
Onsite Newspaper of the XI International Conference on AIDS
One World. One Hope. One Day at a Time

Issue Number One, Monday, 8 July 1996

Contents of The Daily Progress, Number One

       Opening Ceremony: Emotions run high as delegates gather
       Awards celebrate young investigators
       Community forum achieves progress on key issues
       Another View: Basic scientists must recognize value of
          International Conference
       Guest Editorial: HIV risk linked to women's sexual rights
       Rally demands renewal of Canadian AIDS strategy
       On the Horizon: Schedule
       Feature Review: Can combination therapies eradicate HIV?
       Antiretroviral therapies reduce viral load
       Therapy and viral load monitoring: state of the art
       Ritonavir test shows reduced mortality rate
       Fact File
       Satellite Symposium: HIV prevention works
       Fora Communitario progresa en asuntos importantes
       Progres effectues par la Forum Communautaire dans des
          domaines cles
       Program Update
       Masthead for <EM>The Daily Progress


OPENING CEREMONY

Emotions run high as delegates gather

The XI International Conference on AIDS opened with a mixture of fiery
content and passionate demonstrations from the floor. Delegates turned
their backs, covered their ears, blew whistles and shouted while
Canadian Health Minister David Dingwall attempted to deliver his
welcoming remarks, protesting Prime Minister Jean Chr&#233;tien's
absence from the Conference as well as Canada's failure to renew its
National AIDS Strategy.

Premier Glen Clark officially opened the Conference,  sharing the
serious problems British Columbians have as the province with Canada's
highest per capita rate of HIV infection.

Keynote speaker Nkosazana Zuma, Minister of Health for the Republic of
South Africa, stressed the impact of the pandemic in developing
countries. She noted that, by 2010, life expectancies will fall from
66 to 33 in Zambia, from 70 to 40 in Zimbabwe, and from 59 to 31 in
Uganda. "This is a scenario unfolding the world over," she said.
"Nations reeling from poverty, famine and wars are now facing another
real and dangerous threat to their social and economic prosperity."

Earlier in the session, the ceremony began with a film, featuring
people of all ages, races, professions, all touched by HIV/AIDS. They
were joined by another voice from the stage: Doreen Millman of
Vancouver. "You're wondering how someone like me, a 63-year-old
grandmother, got infected.  The answer is very simple....

"It just doesn't matter!" Thunderous applause.

Following opening remarks by the Conference Co-Chairs, a message of
welcome from Wendy Grant-John of the Musqueam First Nation, and a
prayer by Elder Byron Joseph of the Burrard Nation, participants heard
a series of presentations on the global and human impacts of HIV.

UNAIDS Executive Director Peter Piot stated that "it is
unacceptable that people living with AIDS should have to live without
the essential drugs they need." He issued a global call to arms,
stating that "we must turn the global AIDS research agenda on its
head. Ignoring the research needs of 90% of the epidemic is not
just unethical. It is irrational."

Piot echoed the voice of French revolutionary Danton: "Il nous faut de
l'audace, encore de l'audace, toujours l'audace." Audacity, more
audacity, always audacity.

Eric Sawyer, a person living with HIV/AIDS, stressed that "The cure
isn't here. We are a long way from a cure, even for the rich.  And for
the poor, we're no closer than we were 10 years ago. Most people with
AIDS can't get aspirin."

Sawyer denounced government officials who "think public health is
isolating the rich, often white populations from the diseases of poor
people by instituting immigration barriers instead of providing health
care to the sick."

And he condemned "AIDS profiteers" for being more concerned about
maximizing profits than saving lives. "To the drug companies, people
with AIDS say, it's time to drop your prices," Sawyer said. He called
for a two-tiered pricing system to allow reasonable profits on HIV
drugs sold to rich populations, while making the same drugs available
at cost or minimal profit to poor people around the world.

Sawyer called for a partnership between PLWH/As, drug companies, the
broader business community, and especially governments, to make
treatment and prophylaxis available for tuberculosis, PCP, and
diarrhoeal diseases -- the three biggest killers of PLWH/As. He noted
that $60 per year can save a person's life. Tuberculosis
prophylaxis costs $15 per person per year in Uganda, generic
Bactrim costs $32, and NTZ manufactured in one-tonne batches may
soon be available at a cost comparable to TB drugs.

While a unified effort is needed to take advantage of the new test
methods and treatments that do exist, "it's time for the media to stop
talking about a cure that doesn't yet exist. It's time to start
talking about global access to health care," Sawyer concluded. "We
must demand access for all, because greed kills! Access for all!"
Sawyer's last words touched off a demonstration on the plenary floor.

The ceremony closed with the voices of four Vancouver choirs and
Canadian performer Molly Johnson, founder of the Kumbaya Festival,
which raises funds for AIDS in Canada. During the finale, a 1,000
square-foot quilt was unveiled. Created by local quilter and fashion
designer Doreen Rennschmid, in conjunction with artist Joe Average,
this quilt will serve as the dramatic backdrop for Conference plenary
sessions.

Awards celebrate young investigators

Eight young investigators have been chosen for special honour at a
ceremony to be held Thursday, July 11 beginning at 7 p.m. in GM Place.
The work of each was chosen as one of the two top-rated abstracts in
its conference track by the 700-member International Scientific
Committee in blind reviews of abstracts submitted by authors under 35
years of age. Those chosen will receive a Young Investigator Award and
a $2,000 grant to encourage their continued commitment to work in this
field.

