HIV drugs are too expensive and too complex for people with HIV in poor countries in sub Saharan Africa and HIV prevention is a more priority than treatment, according to Dr Joep Lange, of the Netherlands.

Speaking at the EACS conference in Madrid, Dr Lange said that with nearly 40 million now living with HIV and over 4 million new infections each year, we are in danger of losing the prevention battle.
For every six new infections only one is being treated, he said.

In the rich western world the demand for more simplified treatments and prevention of disease complications and side effects is the most important challenge but in poor countries of Africa two thirds of people who need treatments are not getting them.

Over 800,000 people with HIV are now on treatments in sub Saharan Africa and the ‘3 by 5’ target to get 3 million on treatments by 2005 has, “had a very important influence on reaching targets, but universal access is another pipe dream,” Dr Lange said.

In Africa there is reliance on first line and toxic drug therapies and there are constant problems of interrupted supply, limited second line treatment options and very limited monitoring capacity. There is a lack of effective prevention, information and even condoms.“Only three condoms per man per year are available in sub Saharan Africa.”
Searches for an HIV vaccine have so far failed, and prevention alternatives like microbicides, diaphragms and circumcision have so far had limited success because of cost or cultural problems. And there is an urgent need for new prevention methods.“We are now reaching the point where an emergency response will not do,” Dr Lange said.“Even though there are good international funding mechanisms for HIV now these won’t last, he predicted. “We have no problems getting mobile phones and Coca Cola to Africa, so why can’t we get urgently needed antiretrovirals to everyone?”

Investment in healthcare in Africa is very low, and health insurance is almost non existent. Dr Lange called for better financial and health sustainability for Africa, rather than charity, and said the countries profiting from Africa’s plight were the rich countries of the west.

Professor Jurgen Rockstroh, from Germany, said that in some countries, like his own, HIV prevention was working well but there was an urgent need to target high risk groups.“People are coming into the clinics for sexually transmitted infections and finding out they have HIV.” He added: “We have to think how we can engage people in a different way”.

Professor Anton Pozniak, from London’s Chelsea and Westminster hospital, admitted that prevention was failing but said there is not one answer. “Youth of today have to be addressed on sex, STIs and HIV.” New prevention techniques like circumcision can cut infections rates by more than a half but they are not for all and may not be the best methods.

EACS conference chair Professor Santiago Moreno, of Spain, said that for HIV prevention to work implies changing life habits and behaviour.“People know how to prevent HIV but they don’t like to change their lifestyles.” Professor Moreno said the burden of the disease is rising exponentially and predicted that in a few years time the cost of the epidemic will not even be affordable in the rich developed world.