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.