International AIDS Conference features a twin Bill

On day two of the International AIDS Conference, both Bill Clinton and Bill Gates gave speeches on being more effective with available money to fight the disease. There are no planned budget increases from the major governments and donors of the world, so instead the AIDS fighters will need to be less wasteful.

From the Guardian, Sarah Boseley jotted down the following notes from the speeches.

"This is a tough economic environment. Right now there isn't enough money to simply treat our way out of this epidemic," he said.

"If we keep spending our resources in exactly the same way we do today, we will fall further behind in our ability to treat everyone."

Gates cited male circumcision, which a major trial four years ago showed could reduce the chances of a man contracting HIV by 60% – although it is as yet not proven to protect women.
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Clinton, a former two-term US president, called for better use of the limited funds available in a separate speech warning that excessive resources went on bureaucracy, unnecessary trips and unread reports.

"In too many countries, too much money pays for too many people to go to too many meetings and get on too many aeroplanes to do too much technical assistance," he said. "Too much money is spent on reports that sit on shelves. Every dollar we waste a day puts a life at risk."

He called on America to lead the way and for all countries "to do some soul-searching … and actually spend the money on the people it was meant to help instead of the apparatus in the country in question".

Clinton said he did not want to blame anybody. "I was president for eight years and I had no idea it was as bad as it was," he said. But, he added: "We can fix this."

Two new studies could help AIDS prevention efforts

Since there are currently only enough drugs to treat a third of all people with HIV and money to provide the drugs is unlikely to increase, more AIDS prevention efforts must take place. Two more studies that were released to coincide with the International AIDS Conference might make prevention easier for governments and NGOs.

First, a study has found that using a vaginal gel that has the same active ingredients as anti-retroviral drugs helps prevent women from getting HIV. Another study shows that cash transfer programs help young women say no to sex.

From this New York Times piece that we found at Blue Ridge Now, health writer Celia Dugger explains the new studies.

Women who used a vaginal microbicidal gel containing an antiretroviral medication widely used to treat AIDS, tenofovir, were 39 percent less likely over all to contract H.I.V. than those who used a placebo. Those who used the gel most regularly reduced their chances of infection 54 percent, according to a two-and-a-half year study of 889 women by Caprisa, a Durban-based AIDS research center.

Broader trials are needed to confirm the results, and it will most likely be years before the product is publicly available, but if produced on a large scale the gel would cost less than 25 cents per application, the lead investigators estimated.

Because the trial was relatively small and the gel was nowhere close to 100 percent effective, AIDS scientists and public health officials wanted to see another trial get similar results before they undertook the large fund-raising and public education efforts that would be needed to make billions of doses of the gel, as well as the applicators, which are more expensive, and then to persuade women to use them and governments of poor countries to adopt them.

Dr. Bruce Walker, a Harvard Medical School professor who was not involved in the study, said a cheer erupted when researchers unveiled their findings to a small group of scientists last month in Durban.

“This is the first time that there’s been a tool that women can use to protect themselves from becoming infected,” he said. “It’s a game changer.”
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In another piece of progress against AIDS, a separate, large study in Malawi sponsored by the World Bank, and made public on Sunday, found that if poor schoolgirls and their families received small monthly cash payments, the girls had sex later, less often and with fewer partners.

A year and a half after the program started, the girls were less than half as likely to be infected with the AIDS or herpes viruses than were girls whose families got no payments. The likelihood that the girls would agree to sex in return for gifts and cash declined as the size of the payments from the program rose, suggesting the central role of extreme poverty in sexual choices.

“Maybe we can combine these behavioral and biomedical interventions,” said Dr. Tim Farley, a scientist with the World Health Organization involved in H.I.V. prevention research. “We need to pursue both avenues.”

International AIDS Conference worries about money

At the start of the International AIDS Conference in Vienna there is a lot of worrying about money. The speakers at the conference all expressed concern about money for AIDS funding being cut back or staying the same. Right now, only a third of HIV-positive people receive drugs to stay healthy, more funding is needed to give the drugs to all.