Top honours in Track A (Basic Science) go to Marinka Tellier of the
University of Florida for her work in evaluating the efficacy of a
conventional dual-subtype feline immunodeficiency vaccine against
heterologous challenge (to be presented at Session 105 on Monday), and
Paul Parren of California's Scripps Research Institute for his role in
identifying a single recombinant antibody which affords complete
protection against HIV-1 infection in mice (Session 122, Monday).

Clinical researchers from England and the US will be spotlighted in
Track B.  Amanda Mocroft of London's Royal Free Hospital will accept
the award for her work on anti-herpes treatment and the risk of
Kaposi's sarcoma in HIV infection (Session 138, Monday). Femke Bouwman
of Johns Hopkins University in Baltimore will be honoured for
insightful work on the clinical progression of dementia as a
complication of HIV infection (Session 413, Thursday).

In Track C (Epidemiology and Public Health), Canadian Steffanie
Strathdee of the British Columbia Centre for Excellence in HIV/AIDS
will receive recognition for her work on the role of social
determinants such as depression and a history of sexual abuse in
predicting needle-sharing behaviour among injection drug users
(Session 131, Monday).  Grace John of the University of Nairobi and
the University of Washington also receives the award for her study of
cervicovaginal viral DNA in pregnancy and its possible relationship to
maternal-child transmission during birth (Session 328, Wednesday).

The winners in Track D (Social Science: Research, Policy and Action)
are Michael Orsini of Montreal for his presentation on the "politics
of identity" among AIDS activists and, in particular, how activism is
affecting the lives of gay men (Session 224, Tuesday).  Christopher
Mast of the Johns Hopkins University School of Public Health will
accept the award for his Thursday poster presentation on the effects
of common beliefs and practices about the routine immunisation of
children born to HIV-infected mothers in Uganda.

Community forum achieves progress on key issues

Participants in Community Forum 96 achieved progress in identifying
and recommending action on the key issues faced by those on the front
lines of the international response to HIV/AIDS, said Teresita
Bagasao, who gave the keynote speech at the Forum's closing plenary.

Bagasao acknowledged that the Forum, an international gathering of
persons living with HIV/AIDS and community organisation workers, had a
difficult task in trying to come up with a consensus on what strategic
action to take on these issues. But Bagasao, of the Manila-based
Kabalikat Ng Pamilyang (Partnership with Filipino Families), reported
that "we managed our diversity, multiple languages, cultures, time
zones, and contexts. It was a struggle, but there is no progress
without struggle."

Participating in the Forum, held Friday and Saturday at the University
of British Columbia, were 100 people from each of the world's five
regions: Africa, Asia-Pacific, Latin America/The Caribbean, Europe,
and North America. The closing plenary featured reports from
participants who worked on strategic planning and skills building in
subgroups structured around four themes: human rights, treatment,
social research and evaluation, and community and organisational
development.

One of the action items in the human rights report was the formation
of a global working group of NGOs concerned with protecting human
rights of persons living with HIV/AIDS and those vulnerable to HIV
infection. Participants examining treatment issues included in their
report a call for a global standard of care. The social research and
evaluation area report stressed that community organisations should
integrate research into their programs. A point made in the community
and organisational development report was that national AIDS programs
should allocate at least 15% of their funds to NGOs and other
community-based groups.

Beyond the Forum, and the XI International Conference on AIDS, Bagasao
said any effective action on HIV/AIDS issues "starts with and depends
on us, and on our own empowered collective action...What we achieved
over the last two days will only be meaningful if each and every one
of us does our part. We can continue to make a difference if we take
personal responsibility for implementing some of the strategies and
plans we've arrived at."

ANOTHER VIEW

Basic scientists must recognize value of International Conference
by Mark A. Wainberg, Ph.D.

Almost all grant applications in basic research areas of HIV/AIDS
begin by referring to the enormity of the pandemic. Frequently, the
applicant will cite United Nations/World Health Organization
statistics to further substantiate this point and project numbers of
cases expected during the next decade. Next is often a motherhood
statement about the need for outstanding research targeted at a better
understanding of the HIV replication cycle, cellular controlling
elements, and gene and protein function, to develop effective vaccines
and treatment strategies. The applicant then launches into a detailed
discussion of the proposal, with the hope of convincing reviewers of
its relative merit.

But the number of abstracts submitted by Track A scientists to the
International Conference on AIDS has fallen to about half the numbers
received by other tracks. Basic scientists commonly explain this gap
by stating that the quality and quantity of excellent scientific
presentations is below what is commonly found at more specialized
conferences, that there are too many other meetings to attend, or that
they are tired of conferences that are influenced by activists and
other special interests seeking to gain media attention through public
demonstrations. The conclusion to this line of reasoning is that the
International AIDS Conference is a waste of money, and that
researchers' time is better spent in the lab.

Organizers of the International Conferences on AIDS have already
responded to these concerns by holding the meetings every two years,
instead of annually. However, an excellent case can be made for
enhancing the role of the International Conference on AIDS and
encouraging scientists of all types to take part.

