Pre Reading Questions

Read the following poem:

Virus
It's there when you are,
you can't see it, but it can
see you, you can't touch it
but it can touch you, you
can't stop it but it can stop
you, you can't hear it, but it can
hear you, you can't smell it
but it can smell you, you can't
kill it but it can kill you. AIDS.

Dedicated to those who have died and those who will.

Alex Michaels

1. Interpret and respond to the poem's line 'you can't stop it but it can stop you'.
2. Do you agree that AIDS "can't be stopped"?
3. If the virus cannot be eradicated, can its progressed be slowed?
4. If so, how?

Post Reading Questions

a. According to the article, why are f. What startling admission did
most people living with H.I.V. President Clinton make in regard to
"doomed to die"? controlling AIDS?

b. To what failure did the speakers at
the International AIDS conference
attribute the current magnitude of
the AIDS epidemic?
c. According to the article, what
specific H.I.V. preventions and
treatments should be more
accessible to the world population?
g. How is H.I.V. usually spread in the
former Soviet Union?
h. How has the American population
affected by H.I.V. changed since the
mid-1980s?
i. According to the article, what would
be the "ideal prevention" for H.I.V.?

d. What was the consensus at the
International AIDS conference
regarding allocating resources
toward preventions or treatments?
e. According to the article, why did the
world "lose valuable time in
controlling AIDS"?
j. How does lowering the amount of
H.I.V. in the blood affect the risk of
transmitting the disease to others?
k. According to Ali Hassan Mwinyi-the
former president of Tanzania, how
can political leaders address the
H.I.V. epidemic?

Activities:
Get into your groups:
• disease education
 • sex education (including safe sex education and condom education)

• needle exchange programs

• blood tests to determine H.I.V. status

--Describe how this H.I.V. prevention strategy works
--Explain the most current research regarding this prevention strategy
--Identify a program, government, or other resource that employs this prevention strategy
successfully
--Explain how you measured "success" in regard to the prevention program you chose

Further Questions for Discussion:

--How are vaccines developed and tested? Why do researchers say that we are years away
from an AIDS vaccine?
--How have drug therapies for AIDS changed throughout the last twenty years?
--How do certain laws protect H.I.V.-positive people from discrimination?
--How does the H.I.V. virus become resistant to certain drugs?
--How do third-world countries seek financial aid to combat the spread of H.I.V.?

The Urgent Search for an AIDS Plan

By LAWRENCE K. ALTMAN, M.D.

BARCELONA, Spain, July 14 — In theory, AIDS is "That is why treatment is so important in developing
preventable and treatable. But in reality, AIDS has countries," said Dr. Peter Piot, the under secretary
spread so rapidly it rivals the worst epidemics in general of the United Nations in charge of its AIDS
history. program.