From this Reuters article, writer Kate Kelland covered the start of the conference.

Speaking at the start of an international gathering of some 20,000 AIDS activists, scientists and HIV patients in Vienna, U.N. Secretary General Ban Ki-moon praised progress made against the human immunodeficiency virus (HIV) that causes AIDS, but said this could be jeopardized if governments trimmed budgets.

"Some governments are cutting back on their response to AIDS. This should be a cause for great concern to us all," he told the conference via videolink from New York.

Michel Kazatchkine, head of the Global Fund to Fight AIDS, Tuberculosis and Malaria said it needed up to $20 billion in the next three years to sustain progress.

"I am hugely afraid. I am very concerned," he told reporters at the Vienna conference. "Because of the (global financial) crisis ... because of the competing priorities."

"I hear of many governments cutting official development aid, but I hear other governments saying that despite cuts in other areas, foreign assistance will remain -- and I also hear other governments with good news. It is very up and down."
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A report published at the conference by the Joint United Nations Programme on HIV/AIDS (UNAIDS) found that overall support for global AIDS effort from donor nations flattened out last year in the midst of global economic crisis.

In 2009, the Group of Eight leading wealthy nations, the European Commission and other donor governments provided $7.6 billion for AIDS relief in developing nations, compared with $7.7 billion disbursed in 2008, it said.
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World leaders set this year as a deadline for universal access to treatment for all HIV/AIDS patients who need it, but the head of the International AIDS Society Julio Montaner echoed the tone of protesters, who shouted "broken promises kill."

Montaner rebuked politicians for failing to deliver on their promise, saying that only a third of the 15 million people who need potentially life-saving AIDS drugs currently get them.

"Today we have treatments that work, we have shown that this can be done ... what we need now is the political will to go the extra mile to deliver on universal access," he said.

New study links AIDS to poverty in US

A new study examines how AIDS and poverty are related in the United States. The new study was released to coincide with the International AIDS Conference now taking place in Vienna.

The study says that infection rates are nearly double for heterosexuals in poor neighborhoods than in wealthier areas. The authors of the study conclude that poverty is the leading factor in determining who is infected with the disease. The chances of one meeting a sexual partner with AIDS may be doubled according to where one lives.

From this Associated Press article that we found at KAIT, writer Mike Stobbe tells us how the study was conducted.

"In the United States, we haven't have a history of looking in depth at the association between poverty and HIV," said Dr. Jonathan Mermin, director of HIV/AIDS Prevention for the Centers for Disease Control and Prevention. Mermin oversees the CDC team that did the new study.
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The study involved a survey in 2006 and 2007 of 9,000 heterosexual adults, ages 18 to 50. They answered questions on a computer about their income, condom use and other details and were given HIV tests.

The research was done in high-poverty neighborhoods in 23 U.S. cities. It focused on heterosexuals who don't use intravenous drugs; that group accounts for about 28 percent of Americans living with HIV. It did not involve gay or bisexual men, who have the highest rates of HIV in the United States.

The results: HIV was detected in 2.4 percent of the people who were living below the federal poverty line, which in 2007 was an annual income of roughly $10,000 or less for an individual. The 2.4 percent translates to roughly 1 in 42 people.

In contrast, infections were found in 1.2 percent of people in the same neighborhoods who made more money than the federal poverty guideline. That's 1 in 83 people.

Both rates were higher than the national average, which is 0.45 percent, or 1 in 222 people.

The results suggest that people in low-income neighborhoods are more likely to be infected because they live among more people who are infected. Perhaps more people in such neighborhoods have used illegal drugs or had other experiences that put them at higher risk, Mermin said.

HIV infections drop in high risk countries

Some very good news was released today on HIV rates. A new report from UNAids says that HIV rates have fallen amongst young people in the 15 hardest hit countries. The statistics were released ahead of next week's International AIDS Conference.

UNAids gives two reasons for the drop in HIV infections with young people. First, they say that young people are doing the prevention themselves by using condoms or abstaining. Another cause for the drop is the world putting a lot of attention and money into educating the public on how to avoid AIDS.