The International Conference on AIDS is the only major meeting in our
field that brings together scientists working in the many disparate
areas of HIV/AIDS. The intense media coverage generated by the
Conference ensures that the world is informed of research
breakthroughs, as well as the need to redouble HIV prevention efforts.
Governments and taxpayers want to hear that money invested in research
has paid dividends. The media accomplish this far more efficiently
than we could ever do on our own, and never more effectively than
during the International Conference. The fact is that all scientists
working in HIV/AIDS benefit from the media coverage devoted to the
pandemic, and from lobbying by activists and other interested parties.

Track A scientists must realize that they cannot have it both ways.
They cannot justify their research based on the catastrophic
international dimensions of the pandemic, then dismiss the
International Conference as an irrelevant venue for scientific
exchange. Basic and molecular scientists must recognize that their
obligations in relation to international dimensions of HIV/AIDS are no
less compelling than those that motivate their colleagues in Tracks B,
C and D. New initiatives in vaccine research and other prevention
efforts can emanate from the minds of bright Track A scientists, but
only if they are encouraged to think in global terms.

Certain scientists, who should know better, have tried to portray the
International Conference as an inappropriate venue for presentation of
first-class results. We will all be losers if this attitude gains
further credence. Rather, Track A scientists who have never been to an
International Conference must be encouraged to attend the next one. We
needn't insist that all scientists in HIV/AIDS attend every meeting in
the series, but it is reasonable to expect senior investigators, in
particular, to recognize their obligations to the International
Conference.

This year, in both quantity and quality, the Track A abstracts have
ensured the success of the basic science segment of the International
Conference. A continuing effort should be made to build on this
success and achieve an even more impressive turnout of Track A
scientists in Geneva in 1998.

Dr. Mark Wainberg is a co-coordinator of Track A at the XI
International Conference on AIDS and Director of the McGill University
AIDS Centre in Montreal, Canada.


GUEST EDITORIAL: HIV risk linked to women's sexual rights
By Mabel Bianco, MD

While a lack of respect for women's sexual and reproductive rights is
a world-wide problem, HIV positive women suffer a clear violation of
these rights in many societies, especially in developing countries.

Around the world, cultural and religious traditions have blocked
broader recognition of issues related to gender and sexuality. Female
genital mutilation, early and compulsory marriage of girl children,
sexual exploitation, abuse and rape of girls and women, and the lack
of any opportunity for many women to refuse unprotected sex all
contribute to the high risk of HIV infection among women. And all
represent clear violations of women's sexual rights.

Latin America is a region where Catholicism is the dominant religion
and abortion is illegal. Ironically, HIV positive women in this region
suffer social pressure to interrupt their pregnancies by resorting to
unsafe abortions, with the accompanying high risk of severe health
problems or death. In many countries, as well, women living with HIV
have no access to family planning services, and are sometimes obliged
to undergo sterilization or other procedures that they do not freely
choose.

Compulsory HIV/AIDS testing of pregnant women is a common practice
around the world, even in countries where compulsory testing is
supposedly illegal. Often, the purpose of the test is to prevent risks
to health workers, not to provide care women and their babies.
Pregnant women who are HIV positive may also be forced to undergo AZT
treatment on the basis that it will prevent transmission of the virus
to their unborn children. In some developing countries, drugs are
often administered without adequate controls, in violation of
established treatment protocols.

Women living with HIV face increased marginalization and stigma,
particularly because their serological status raises doubts or
suspicions related to their sexual behaviour. They also suffer
coercion and violence in the denial of their sexual and reproductive
and economic rights. They are generally expected to interrupt their
sex lives and forego childbearing, to avoid transmitting the virus. In
Africa and Asia, if they are married and their husbands die, they are
likely to lose their properties and be abandoned by their families. In
these regions, many widows are obliged to prostitute themselves and/or
their children to survive.

No effort to guarantee women's sexual and reproductive health will be
complete without a comprehensive range of health services, including
birth control counselling, access to contraceptives, and STD and
HIV/AIDS prevention and treatment services. Women's health and
maternal care services must be delivered in a way that eliminates
discrimination on the basis of HIV status.

Yet this basic standard might well be considered utopian at a time
when both the quantity and quality of health services in poorer
countries is so woefully inadequate. Structural adjustment policies
applied in most developing countries have led to significant
reductions in health services in general, and in women's health care
in particular.

Meanwhile, population policies generally lead to the violation of
women's sexual and reproductive rights. In anti-nathalist countries,
family planning is promoted without adequate counselling, often with
limited effort to ensure a free and informed choice among
contraceptive methods. In nathalist countries, meanwhile, women's
reproductive rights are violated by a lack of family planning and
legal abortion services. The common denominator is that women's
reproductive choice becomes a contradiction in terms. Too often, as
well, STD programs treat infected women as "vectors" of disease,
rather than ill individuals who need treatment and care.

In the months and years ahead, all of these breaches of women's
reproductive rights must receive the same critical attention as other
flagrant human rights violations. There is no doubt that education and
effective empowerment of women is one of the keys to slowing the
transmission of the AIDS virus.

Mabel Bianco, MD, is President of the Foundation for Studies and
Research on Women (FEIM) and Coordinator of the International Women's
AIDS Caucus/IAS.

Rally demands renewal of Canadian AIDS strategy

During a rally and march held to coincide with the opening of the XI
International Conference on AIDS, more than 2,000 activists issued a
loud demand for the Canadian government to renew its National AIDS
Strategy.

"We demand that Canada wake up and give us back our strategy," said
Tom McCauley of the B.C. Persons With AIDS Society.