AIDS has killed more than 20 million people since
1981, when the first cases were discovered in the
United States. Today, 40 million people live with
H.I.V., the AIDS virus, and most are doomed to die
for lack of the powerful combinations of drugs that
can control the infection. And because these people
lack access to the blood test that can tell if they are
H.I.V. infected, they may unwittingly transmit the
virus to another 45 million people by 2010.
The magnitude of the epidemic is a tragedy that
speakers at the 14th International AIDS Conference
held here last week attributed directly to the failure to
make effective preventions and treatments available to
vast populations in Africa and elsewhere.
The preventions include relatively inexpensive and
simple measures: disease information, sex education,
safe sex, condoms, needle exchange programs and
blood tests.
Treatments include drugs to counter H.I.V. and the
unusual infections that accompany AIDS. Lack of
anti-H.I.V. therapy has orphaned at least 11 million
children.
A solution to better control the epidemic, AIDS
experts and economists said, is to spend $10 billion a
year, largely from donations from rich countries.
But what is the most effective way to spend it?
Preventing more people from becoming infected? Or
treating those who are infected?
Some AIDS experts had expected vested interest
groups at the conference to bitterly debate the
priorities. But if the rhetoric from the 17,000
participants from 124 countries at the largest AIDS
conference ever held is a valid indicator, there was an
overwhelming consensus for supporting prevention
and treatment because one cannot work without the
other.
"The issue has been widely discussed, and common
sense and basic health principles say both need to go
together," said Dr. Jordi Casabona, an infectious-
disease expert in Barcelona and a co-president of the
conference.
Without a vaccine, few epidemics can be controlled
by treatment or prevention alone, Dr. Casabona said at
the closing news conference.
"The conflict between prevention and treatment has
been blown out of proportion," said Dr. Merle A.
Sande, an AIDS expert at the University of Utah.
"Most everyone involved in treating AIDS believes
that prevention is more important yet feels that the
millions of infected people deserve therapy," said Dr.
Sande, who resigned as chairman of medicine at the
University of Utah to commute to Uganda from Salt
Lake City to direct the Academic Alliance for AIDS
Care and Prevention in Africa. Pfizer has given a large
grant to the alliance, which teaches African doctors
how to use the powerful combinations of anti-H.I.V.
drugs.
However, Dr. Julio Frenk, the Mexican health
minister, introduced a cautionary note by urging
participants to do further research to determine what
programs work or fail.
"Just as we don't have enough evidence to
demonstrate the effectiveness of prevention programs,
we don't fully know how to allocate resources among
interventions in the most efficient manner," Dr. Frenk
said.
With action needed before definitive answers are in,
the United Nations is set to issue a plan of attack for
the October meeting of the Global Fund for AIDS,
Tuberculosis and Malaria. With about $3 billion of its
$10 billion goal in hand, it is unclear whether this will
be sufficient to support a comprehensive prevention
and treatment strategy. So supporters of each are
likely to lobby and compete for the available money,
just as scientists have long done in seeking grants
from the government and private foundations.
The world lost valuable time in controlling AIDS
when the epidemic was much smaller. It was a time
when experts pinned their hopes on quick
development of a vaccine instead of aggressive, large
campaigns to stress other prevention measures like
H.I.V. testing, safe sex and condom use.
Political leaders contributed to the delay. Bill Clinton
said in an interview here that he regretted not having
done more to control AIDS while he was president
and that he was wrong not to push harder for needle-
exchange programs to prevent transmission among
injecting drug users and then to their sexual partners.
Former presidents rarely make such admissions,
particularly so soon after leaving office.
Drug users are fueling the initial stages of epidemics
in many countries, including those of the former
Soviet Union.
The delay in not responding more effectively and
earlier to the AIDS epidemic now makes prevention
and treatment even more challenging because of the
magnitude of the epidemic.
"We have known what works" in preventing AIDS for
several years but it did not get translated into enough
action, said Dr. Helene Gayle, who headed the AIDS
program at the Centers for Disease Control and
Prevention and now is on loan to the Bill and Melinda
Gates Foundation.
In a report sponsored by her foundation and the Henry
J. Kaiser Family Foundation, Dr. Gayle and more than
30 other experts wrote:
"Effective H.I.V. prevention is more than education,
and more than a condom, a clean needle or any other
single commodity. Effective H.I.V. prevention
involves a thoughtful, planned combination of
interventions and policies that work synergistically to
reduce overall rates of transmission."
People at high risk for AIDS need to know what
causes it and how to avoid it. But "it is staggering
how much people still don't know" about AIDS in
China, India and the former Soviet Union, where
H.I.V. is being transmitted at alarming rates, Mr.
Clinton said.
"One of the things that I have been a little concerned
about is that they have put too much emphasis on
getting the public health network pieces up, which is
good, but relatively too little on just putting the stuff
out there through the airways and watching the grass-
roots people change their behavior," Mr. Clinton said.
In the former Soviet Union, where H.I.V. is being
spread through heterosexual sex, Mr. Clinton said,
"the extent to which young girls are still engaging in
dangerous behavior either because they are
constrained to it or think it is their only way out of
abject poverty in that part of the world is chilling."
Still, experts say they have much to learn about what
messages to send to those at the highest risk of
infection.
In the epidemic's infancy, when 150,000 Americans
were acquiring H.I.V. each year, most infected people
were gay white men. The new face of AIDS in the
United States now is largely female and black, as it is
elsewhere.
The 40,000 Americans who have become infected in
each of recent years is fewer than the 150,000
infected annually in the mid-1980's, but remains far
too high and requires delivering new prevention
messages in new ways, health officials said.
To make therapy more effective in the third world,
C.D.C. researchers have developed less costly
versions of two tests commonly used to determine
when to start anti-H.I.V. drugs and to monitor their
effectiveness. One is a new method to monitor, at one-
fourth the cost of the standard tests, the number of the
CD-4 immune cells in the blood that the AIDS virus
destroys. The second is a new way to monitor the
amount of H.I.V. in the blood at one-fifth the cost of
standard tests.
The ideal prevention would be a vaccine that prevents
nearly all recipients from becoming infected and
unable to transmit the infectious agent to other people.
But no such vaccine exists for AIDS and none is
likely to be available for several years, if one is ever
developed, experts said.
Dr. Lawrence Corey, a vaccine researcher at the
University of Washington, said at the conference that
there were hints from early studies that the newest
experimental AIDS vaccines might lower the amount
of H.I.V. in the blood to slow the progression of
infection to illness and modify symptoms but not
prevent transmission.
It will take years to do the trials to learn whether the
experimental vaccines could prevent transmission of
H.I.V. and how long they would work. "This is the
deck we may be dealt," Dr. Corey said in urging
policy makers to start thinking about how to put them
in place in the event they are licensed.
Another reason for linking prevention and drug
therapy is that studies have shown that lowering the
amount of H.I.V. in the blood reduces the risk of its
transmission to other people.
But the risk is not zero, a finding that tells health
officials they need to bolster anti-H.I.V. treatment
efforts with messages to prevent a mistaken belief
among patients that they can abandon safe sex
practices.
Studies have shown that anti-H.I.V. therapy needs to
be taken for a lifetime because the drugs cannot rid
the body of the virus. And because H.I.V. has
increasingly developed resistance to the drugs, the
International AIDS Society, a conference sponsor, and
the World Health Organization announced that they
were developing a program to monitor H.I.V. drug
resistance throughout the world.
Experts say they are uncertain how often resistance
makes therapy ineffective. Whatever the frequency,
Dr. Stefano Vella, the outgoing president of the
International AIDS Society, Dr. Scott M. Hammer, an
AIDS expert at Columbia's College of Physicians and
Surgeons in New York City, and other leaders
cautioned against using resistance as an excuse for not
offering treatment in the third world.
At a panel sponsored by the International AIDS Trust,
a number of current and former heads of state pledged
to encourage more political leaders to speak out on
AIDS by fighting denial, discrimination and stigmas
and to replace rhetoric with action.
Ali Hassan Mwinyi, a former president of Tanzania,
recalled that when AIDS first appeared in his country
"it caused panic, confusion and denial among all of us
because we all were sexually active."
Leaders are now duty-bound to fight the confusion
and educate their people, Mr. Mwinyi said, and "a
leader who speaks about condoms will influence
people to use condoms."
In underscoring the importance of accountability, Dr.
Piot, the United Nations official, said voters should
replace the world's political leaders who do not
provide what is needed to combat AIDS.