From the Guardian, health writer Sarah Boseley gives us the statistics.

The news was even better in 12 of those countries, where HIV levels have decreased by 25% among 15- to 24-year-olds. This in response, UNAids believes, to dogged prevention campaigns warning of the dangers of HIV/Aids and the need for people to change their sexual behaviour.
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The biggest drop was in Kenya, where HIV in 15- to 24-year-olds fell 60% between 2000 and 2005 to 5.4% in urban areas and to 3.6% in rural ones. Among young pregnant women in Ethiopia, the report shows a 47% decrease among in urban areas and 29% in rural areas. In urban areas of Malawi and Côte d'Ivoire, the prevalence in the same group fell 56% and in Burundi and Haiti it dropped by nearly half. Reductions of more than a third took place in Namibia, Zimbabwe, Botswana, Cote d'Ivoire, Rwanda and Lesotho.

Most of the figures come from antenatal clinics, where pregnant young women are tested. Mathematical modelling shows they are a good indicator of trends across the whole age group. But population surveys are better, and were available in seven countries. Six saw a drop in prevalence among young women – but in only four was there a fall among young men.

UNAids believes the progress is down to efforts to persuade young people to change their sexual behaviour. In 13 countries where research was carried out, young people were reported to be waiting longer before first having sex. Usually this was young women rather than young men, but in Cameroon, Ethiopia, Malawi and Zambia, both sexes were waiting longer.

The study also found that both were having fewer sexual partners and that condom use has increased among young women as well as among young men.

UNAids' proposed treatment approach is called Treatment 2.0 and could prevent 10 million deaths by 2025, it says. Only a third of the 15 million people who need Aids drugs have them and this strategy is intended to enable everybody to have access – in line with the G8 Gleneagles pledge. UNAids also calculates the plan would cut new HIV cases by one million a year, because the drugs make those taking them less infectious.

International AIDS Conference: Children have been short-changed in the response to AIDS

from Africa Science News

A story from last week on the International AIDS Conference. A South African Professor suggests that policies must be refocused to help children.

Written by Henry Neondo

Children have been short-changed in the response to AIDS. They are visible in the photo opportunities and headlines, but mostly invisible in the response to HIV," Prof Linda Richter, of the Human Sciences Research Council of South Africa, told the XVIIth International AIDS Conference here today in a plenary address entitled "No Small Issue: Children and Families".

Richter’s is the first plenary address to be devoted to the wellbeing of children affected by HIV and AIDS in the conference’s 23-year history. UNAIDS estimates that 2 million children aged 0-14 were living with HIV in 2007 - an eight-fold increase since 1990 - while both new infections and deaths among children have grown three-fold in the same period.

Some 370 000 children became newly infected with HIV last year and about 270 000 children died. About 90% of these children live in sub-Saharan Africa, where an estimated 12.1 million children have also lost one or both parents to the AIDS epidemic.

While the global response to AIDS has accelerated, prevention, treatment and care, children continue to lag behind. The overwhelming majority of children who are HIV-positive are infected through mother-to-child transmission.

Despite recent progress, services to prevent mother-to-child transmission (PMTCT) in low-and middle- income countries - the effectiveness of which has been established for over 10 years – reach only a third of those that need them.

Only about 10% of children living with HIV are receiving ART worldwide. Last year, fewer than 8% of infants in low- and middle-income countries were tested within two months of their birth, and only 1 in 25 babies exposed to HIV received the antibiotic co-trimoxazole, which is essential to prevention.

There are serious gaps in the data on children and HIV, and the evidence that does exist is often overlooked.

For example, very little is known about infections among children between infancy and 15 years of age, despite household surveys in countries showing significant levels of HIV prevalence in this age group.

Conversely, population-based surveys in many African countries identify relatively low number of child-headed or skip-generation households (with only elderly people and children) – yet very large amounts of money and attention are focused on these tragic but relatively rare situations.