Howard Engel, of the activist group Wake Up Canada&#33;, said the call
for renewing the strategy connects to the global issue of protecting
human rights. "We are marching in solidarity to show the world that
the disrespect and neglect for persons with HIV/AIDS and our
communities is immoral, globally destructive, and cannot be
tolerated."

Louise Binder, of the Toronto PWA Foundation, noted that
discrimination against people with HIV/AIDS is a global issue.
"Disease does not discriminate, but bigots do," said Binder, a person
living with HIV/AIDS.

Rally participants made their way from Vancouver's main public library
to B.C. Place Stadium, one of the Conference venues, chanting "we want
a strategy, not another tragedy."

On the Horizon

MONDAY, JULY 8

Satellites

Agouron Pharmaceuticals
0600 -  0800
Recent Advances in Antiretroviral Combination Therapy
Pan Pacific Hotel: Crystal Pavilion

World Health Organization/HPR/HEP
1900 - 2000
Roles Teachers' Unions Are Playing to Prevent HIV/STD:
Analysis and Critique
Hotel Vancouver: Waddington Room

NeXstar Pharmaceuticals, Inc.
1900 - 2100
Focus on Liposomal Therapy in AIDS-Related Diseases
Four Seasons Hotel: Park Ballroom

Gay Men's Health Crisis
1900 - 2100
Oral Sex Between Men: Research Update And Community Perspectives
Vancouver Library

Vancouver Hospital, Department Of Dentistry/
DAAC Dental Alliance of AIDS/HIV Care
1900 - 2100
Oral Examination Practice Sessions &
 Identification of Oral Lesions of  HIV for Heatlh Care Providers
Listel O'Doul's Hotel: Courtyard Room

United States Agency for International Development,
Health Technical Services Project
1900 - 2100
United States Agency for International Development (USAID)
Town Meeting
Hotel Vancouver - Saturna Island Room

Bristol-Myers Squibb Company
1900 - 2130
Improving Survival in People Living with HIV Infection:
Current Therapies, Future Strategies
Vancouver Trade & Convention Centre: Ballrooms A & B

Gilead Sciences
1900 - 2130
Management of CMV Retinitis: Where Are We Today?
Waterfront Centre Hotel: Mackenzie Room
National AETC Program,
U.S. Public Health Service,
AIDS Care Treatment and Support Programme,
Health Canada (Joint U.S.A.-Canada-Mexico Satellite)
(continues Tuesday, July 9)

1900 - 2130 Each Day
Innovative Partnerships in Education and Care:
Health Professionals and People Living With HIV/AIDS
Vancouver Renaissance Hotel

Sexually Transmitted Diseases Branch,
National Institute of Allergy and Infectious Diseases,
National Institutes of Health
1900 - 2200
Topical Microbicides
Wall Centre Garden Hotel: Ballrooms C & D

Ortho Biotech
1900 - 2200
HIV Infection and AIDS:
New Biology, Therapeutic Advances, Clinical Implications
Westin Bayshore Hotel: Ballroom

European AIDS Treatment Group, Berlin,
British Columbia PWA & Positive Women's Network, Vancouver
1930 - 2100
Women in Treatment Activism 1996
The YWCA Hotel

Film Festival

Bright Eyes / 7 pm
Judge MacGill Theatre

Zero Patience / 9 pm
Judge MacGill Theatre

Cultural Events

Theatre/Dance Festival / 8pm
Vancouver Playhouse, Hamilton at Dunsmuir
Tickets: $14 general admission
TicketMaster 280-4444
(also on Tuesday July 9)

Don Juan in Hell / 8pm
Bard on the Beach tent,
Vanier Park, 1100 Chestnut Street
Tickets: $25
TicketMaster or Bard box office 739-0559

World Beat Party
doors 8pm, music 8:30pm
The Rage, 750 Pacific Blvd. South
Tickets: $25 Conference delegates / $30 non-delegates
TicketMaster 280-4444

The Robson Square Art Exhibit
July 6 to July 11 noon to 9pm
free of charge

Vancouver Art Gallery
"General Idea, Infections" and
"The Group of Seven Retrospective"
On view throughout the Conference
750 Hornby Street
Mon-Sat 10am - 6pm, Sun 2 -5 pm
Admission: Adults $6, seniors $4, students $3, under 12 free
Pay what you want Thurs 6-9pm

Poor Superman
June 26 to July 27 8:30pm
July 10 special 2 for 1 at 4:30pm
Arts Club Theatre New Revue Stage
1585 Johnston Street
Tickets: Monday to Thursday $21.50, Friday and Saturday $25.50
Box Office: 687-1644

For more information on the Conference cultural program,
please refer to Vancouver's arts and entertainment weekly,
The Georgia Straight, copies of which are
available at all Conference venues.

FEATURE REVIEW

Can combination therapies eradicate HIV?
by Mitchell Beer

It's a possibility that people are discussing in research labs and
clinics across North America and Europe. It was a hot topic during
coffee breaks at the satellite sessions attached to the Conference.
It's making the rounds on the Internet, and exploding into sudden
controversy in the popular press. It's a source of immense hope for
people whose T-cell counts are suddenly making a strong comeback. And
it's raised a variety of concerns for AIDS activists who fear that
research funding and HIV prevention efforts will appear less urgent
once the news reaches the general public.

