The Pandemic and the Blue Lady

With over two dozen heads of state, hundreds of health ministers and another 2,500 representatives from civil society, nongovernmental and grassroots organizations having descended on New York for the first ever United Nations Special Session on AIDS, two things have become horrifically clear.

One is that the AIDS crisis is a global crisis. Thirty-six million people are living with HIV or AIDS today. Twenty-one million have died. Of that number, 75 percent have perished in sub-Saharan Africa. And 95 percent of those currently infected have no access to treatment, largely because their governments are poor and rich governments are stingy.

Two is that the AIDS crisis requires swift and immediate action -- and that swift and immediate action rarely comes from the United Nations. Though UN Secretary General Kofi Annan announced in April the creation of a global fund to finance the fight against AIDS -- urging governments, foundations and corporations to come up with $7-10 billion annually -- so far, a measly $500 million plus has been raised. The U.S. has pledged $200 million from foreign aid previously earmarked by the Clinton administration. France has offered $127 million; Britain $100 million. The Bill and Melinda Gates Foundation handed over $100 million in mid June.

William Roedy, president of MTV Networks International and chair of the Global Business Council on HIV/AIDS, had the courage to point out on one UN panel that western governments and businesses spent $100 billion on Y2K, whereas no more than $1 billion was expected to be raised by the same group by the end of the year for AIDS. That did not really answer the question by a youth activist from Swaziland about the intertwined problem of poverty and AIDS (or how he and his friends might find decent employment), but it did put the state of the AIDS crisis in perspective.

AIDS on its 20-year anniversary is like a tightly wound ball of thread quickly gaining girth as it gains speed on a precipitous slope. There is still no cure, but since 1987 there has been a treatment -- AZT -- and since 1996, a means to prolong life: the AIDS cocktail, which, thanks to generic drug companies like Cipla in India and pressure from activists on Big Pharma, may soon cost as little as $1 a day for poor countries, compared to the $150 daily price tag of a year ago.

Yet an available treatment has raised almost as many problems as solutions. Now that the triple cocktail has proved effective, the dark question remains: Who will get it? And if the AIDS cocktail is widely distributed, the lateral question is: Will new strains of AIDS develop should inadequate funding and decrepid health care systems result in administering the drugs incorrectly?

For the moment, in the absence of billions in aid, only the first question is being answered: those with health insurance living in wealthy countries will get the drugs. Konstantin Lezheatsev, a Ukrainian physician from Doctors without Borders, told me that of the 300,000 people in his country infected with HIV, only 50 are receiving anti-retroviral treatment. One of the untreated was standing at his side: a hallowed-out 34-year-old named Volodya Zhovtyak, who showed me, with an appropriate Russian curse, the stamp he received on his passport at U.S. customs to indicate he is infected. He said he expects to die.

AIDS workers like Lezheatsev talk quickly because, for them and their patients, time is running out. They race on with gruesome statistics, tragic anecdotes and a sense of utter frustration. But, just as rapidly, they point out that drug treatment is not the only challenge.

Participants in the UN special session tended to agree that combatting AIDS requires a three-pronged approach: drug treatment, preventative education and economic development. Should the $9 billion global AIDS fund coffers be filled this year, the UN plans to allocate half for prevention with measures like distributing condoms, educating young people and reducing mother-to-child transmission. The other $4-5 billion will go toward AIDS drug treatment and fighting opportunistic diseases like tuberculosis and malaria that occur among AIDs patients.