Current approaches to children affected by HIV/AIDS too often focus only on "AIDS orphans", to the detriment of other needy children and families.

Targeting interventions specifically to orphans or AIDS-affected children is neither helpful nor efficient in hard-hit communities where there is widespread poverty and destitution. In these circumstances, orphans are seldom worse off than other vulnerable children.

Singling out specific groups of children can even result in undesirable effects, such as stigmatization and abuse of those in need of help. All children in communities severely affected by HIV require support."Children orphaned by AIDS are, sadly, only the tip of the iceberg of HIV-affected children," said Professor Richter.

"Our primary focus in designing and implementing policies must be the actual needs of all children affected by HIV/AIDS, not whether they meet an agency’s definition of ‘orphan’. "Families, broadly defined, care best for children. Yet many efforts to assist children affected by HIV and AIDS have ignored the clear benefits of supporting families, many of which live in extreme poverty and receive little or no assistance from governments."care for child

The poorest families face the worst effects of the epidemic, financing the health care of those who are sick, and absorbing kith and kin - largely by eating less and spending less on education and health care. This critically affects the wellbeing of children," remarked Professor Richter.

In several southern African countries, more than 30% of families have an adult member living with HIV or have experienced a recent AIDS-related death. In addition, over 60% of children live below the poverty line - in countries that are themselves already very poor.

In such situations, support to individual children by local community members and organizations has been critical, but falls woefully short of meeting children’s needs. To date, however, few interventions for children have been formulated, resourced or implemented on a scale that matches the epidemic’s impact on children and their families.

The current response for children is largely composed of ad hoc projects with limited outreach that are often imperfectly designed and underfunded. In the most severely affected regions, families and communities are left to bear the overwhelming burden of the epidemic, including approximately 90% of the financial cost.Indeed, only about 15% of households supporting vulnerable children globally receive any support from community-based or public sector programmes.

"Civil society organizations and faith groups provide most of the available support," Richter said. "But small, localized projects can only take us so far. To have a bigger impact requires larger and more systemic responses – responses which support families and address the pervasive poverty in which so many of them live."In her plenary remarks, Prof Richter laid out a new action agenda to provide the poorest families in poor countries with social protection and universal access to services, key steps toward addressing the needs of children affected by HIV/AIDS.She called forredirecting support for children and through their families saying families are the most influential force in the lives of children and adolescents.

"Strengthening the capacity of families through systematic, public sector initiatives has been identified globally as one of the most important strategies in building an effective response for children. Institutional, orphanage and other forms of non-family care have well-documented problems and cost up to ten times more than family care."By targeting only individuals, many HIV interventions and services – such as PMTCT, the home care of a very ill person or starting a family member on antiretroviral treatment – are missing critical opportunities to reach out to family and community members as well.

Action for children’s wellbeing must address not only their health but also their basic material needs, psychosocial wellbeing and cognitive development. These comprehensive approaches provide crucial opportunities to reinforce key components of primary health care delivery for all, integrate health sector action with child-focused work in other sectors, and leverage broader advances in social development.

Further, she called forprovision ofsocial protection for poor familiesas HIV-infected families typically experience a worsening of their socioeconomic status, which greatly affect children in their care. Reducing the impact of extreme poverty through social protection efforts is the crucial missing ingredient in responses to children affected by HIV/AIDS. "Every developing country, no matter how poor, can afford a social protection package for children affected by HIV and extreme poverty," Professor Richter remarked.

The International Labour Organization estimates the cost of a small universal old age pension, universal primary education, free primary health and a child benefit of US$0.25 per day at between 1.5 to 4.5% of GDP in low-income African countries. "Putting needed resources into the hands of affected families should be urgently considered in order to expand the impact of small-scale programmes currently reaching only very small numbers of children," she added.

Richter also noted the success of income transfers programmes, especially for the poorest families affected by HIV/AIDS who are often too incapacitated to take advantage of micro-lending or skills training programmes.