Slowly, carefully, almost without quite believing their own findings
and experience, AIDS practitioners are beginning to ask whether it
might be feasible to eradicate the human immunodeficiency virus in
people living with HIV/AIDS (PLWH/As). The theme is rapidly gaining
momentum among a group of researchers and clinical practitioners
specialising in the measurement of viral load, use of combination
therapies, and the daunting but tantalising effort to indefinitely
delay the onset of viral resistance.

If anyone had asked six to 12 months ago whether HIV could be
eradicated, "they would have been laughed at," said Julio S.G.
Montaner, Program Co-Chair for the Conference and National Co-Director
of the Canadian HIV Trials Network. "Today, the question not only
doesn't get you into trouble, it's actually worth asking."

Montaner stressed that the ability to eradicate HIV is still only a
hypothesis. "We're not saying we can eradicate anything. We're saying
our data show that we can effectively suppress viral resistance in a
number of people over a period of time." But if researchers like
Montaner, David Ho and Doug Richman are correct, "we're onto something
very, very big."

The first of several building blocks supporting the drive toward HIV
eradication is a recent flurry of developments in the measurement of
plasma viral load. Until recently, monitoring of HIV progression was
based on CD4 counts, which could only measure damage that had already
occurred.

The second important leap has been the growing scientific consensus
that combination therapies are beneficial -- a view considered
questionable just a few years ago. This is where new drug development
has been critically important, said Montaner. "In the world of only
one or two combinations, it was reasonable for people to say 'don't
use it now, because you're going to need it later'...In six months
we've doubled our therapeutic armamentarium in Canada, and that has
made double and triple therapies a reality."

At the First HIV Eradication Meeting last month, Montaner reported the
prospect of delaying the onset of resistance opens the door to the use
of cheaper drugs that would otherwise invite the development of
resistant strains.

In a late-breaker session Thursday, David Ho of the Aaron Diamond AIDS
Research Center in New York will suggest that a 1.5- to three-year
course of combination therapy may completely eliminate infected
macrophages and CD4 cells. A group of eight patients receiving
nelfinavir, zidovudine and lamivudine showed a 100-fold drop in plasma
viral load in the first two weeks of treatment, but Ho will recommend
a longer period of therapy to eradicate longer-lived infected
macrophages.

But in contrast to the optimism that was evident as the XI
International Conference on AIDS got under way, many AIDS
practitioners and activists are nervous about the potential dangers of
framing HIV as a manageable, chronic disease that might soon be
curable. They fear that funders may place HIV on a par with conditions
like diabetes, and that AIDS education and prevention efforts may be
stalled.

"We've made progress, but undetectable levels do not mean zero
levels," said Maggie Atkinson, Co-Chair of AIDS Action Now! in
Toronto, Canada. "We don't really know the clinical effects of these
treatments."

Martin Delaney, Founding Director of Project Inform in San Francisco,
adds that it would be terribly premature to send out the message that
HIV is under control. "Even though we may be on the brink of
something, there's a huge gap between clearing the first person of a
disease and turning that into a practical medical strategy that will
apply to hundreds of thousands of people." Even if it becomes possible
in two years to discontinue therapy for some PLWH/As, "it's going to
take a decade or more just to roll it out, even in the US."

Delaney and Montaner both stressed that the state-of-the-art therapies
that could perhaps eradicate HIV will not be universally accessible to
all societies, countries and groups. "We clearly have things to hope
for," Montaner said, but "what is not so clear to me is how we're
going to go full circle and say one world, one hope, one world."

Meanwhile, AIDS researchers in the US are already under intense
pressure to investigate other diseases, and "it's hard to debate
because the truth is that we are spending too little on the other
diseases," Delaney said. "It really forces us into a debate that
nobody wants to have."

Battles over health spending priorities also make it easy to lose
perspective on the amount of money involved, he added: "When you talk
about the amount of money that we quibble over in AIDS, for $100
million here or there you're talking two more jet fighters or one
submarine for the military. The great waste of spending is elsewhere."

The emergence of new combination therapies will also create the need
for a public awareness effort focussed on at least two messages,
Delaney said.

First, news that eradication may be around the corner must not leave
people with the impression that they can now abandon safety practices
designed to prevent HIV transmission.

Second, PLWH/As receiving combination therapies will have to
understand the "enormous precision and discipline" required to make
the treatments work. "People have to commit to disciplined therapy for
a long time," with the knowledge that multi-drug resistance will occur
almost immediately if treatment is interrupted.

Another group with reservations about the new combination therapies is
the AIDS Coalition to Unleash Power (ACT UP).

In an interview from New York City Friday, ACT UP member Ellen Bay
said activists are as eager for good news as anyone else. But "the
optimism that's being displayed in advance of this Conference is a bit
scary to me," Bay said. "We have to temper our pleasure at the
possibilities with some common sense, and not just grab onto this
merry-go-round and say we have a cure."

Bay said the availability of combination therapies becomes something
of a "crap shoot" for PLWH/As, who may be deciding to accept a
relatively unknown drug combination for the rest of their lives.
Clinical experience with protease inhibitors only dates back about 16
months, she said, so there's no way to know what physiological impact
the drugs will have over five to 10 years. The information that is
available on the hepatic and renal side effects of protease inhibitors
leads Bay to question their efficacy for injection drug users (IDUs)
or alcoholics who "have lousy livers and kidneys to start with".

