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    Whatever Happened to AIDS?

    Complacency Replaces Crisis As Epidemic Rages On


    Treatment for HIV infection causes serious side effects and eventually fails many patients. Yet Western nations seem to have so much faith in HIV treatment they forget that prevention is the key to stopping AIDS, says Bernhard Schwartlander, MD, PhD, director of HIV/AIDS for the World Health Organization.

    "Back in history, developed nations such as the U.S. had very successful programs among gay men and injection-drug users," Schwartlander tells WebMD. "But with the introduction of very effective treatment, there has been a complete shift toward treatment and giving pills. The prevention elements of the response have been almost forgotten. So what we see in all developed societies is an increase in risk behavior and sexually transmitted diseases and even in HIV. There is no room for complacency. Every infection that happens in places where we have all the resources is one infection too many."

    International Threat

    A quick look beyond U.S. borders offers a totally different picture. Every hour, 350 people die of AIDS. Another 42 million people have HIV infection; nearly all will die. Fee, just back from a visit to Tanzania in the shadow of Mount Kilimanjaro, calls it "a dreadful situation." Markel says the same thing.

    "If you travel to Africa, it is remarkable how many people are HIV-positive and not being treated. They are not nearly as blasé," Markel says. "Just a few weeks ago the CIA came out with a report that HIV is the greatest international security threat. By 2020, 65 million more people will die. So it is something we should be alarmed about. We need to be inspired to do something about this worldwide epidemic."

    A start has been made. The United Nations has organized a global fund to fight malaria, tuberculosis, and AIDS. Early funds will be spent to treat people in nations where there is an existing health infrastructure, and to create such infrastructure in nations where it does not exist. The U.S. is the largest funder of AIDS programs in the world, Schwartlander says. To a large extent, future efforts will depend on ever greater funding from the U.S. and other wealthy nations.

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