.S. scientists from this year's conference is retaliation for that reception. Another reason may be the contentiousness of the President's Emergency Plan for AIDS Relief (PEPFAR), the Bush administration's plan that pledges $15 billion to 14 countries to fight AIDS over five years. The pledge comes with strings attached: the only medications to be purchased with PEPFAR funds are those approved by the Food and Drug Administration (and thus under patent), even though cheaper, foreign-made generic drugs have been approved by the World Health Organization, and one-third of the money relegated for prevention efforts has to be spent on sexual abstinence programs. -Dalia Sofer