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San Francisco Chronicle
Reaching poor nations vital in fighting AIDS, doctor says:
Sabin Russell at srussell@sfchronicle.com.
February 23, 2005
Boston - With his ambitious goal of treating 3 million patients in poor countries with AIDS drugs by year's end looking increasingly out of reach, Dr. Jim Yong Kim of the World Health Organization called for a renewed push by world leaders and top scientists to get the medicines to as many poor people as possible.

"Please stop speculating whether we will make it or not, and do all you can to make it happen,'' Kim said Tuesday in a keynote address to the 12th Annual Retrovirus Conference, the leading scientific meeting on progress in AIDS research.

Kim said that extraordinary progress toward the goal of the so-called 3- by-5 program had already been made: In the last six months of 2004, the number of people in poor countries receiving AIDS drugs rose to 700,000 from 440,000.

To reach 3 million, the number treated would have to double by July, then double again by January. That would take a new level of political will from the leaders of India, Nigeria and South Africa, where 41 percent of the 5.1 million thought to need AIDS drugs currently reside.

Kim said small African nations are starting to outperform the public health efforts of South Africa, where President Thabo Mbeki has yet to embrace with any enthusiasm his own government's plan to provide drugs. Kim noted that tiny Swaziland, Lesotho and impoverished Zambia have made great strides in meeting their targets.

"If those three countries meet their goals at the end of 2005, it might be quite embarrassing to South Africa to say they have reached only 10 percent, " Kim said.

In remarks to reporters earlier in the day, Kim called Mbeki "a very smart man who spent all his life fighting for social justice." But, he said, he believes the South African president does not understand the "social justice implications" of providing a rapid scale-up of an AIDS treatment program there, where more than 5 million people are living with HIV.

"The rich people in South Africa are getting access to treatment,'' said Kim, who was born in South Korea, raised by his immigrant parents in Iowa, and trained in medical anthropology at Harvard.

Kim doled out praise to the World Bank, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and to the Bush administration's emergency program for AIDS relief, for making the progress of the last six months possible.

For too long, he said, the world health community has been content to describe the scope of the AIDS problem -- and to urge that international attention be paid to it -- but has failed to put words into action. The 3-by- 5 program is an effort, he said, to get the "World Health Organization back in the AIDS business" by setting "a clear, measurable target.''

Speaking before an elite audience of 3,900 AIDS researchers from 72 countries, Kim called for a "public health approach" to the epidemic, shunning perfection in favor of practicality. He said that doctors who object to "second-class therapy" for the Third World are ignoring evidence that simplified treatment regimens, without extensive laboratory testing, produce good outcomes for the overwhelming majority of patients.

Waiting for sophisticated tests of viral load and white blood cell counts before providing antiviral drugs would mean "millions dead,'' Kim warned.

Much of the Boston meeting will be devoted, however, to the sophisticated analysis of the AIDS virus and to studying the nuances of treating the infection with various combinations of 20 approved AIDS drugs.

Much of the buzz at this year's session centers about the revelation a week and a half ago in New York that a single patient had come down with a possible new strain of HIV that was resistant to all but one antiviral drug and that apparently led to a rapid decline in the man's health. On average, it takes 10 years for HIV to wear down a patient's immune system to the point where he or she develops the opportunistic infections that are symptomatic of AIDS. This patient -- who was an abuser of methamphetamines -- may have reached that point in months.

The issue is hotly debated among AIDS experts in Boston, however, because no evidence has been presented that the virus is readily transmittable, or that it is in fact a unique and new strain of HIV.



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