Science Magazine Publishes Special Feature on AIDS in Asia, Section on Challenges in Fighting Epidemic

In advance of the XV International AIDS Conference, which will be held July 11-16 in Bangkok, Thailand, the June 25 issue of Science magazine features a special section on AIDS in Asia, as well as two "Policy Forum" articles, a "Perspective" article and an opinion piece examining the challenges in the global fight against HIV/AIDS. Summaries of the articles appear below:

• "A Global Response to AIDS: Lessons Learned, Next Steps": Although the world sees Thailand and Cambodia as "models" for fighting HIV/AIDS in Asian countries and "striking leadership" has emerged from China, the "window of opportunity" for successfully battling the disease "is closing," Peter Piot, executive director of UNAIDS; Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Jong-Wook Lee, director general of the World Health Organization, write. There is an "explosive" HIV/AIDS epidemic in Asia that is advanced by inequality, poverty, the unequal status of women, stigma and cultural myths, the authors say. Despite having the "science, the technical capacity and the know-how" to fight HIV/AIDS, investments have not yet yielded a "lasting impact" on the epidemic in Asia, according to the authors. However, there is "room for optimism," as financial assistance for HIV/AIDS programs has increased and several countries have expanded access to antiretroviral drugs, the authors say. The three "key" challenges for fighting HIV/AIDS are increasing human capacity and global funding; ensuring prevention and treatment; and providing strong national leadership and commitment, the authors conclude (Piot et al., Science, 6/25).
  
  
• "Developing an AIDS Vaccine: Need, Uncertainty, Hope": The "journey of understanding" HIV and developing an effective vaccine for the virus is "far from complete," Emilio Emini and Wayne Koff, both of the International AIDS Vaccine Initiative, write. HIV has developed mechanisms to escape elimination by its host and poses "particularly difficult obstacles" for creating an effective vaccine, the authors say. Developing an HIV vaccine will be a "daunting" task; however, there is "universal agreement" that efforts must be "redoubled" to address the scientific challenges, the authors say. Efforts to address these scientific challenges and improve vaccine vectors and other vaccine strategies will require greater "collaborative scientific activity," Emini and Koff conclude (Emini/Koff, Science, 6/25).
  
  
• "Regulatory Challenges in Microbicide Development": As the "scientific prospects" for developing a microbicide to prevent HIV infection are improving, regulatory "obstacles" to testing and licensing such a product are expanding, Paul Coplan, Mark Mitchnick and Zeda Rosenberg of the International Partnership for Microbicides write. The "lack of well-defined criteria and pathways" for licensing microbicides in developing countries is a "significant hurdle" to delivering them to women in those countries, the authors say. Most microbicides currently undergoing clinical trials are new drugs, which require review by countries' national regulatory authorities, according to the authors. Although many developing countries rely on U.S. or European regulatory reviews for new drugs, FDA has raised concerns that the approval of microbicides could lead to a decrease in condom use, potentially leading to an increase in the net number of HIV cases, the authors say. However, FDA's concerns will have "little relevance" in countries where "only 1% of sexually active women report condom use in the past 12 months," the authors say (Coplan et al., Science, 6/25).

Opinion Piece
It is "not too late" to avoid the potential "disaster" of HIV/AIDS spreading rapidly in China, India, Indonesia and other Asian countries, Joep Lange, president of the International AIDS Society, and Vallop Thaineua, permanent secretary of Thailand's Ministry of Public Health, write in an opinion piece. However, prevention of such a disaster will require the "mobilization of the necessary forces," including a "global network of relevant institutions and organizations," Lange and Vallop, who serve as co-chairs of the XV International AIDS Conference, say. Although there have been "positive developments" such as the World Health Organization's goal of treating three million HIV-positive people with antiretroviral drugs by 2005, WHO is "still very far from" meeting its target, according to the authors. To successfully fight HIV/AIDS in Asia, skilled personnel need to be motivated and trained to distribute drugs and medical supplies, Lange and Vallop say, adding that "[w]e need to move beyond the rhetoric" and provide "comprehensive solutions" that go beyond just providing drugs (Lange/Vallop, Science, 6/25).

AIDS in Asia
Science this week also features a series of articles on AIDS in Asia, the fourth part of an occasional series. The first part of the series on HIV/AIDS in Southeast Asia was published in the Sept. 19, 2003, issue; the second part on HIV/AIDS in China was published in the April 23 issue; and the third part on HIV/AIDS in India was published in the June 4 issue. Reporting for the series was supported in part by a fellowship to Science correspondent Jon Cohen from the Kaiser Family Foundation. Brief summaries of the articles appear below:

• "Asia and Africa: On Different Trajectories?": Although some AIDS experts predict that Asia will have more HIV-positive people by 2010 than the 30 million HIV-positive people who currently live in Africa, the epidemics on each continent are "surprisingly different," Science reports. Unlike in Africa, HIV in Asia has not spread "rapidly" by heterosexual sex, and many experts do not believe it is likely to do so in many parts of the continent, according to Science (Cohen, Science, 6/25).
  
  
• "The Asian Epidemic Model's Provocative Curves": Tim Brown and Wiwat Peerapatanapokin of the East West Center in Bangkok have created the Asian Epidemic Curve to understand the forces that drive HIV transmission trends through countries that "typically" have many injection drug users, large numbers of commercial sex workers and clients, men who have sex with men and few women with multiple sex partners, Science reports. The model shows that doubling the number of female sex workers and clients propels Asian epidemics "more powerfully" than any other force, according to Science (Cohen, Science, 6/25).
  
  
• "Monitoring Treatment: At What Cost?": The "hard part" of providing wide access to antiretroviral treatment in developing countries in Asia is determining "how best to use the drugs," Science reports. An "additional hurdle" to providing treatment is covering the costs of some "prohibitively expensive" tests that are "essential" to effective antiretroviral treatment, according to Science (Cohen, Science, 6/25).
  
  
• "TREAT Asia Spans the Continental Divide": The Therapeutics Research, Education and AIDS Training program, launched by the American Foundation for AIDS Research, has a database of 1,200 HIV-positive people who are receiving antiretroviral treatment in China, India, Indonesia, Thailand, Malaysia, Taiwan, Hong Kong, the Philippines and Singapore that allows clinicians to compare outcomes of various treatment regimens, Science reports (Cohen, Science, 6/25).