For Julio Montaner, only time will tell whether the encouraging
results of the past six months will translate into an effective,
consistent assault on HIV.  "The way you test a hypothesis is to take
the opposite approach -- you say that HIV cannot be eradicated, so
let's try to prove that. And that's what we're doing." While
proponents of the eradication theory are clearly excited at the
direction in which their research is taking them, they stress that
they're not declaring an end to the war on AIDS.

"The issue today is that we're asking the question," Montaner said.
"Six months or a year ago, it wasn't a question that we could even
formulate."

Antiretroviral therapies reduce viral load

The combination of the reverse transcriptase inhibitors lamivudine
(3TC) and zidovudine (ZDV) does offer clinical benefits as measured by
lowered HIV levels in the blood, higher CD4  count and lessened risk
of progressing to AIDS, says  Andrew Phillips of London's Royal Free
Hospital School of Medicine.

Phillips reported in yesterday's Session 136 on a randomised trial of
ZDV/3TC among 620 North American patients.  For the group which had
never before received zidovudine, treatment was given with either drug
alone or a combination of both. Individuals who had previously taken
zidovudine were treated with a combination of either ZDV/3TC or
zidovudine with dideoxycytidine (ddC).

Throughout the trial, both groups receiving the ZDV/3TC combination
maintained significantly lower levels of HIV RNA, a higher CD4+
cell count, and a quantifiable decrease in the expected risk of
progression to AIDS. The main point, says  Phillips, is that the delay
in clinical progression corresponds well to the observed
treatment-induced changes in HIV RNA and CD4+ cell counts.

In the same session,  Maureen Myers of the INCAS Study Group reports
on a comparison of several combination regimens involving ZDV,
didanosine (ddI) and nevirapine (NVP) in 152 individuals who had not
previously received antiretroviral therapy.


Over the course of the year-long study, there was a substantial
decrease in mean plasma viral load with use of two- and three-drug
combinations, with a mean decrease of more than 2 log10 within a month
of starting.  The regimens were well-tolerated.

Louis Saravolatz of Detroit will report on results in a trial of zdv,
ddI and ddC carried out by Terry Beirn Community Programs for Clinical
Research on AIDS, while  F. Brun-Vezinet of the Delta Virology Group
in France discusses a trial of the same drugs to elucidate the
connection between viral load and immunological measures.

Therapy and viral load monitoring: state of the art

In AIDS work, every achievement is linked to every other. This morning
in plenary session, Scott Hammer of the Harvard Medical School
examines those links with a broad overview of recent therapeutic
advances which, he says, offer a renewed sense of hope.

The days are over when the only option for treatment was AZT
(zidovudine, also known as ZDV), said Hammer in a pre-Conference
interview. Although it remains a useful therapeutic agent, it has been
joined by several other nucleoside-analogue reverse transcriptase
inhibitors (ddI, ddC, 3TC, D4T) as well as a class of non-nucleoside
agents (including nevirapine, delavirdine, loviride and DMP-266).
Resistance has emerged with some of the non-nucleosides. However,
Hammer noted, their value is now being appreciated for combination
therapy and selected situations where resistance is less of an issue,
such as for prophylaxis in accidental needle sticks or for newborns of
HIV-infected mothers. Acyclic nucleoside phosphonates comprise still
another class of reverse transcriptase inhibitors for which clinical
trials have begun. Combination treatment with several of these agents
can not only help avert resistance and minimise toxicity, said Hammer,
but has now been found to afford real clinical benefit for those with
both intermediate-stage and advanced disease. No longer need
antiretroviral therapy be reserved for the most advanced patients.
Hammer will describe trials of one particular combination -- ZDV/3TC
-- in detail, and offer a preview of many other upcoming presentations
at this conference.

Perhaps the biggest news, said Hammer, is the whole new group of drugs
aimed at a entirely different target: viral protease. These include
saquinavir, ritonavir, indinavir, nelfinavir and VX-78, being
developed by Vertex and Glaxo-Wellcome. He notes that several --
particularly ritonavir and indinavir -- have already proven their
clinical worth, and combinations which promise unprecedented
suppression of viral replication are being explored.

With every new agent developed, learning takes place. Hammer spoke of
the "roller coaster ride" investigators typically experience, where
fresh peaks of hope are followed by plunges into the depths as
problems emerge, and rising expectations as solutions or ways around
obstacles are found. With non-nucleoside RT inhibitors, the initial
problem was resistance, and the emerging solution is combination or
"niche" use. So far, said Hammer, protease inhibitors are on the way
up with no dip in sight. Very significant and sustained increases in
CD4+ cell counts and potent virus suppression are giving rise to real
clinical benefit in trials, he noted. And the benefit of
antiretroviral intervention is being demonstrated even at the stage of
primary infection -- perhaps early enough to change the whole course
of the disease. It is even becoming acceptable, Hammer said, to speak
of a day in the future when actual eradication of HIV may be possible
-- a notion that would have been ludicrous as recently as six months
ago. In the process, he noted, a great deal has been and will be
learned about pathogenesis, mechanisms of resistance and optimal
strategies for combination therapy.

At the same time, Hammer noted that great strides have been made in
the preventive use of antiretroviral agents. One which he said truly
has the potential for global impact has been the achievement of a
2&#47;3 reduction in the rate of maternal-foetal HIV transmission with
ZDV, leading to hope that combinations with newer agents can increase
the benefit here just as they have in therapeutics. Antiretrovirals
have also proved of use in reducing the hazard of occupational
exposure to HIV.

