As AIDS conference opens, access to drugs still lacking

BANGKOK -- The 15th International AIDS Conference opens here today promoting a wish for everyone with AIDS to have access to life-extending antiretroviral drugs. But a study released yesterday by the World Health Organization showed progress remains painstakingly slow.

Test offers hope on HIV infection in newborns. A14.

The report said 440,000 people in developing countries have access to the drugs -- an increase of 40,000 in the first six months of this year. WHO, which has a goal of treating 3 million people by the end of 2005, had hoped to have reached 500,000 by now.

''It's depressing -- it's worse than we would like," Jim Yong Kim, the head of the agency's AIDS division, said last night. ''But do we back off the target? No. We try to learn from what has happened, and we work like crazy."

The conference is expected to attract 20,000 people from all the world, making it the largest-ever AIDS gathering, now held every two years. UN Secretary General Kofi Annan is set to be one of the opening speakers at today's plenary, while Nelson Mandela, South Africa's former leader, will address delegates at the end of the five-day meeting.

Celebrities such as Richard Gere, Oprah Winfrey, and Ashley Judd will also speak to the gathering of AIDS specialists, people living with HIV, and government officials.

The conference will feature hundreds of presentations on issues including finding ways to get more people tested for HIV; a sharp rise in the number of young women getting infected in sub-Saharan Africa; the need for Asian countries to stress prevention; and updates on vaccine trials and other prevention methods.

For the past several years, the focus among grassroots activists has been to extend treatment to as many people as possible in poor countries. An estimated 5 million to 6 million people in the developing world -- the vast majority in sub-Saharan Africa -- need antiretroviral treatment, according to WHO and other AIDS specialists.

In the developed world, nearly everyone who needs the drugs can get them. One roadblock in developing countries had been price, but since the cost of the drug cocktail dropped to as low as $300 a year recently, other problems have come more sharply into focus.

Among them: getting the drugs into countries; distributing the drugs to clinics; training enough health workers to monitor treatment; and persuading more people to take HIV tests.

UNAIDS estimated last week that 38 million people around the world are infected with HIV, 70 percent of them are in sub-Saharan Africa. While the UN agency warned of an expanding epidemic in Asia and Central Europe, some 15 African countries saw a decline in the number of people with HIV in 2003 from two years earlier.

Kim said at a news conference yesterday that 56 countries have asked the WHO for assistance in expanding treatment, following the organization's announcement of its goal to treat 3 million people. He also said that countries and nongovernmental organizations have trained 3,000 people in poor nations to administer the drug regimens, bringing the number of trained health workers to 15,000 in poor countries. The WHO has set a goal of 100,000 by the end of the next year.

Several AIDS specialists have criticized the WHO for setting such an ambitious goal, saying it could backfire if relatively few people are reached.

But AIDS activists have used the goal to treat 3 million people as part of their campaigns to pressure governments and agencies to rapidly accelerate their work. A group of activists is planning a protest today at the conference to push for more treatment.

Stephen Lewis, Annan's special representative on AIDS in Africa, said in an interview there is great anticipation in Africa for treatment to expand soon.

''Everyone seems to be training to handle the drugs. Everyone wants to agree to guidelines. Every country has enough in place to get things going," he said. ''If we can only break through the impasse of getting drugs into countries and getting work started, then I think we can reach this goal" of 3 million treated.

Kim said he runs into many naysayers about rapidly scaling up treatment. But he said there was a moral obligation to push as hard as possible now.

''I see dead people," he said. ''We are living with this terror. We are all going to have to account for all these people we aren't reaching."

John Donnelly can be reached at donnelly@globe.com.