Income transfer programmes can include social security entitlements such as old-age pensions and child support grants; programmatic interventions targeted to vulnerable communities and households; treatment allowances; or small amounts of money to cover the transport and opportunity costs of accessing HIV/AIDS prevention and care services."Whatever approaches are taken, some form of income assistance for the neediest households is critical," Richter said. "In many high-prevalence countries in Africa, poverty is arguably the single biggest barrier to the scale-up of HIV treatment and prevention.

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International AIDS Conference: UN goal for HIV drug access won't be reached by all"

from AFP via Google

An update from the International AIDS Conference in Mexico City. Leading experts say the goal of access to anti-HIV drugs is unlikely to be reached around the world. - Kale

Looking to the mounting bill for the drugs that keep millions of poor people alive, they also said China and other fast-advancing economies could shoulder more of their own burdens in the future, freeing up resources for countries mired in poverty.

Speaking on the sidelines of the International AIDS Conference on Wednesday, Global Fund chief Michel Kazatchkine and UNAIDS head Peter Piot said they believed countries still stood by the fast-approaching 2010 target, although they doubted the goal would be reached by all.

"When we look at global targets, none of us believes that it will be 100 percent everywhere," Kazatchkine told a group of reporters.

"But if you look at individual countries, and if you look at the percent that have achieved universal coverage or (will) be close to universal coverage, there may be much more than you may think of."

The 2010 target, enshrined in a June 2006 UN General Assembly resolution and supported by the Group of Eight (G8), is emerging as a touchy political issue.

Three million badly-infected poor people now have been able to grasp the drug lifeline, thanks to a big scaleup in the last two years, but this is still two-thirds short of the total in need and time is running out to meet the deadline.

As a result, activists have closely scrutinized the July G8 summit statement, and last week's UNAIDS report on the state of the pandemic.

Some see a weakening verbal commitment to 2010 and a dangerous slippage to 2015, which is also the end-date for the UN's Millennium Development Goal on reversing the spread of HIV.

Piot, UNAIDS' executive director, said, though, "the (2010) commitment has not changed whatsoever.

"2010 is 18 months from now," he admitted. "What we've seen is that in a number of countries, they've already reached their universal access targets, others not."

Some countries could achieve universal access in 2011 or 2012, in line with their national programs, Piot's spokesman explained.

In other comments, both Piot and Kazatchkine, who is executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said there would have to be fresh ideas for tackling the mounting cost of keeping people alive with antiretroviral drugs.

Some 33 million people around the world are infected with HIV, 90 percent of whom live in developing countries.

By some estimates, universal access will cost 54 billion dollars per year in 2015 -- and the bill will endure for decades, as the treatment is for the rest of one's life.

Kazatchkine said he looked to the G8 countries, which account for 90 percent of contributions to the Global Fund, to meet their commitments.

So far, they are only a little more than a third to the way of fulfilling the pledges they made at their 2005 Gleneagles summit.

He and Piot also said that middle-income countries that were advancing rapidly towards prosperity should, in future, shoulder more of the bill.

"If you are in the lower tranche of middle-income countries, you would contribute let's say 30 percent and the Global Fund would contribute 70 percent.

"If you are in the upper tranche of middle-income countries, the Global Fund would contribute 30 percent and you would contribute 70 percent," said Kazatchkine.

He noted that Russia, buoyed by the influx of petrodollars, has pledged to reimburse 300 million dollars received from the Global Fund.

"I think this opens the door to China and one day maybe India, but at least (to) those countries that are generating so much wealth," he said.

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International AIDS Conference: Is changing behavior the key?

from the Independent

A series of questions and answers about AIDS. - Kale

By Jeremy Laurance,

Why are we asking this now?

Aids has killed more than 30 million people in the last quarter century and is continuing to cause around two million deaths a year. Yet as a predominantly sexually transmitted disease, it is possible to avoid it by taking precautions – using condoms and avoiding multiple sexual partners.