Hammer's presentation will also outline the state of the art in viral
monitoring tools, with specific reference to research to be presented
later in the conference. New, accurate measures of HIV RNA can help
predict disease progression, assess the efficacy of new therapies and
add to the fund of knowledge about pathogenesis. The new techniques,
he said, offer a much more sensitive tool with which to measure an
individual's health status than do CD4+ cell counts, and have greatly
contributed to the development and trial of more potent therapeutic
agents.

Pathogenesis, new therapies and better monitoring -- all are
inextricably linked. Challenges remain, stressed Hammer; resistance
may be foremost among them as it was with the older agents. However,
the newest and most potent agents offer real hope for the first time
that viral replication may be suppressed so quickly and so completely
that mutation is simply precluded.

Protease inhibitors: Ritonavir test shows reduced mortality rate

In Session 136 today,  Bill Cameron of the University of Ottawa will
present the results of a multicentre trial of ritonavir -- a potent
protease inhibitor which can be taken orally -- in 1,090 people with
advanced HIV disease.

At the outset of the trial, all participants had a history of previous
antiretroviral therapy and CD4+ cell counts of fewer than
101&#47;microlitre; the median was about 20 for the group as a whole.
Participants continued their usual therapy during the study.  After
four months,  Cameron says, ritonavir had proved of such benefit that
it was made available to any participant with a new or recurrent
AIDS-related illness.

Although adverse reactions including nausea, diarrhea and weakness did
appear, ritonavir was shown to be effective at preventing new or
recurring AIDS-related illnesses and prolonging life. The mortality
rate in the group taking ritonavir was 4.8%, compared to 8.4% of those
receiving placebo, and this survival benefit has been sustained.  The
rate of progression to either more advanced disease or death was 15.7%
for the ritonavir group and 33.1% for those on placebo.

In a pre-Conference interview, Cameron noted that the benefits of
ritonavir increase significantly when it is used in combination with
other agents, such as ZDV, ddC and 3TC.  He that combination of
ritonavir with other protease inhibitors may provide even better
results.

In the same session,  Charles Hicks of North Carolina describes the
safety and efficacy of ritonavir in large doses.   Jonathan Shapiro of
California will discuss possible reasons for eventual loss of efficacy
in monotherapy trials of saquinavir, another protease inhibitor.
Miklos Salgo of New Jersey will describe a trial of a saquinavir/ddC
combination, while  Roy Steigbigel of New York will present the
results of varying dosages of indinavir.   Joseph Gathe of Texas
concludes the session with trial results for a combination of viracept
and D4T.

Fact File

The XI International Conference on AIDS is the world's largest
gathering of researchers, clinicians, people living with HIV/AIDS,
exhibitors, and media.

       Anticipated number of Conference participants: 15,000
       Number of exhibitors: 1,000
       Number of media: 1,000 to 1,500
       Countries represented: 125
       Abstracts to be presented: 5,380
       Conference volunteers trained: 1,007
       Languages that volunteers speak: 56
       Hours of volunteer time committed: 20,000
       Delegates funded by Conference scholarship program: 1,076
       Scholarships awarded to participants working in developing
           countries (percent): 50.8
       Percentage awarded to women: 46
       Percentage to delegates who self-identified as being
           HIV-positive: 45.5
       Scholarship applicants turned down for each one who was
           accepted: 2.13
       Donor organizations that declined to fund the scholarship program
           for each one that accepted: 6
       Estimated new cases of HIV infection per day, world-wide: 7,500
       Estimated new paediatric cases: 1,000
       Kilograms of food ordered for welcoming reception: 4,100
       Kilometres of string required for delegate badges: 11.67

SATELLITE SYMPOSIUM

HIV prevention works

"Let's march on the drug companies," said Thomas Coates of the Center
for AIDS Prevention Studies at the University of California.
"Togetherness, caring, support, acceptance," said Noerine Kaleeba,
cofounder of The AIDS Service Organization (TASO) in Uganda. "That is
how we get to the stage where we can protect against HIV infection.
Shared confidentiality is a therapy in itself."

These were two of the voices heard Saturday at a symposium on HIV
prevention jointly held by the Canadian Public Health Association,
Health Canada, UNAIDS, and the Centers for Disease Control and the
National Institutes of Health in the US.

During the day, participants attended sessions on prevention through
working with individuals and families or whole communities.  Other
sessions dealt with organisational and societal change and research
for prevention evaluation.

Throughout, attendees made one thing clear:  their view that
preventive programs are being neglected in favour of research into new
therapies which will be beyond the means of most of the world's people
infected with or affected by HIV/AIDS.  "Clearly," said Thomas Coates,
"the strongest predictor of HIV infection worldwide is poverty."

Yet prevention does work, testified speaker after speaker from over a
dozen countries, reporting on efforts from Mexico to Myanmar, from
Uganda to the US. For example, specific preventive efforts among Thai
soldiers have brought a dramatic drop in new infections in the teeth
of a raging epidemic. But lack of resources restricts the benefits of
preventive campaigns to selected groups: soldiers in Thailand, urban
dwellers in Uganda.