In this respect it is unlike infectious diseases such as flu, which it is virtually impossible to avoid. At the International Aids Conference, which opened in Mexico City this week, experts called for a new focus on HIV prevention through behaviour change. Geoffrey Garnett, of Imperial College, London, told the conference that combining different approaches could "dramatically alter the future spread" of the disease.

How much does the Aids impact vary around the world?

The Aids epidemic is different in Africa than the rest of the world. Where once it was seen as a risk to populations everywhere, it is now recognised that, outside sub-Saharan Africa, HIV is largely confined to high-risk groups including injecting drug users, sex workers and men who have sex with men.

Sub-Saharan Africa is the only part of the world where there is a generalised epidemic that has spread through the heterosexual population. As a result, over two thirds (67 per cent) of all people infected with HIV live in sub-Saharan Africa. Experts do not now expect HIV to spread extensively into heterosexual populations outside Africa.

How easy is it to become infected with HIV through sex?

Not as easy as people think. On average, transmission of the virus occurs in one in 1,000 acts of sexual intercourse with an HIV infected person. For a couple having regular sex, one of whom is infected, the chances of passing the virus are around 8 per cent a year. However, the risks vary widely according to the circumstances and can be as high as one in three acts of sexual intercourse. They are dramatically higher when ulcerative sexually transmitted diseases are present, in anal sex and when the infected partner is at the point in their illness when they are most infectious.

Why is the epidemic so bad in Africa?

No one is really sure. Recent research suggested that there may be a genetic susceptibility that accounts for higher rates of infection among black Africans. Aids deniers, such as Thabo Mbeki, the President of South Africa, have suggested that poverty rather than HIV is the root of Aids in the continent, weakening immune systems through malnutrition. But this ignores evidence showing that HIV infection is higher among the better off, such as teachers, perhaps because they (especially men) can afford to have more sexual partners.

Low rates of circumcision, which is protective, and high rates of genital herpes, which causes ulcers through which the virus can enter the body, have also contributed to Africa's epidemic.

Do African people have more sex?

There is no evidence that they do – though obtaining a definitive answer would be difficult. Epidemiologists believe that, while there are large differences in levels of sexual activity within populations – the young are more active than the old, and city dwellers more active than rural dwellers (because they have access to more partners) – there are likely to be only small differences between populations.

So why theheterosexual spread of the disease in Africa?

It is the question Aids experts are asked most often, but have the greatest difficulty in answering. The answer is likely to be a combination of factors – more commercial sex workers, more ulcerative sexually transmitted disease, a young population, and concurrent sexual partnerships.

It is this last factor that is thought to be key. Even though there is no evidence that Africans have more sex, research suggests there is a higher frequency of overlapping sexual partnerships, creating sexual networks that, from an epidemiological point of view, are more efficient at spreading infection. It may be that serial monogamy, as practised in the UK and many other countries, is an effective barrier to the spread of HIV. It was this issue – of the need to encourage monogamous relationships in Africa – that former US president Bill Clinton highlighted in a BBC interview yesterday.

Aren't condoms the answer?

Yes – if men can be persuaded to use them, and the latest biannual report from UNAIDS, published last week, suggests that condom use is increasing and new HIV infections are falling, partly as a result.

In addition, in seven badly affected countries – Burkina Faso, Cameroon, Ethiopia, Ghana, Malawi, Uganda, and Zambia – young people appear to be waiting longer before starting to have sex. But though new infections dropped from three million to 2.7 million last year, the rate of decline is not fast enough. For every two people that started on treatment with anti-retroviral drugs last year, five become newly infected, amounting to 7,000 a day.

How else should behaviour change?

Injecting drug users are among the groups at highest risk of HIV because sticking a needle that has just been used by someone else into a vein is the most efficient way of transmitting the virus. Efforts at "harm reduction", for example by setting up needle exchange schemes where drug addicts can get clean needles in exchange for dirty ones with no questions asked, should be a key element of any HIV prevention strategy. But only a third of countries have implemented harm reduction programmes. It is a cornerstone of HIV development programmes supported by Australia but gets no support from the US or Sweden.

What's the main area of concern in the West?