Prevention is more difficult than therapeutic research, suggested
Justice Michael Kirby of the High Court of Australia, a former member
of the WHO Global Commission on AIDS.  It's slow, carries little hope
of a Nobel prize and involves the greatest challenge of all:  changing
human behaviour and societies.

In concurrent sessions, participants were independently drawn to a
theme of "mosaics": HIV/AIDS as a mosaic of distinct epidemics within
a pandemic; the mosaic of people worldwide affected by it; the mosaic
of skills needed and of sectors which must collaborate for prevention
to be effective.  Too often, said Kirby, preventive work is expected
to be "totally effective" -- an impossibly high standard, "as
fallacious in the health field as it is in law".

A draft statement incorporating participants' views will be presented
at the XI International Conference on AIDS.  "Eventually," summarized
Kirby, "HIV/AIDS will be a footnote in history. The answer will not be
found in drugs, but in human behaviour."

And, Noerine Kaleeba might have added, in the human heart.


Fora Communitario progresa en asuntos importantes

Los participantes en el Foro Comunitario 96, una reunin
internacional de personas que viven con VIH/SIDA y trabajadores de
organizaciones comunitarias, realizaron su objetivo de identificar y
recomendar accin en los asuntos esenciales de los de primera
lnea ante la respuesta internacional del VIH/SIDA,
manifest Teresita Bagasao, representante de una ONG en Manila y
quien diera el discurso principal en la plenaria de clausura del Foro.

Bagasao reconoci que fue difcil llegar a un consenso cobre la
accin estratgica a tomar un torno a estos asuntos, pero
pudieron controlar toda esta diversidad de idiomas, culturas, husos
horarios y contextos.

Alrededor de cien personas de las cinco regiones del mundo -- Africa,
Asia del Pacfico, Amrica Latina y el Caribe, Europa, y Amrica del
Norte -- participaron en el Foro celebrado en la Universidad de
British Columbia. La plenaria de clausura present informes sobre
cuatro temas: derechos humanos, tratamiento, investigacin y
evaluacin social, y desarrollo de comunidad y organizacin.

Uno de los puntos de accin en el informe sobre derechos humanos fue
la formacin de un grupo de trabajo mundial de ONGs preocupado por la
proteccin de derechos humanos de las personas que viven con el
VIH/SIDA y los vulnerables a la infeccin del virus; asimismo, se hizo
hincapi en la integracin de la investigacin en los programas de las
organizaciones comunitarias.

No obstante, Bagasao seal que cualquier accin efectiva en
torno al VIH/SIDA depender de cmo colaboremos juntos asumiendo
una responsabilidad personal en la aplicacin de estrategias y planes,
finaliz.

Progrs effectus par la Forum Communautaire dans des domaines
cls

Les participants au Community Forum 96, tenu vendredi et samedi 
l'Universit de Colombie-Britannique, ont identifi les problmes de
la lutte internationale contre VIH/sida et ont recommand des
solutions, a dit Teresita Bagasao qui a prononc un discours  la
sance de clture.

Bagasao, de l'ONG Partenariat avec les familles
philippines de Manille, a reconnu que le rassemblement d'une
centaine de personnes vivant avec le VIH/sida et de travailleurs
communautaires de chacune des cinq rgions du monde, a eu du mal
 convenir des mesures stratgiques  prendre. Nous
avons surmont nos diffrences, nos multiples langues, cultures, et
contextes. C'tait une lutte, mais il n'y a pas de progrs sans
lutte, a-t-elle dit.

La sance de clture comportait les comptes rendus des participants
qui avaient examin en groupes la planification stratgique et le
perfectionnement des comptences autour de quatre thmes : les droits
de la personne, le traitement, la recherche sociale et l'valuation,
et le dveloppement communautaire et organisationnel.

Leurs recommandations comprenaient : la formation d'un groupe mondial
d'ONG pour la dfense des droits des personnes vivant avec le
VIH/sida; une norme mondiale de soin et traitement; l'intgration aux
programmes des organisations communautaires d'un volet de recherche;
l'attribution d'au moins 15 % des fonds des programmes nationaux de
lutte contre le sida aux ONG et autres groupes communautaires.

Ce que nous avons accompli n'aura de signification que si chacun
d'entre nous assume ses responsabilits. Nous pouvons continuer 
faire une diffrence si nous mettons en oeuvre les stratgies et plans
que nous avons labors, a conclu Bagasao.

Program Update

Abstract Mo.D.1870, Qualitative Research on High-Risk Behaviour Groups
in Nicaragua, will be presented as a poster on Monday, July 8 by
author Rita Arauz, Fundacin Nimehustzin, Managua, Nicaragua.

The title of Abstract Tu.D.603 by Dan Allman should appear as
Recruiting the Canadian Bisexual Male: Implications for HIV Prevention
Research.

The Xth International Conference on STD/AIDS in Africa will take place
December 7-11, 1997 in Abidjan, Cte d'Ivoire. Information: Exhibition
Booth 212.

Masthead for The Daily Progress

The Daily Progress is the daily newspaper of the XI International
Conference on AIDS. It appears every morning of the Conference, to
give participants an update on the previous day's discussion and
events.

Editor in Chief: Robyn Sussel
Managing Editor: Mitchell Beer
Editorial and Management: InfoLink Consultants Inc., Ottawa
Design: Signals Design Group
Photography: Kim Stallknecht Photography
Production: Working Design
Printing: Broadway Printers Ltd.

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