One of the danger areas is transmission of the virus among men who have sex with men. This is not declining and in some places has increased. In the developing world, too, it has been neglected, but when researchers look for it, they find it. In the UK, after an initial decline in sexually transmitted diseases among men who have sex with men, infection rates are rising again.

Experts say it is an area that needs a more rigorous approach in the future. In countries where this is the main mode of transmission, less than a quarter of the men involved had access to prevention based on condom use.

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Stepping Up the Response to AIDS

from IPS News

The International AIDS Conference opened in Mexico Sunday. Here is a report on the first day. - Kale

The extraordinary mobilisation of economic and human resources against the HIV/AIDS pandemic has borne fruit, but efforts must be stepped up to continue fighting the disease, Mexican expert Jaime Sepúlveda said Monday, one of the plenary speakers at the first session, on the "State of the Epidemic".

According to the 2008 "Report on the Global AIDS Epidemic" by the Joint United Nations Programme on HIV/AIDS (UNAIDS), an estimated 33 million people were living with HIV worldwide in 2007, and two million died.

Sepúlveda also noted that last year, three million people living with HIV in low and medium income countries were receiving antiretroviral therapy, just 31 percent of those in need of treatment, while 2.7 million new cases were registered.

Half of those living with the AIDS virus worldwide are women, and sub-Saharan Africa accounts for more than 60 percent of all cases.

What is the state of the epidemic? "The numbers are growing, but slower than before," Professor Geoff Garnett, one of Monday’s speakers, told IPS.

He added that while there are many new cases, the rate of infection has been curbed by anti-AIDS efforts and campaigns.

However, there are major problems when it comes to measuring the number of new infections each year, which makes it difficult to gauge just how effective the prevention strategies implemented up to now have really been, said Garnett, from the Imperial College of London.

Besides, "we haven’t done enough to evaluate the social, structural and biological variables" involved in high-risk behaviour, he said.

More financing for research on the disease and for the assessment of treatment and prevention is needed, said Sepúlveda, who is now with the Bill & Melinda Gates Foundation.

"What works? In what population groups?" asked Sepúlveda, the founder of Mexico’s National Council for AIDS Prevention and Control (CONASIDA).

Garnett called for an expansion of "combined prevention interventions," including aspects like access to antiretroviral treatment, consistent condom use, male circumcision and the integration of HIV/AIDS education into family planning.

The expert also called for reforms in institutions that fund the fight against HIV/AIDS, like UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, the World Bank and the U.S. President's Emergency Plan for AIDS Relief, and urged them to "work as a team."

At the opening session of this week’s conference Sunday, U.N. Secretary General Ban Ki-moon asked wealthy donor countries to provide more funds for the fight against AIDS, in order to achieve universal access to prevention and treatment by 2010.

But most experts believe these goals, adopted at the 2001 U.N. General Assembly Special Session on HIV/AIDS, will not be met.

"The responses to HIV and AIDS require long-term and sustained financing. As more people go on treatment and live longer, budgets will have to increase considerably over the next few decades," said Ban.

Dr. Alex Coutinho of the Infectious Disease Institute of Makerere University, Uganda underscored the need for systems to fight AIDS in rural and other hard-to-reach areas, as well as outreach to and support for marginalised and at-risk communities, like immigrants.

He also advocated greater involvement in prevention by people living with HIV as a catalyst for change, and said the best way to support AIDS orphans is by keeping their parents alive.

Elisabet Fadul, with the Dominican Network for Youth Rights/Global Youth Partners, pointed out that 40 percent of new infections worldwide occur among young people between the ages of 15 and 24, and said that is why "evidence-based" sexual health plans are needed to provide access for young people.

These actions and policies, she said, should engage youth, and must take the problems they face, like poverty and unemployment, into account. "Are the current prevention strategies effective? Are they based on evidence?" she asked.

Fadul congratulated the ministers of education and health of 33 Latin American and Caribbean nations who agreed on intersectoral strategies for integral sex education and promotion of sexual health on Aug. 1 in the Mexican capital.

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