Global action needed to tackle an out-of-control epidemic

Two MEPs describe their strategies to deal with HIV/AIDS

The battle against HIV/ AIDS needs to be waged constantly with more care of patients and easier access to drugs, says John Bowis

The EU is playing a major role in the HIV/AIDS area but you can never say it is doing enough. There are some aspects of the problem where I do not think enough is being done.

We need constant work, for example, on prevention, on investment in education and in promoting safer sex. This involves investment in changing culture. In some cultures, adult males believe they can have protection from HIV/AIDS by having sex with a young girl. We need to make sure that this is seen as abhorrent and unacceptable. This is a battle that needs to be waged constantly.

We need to contribute to the debate about the TRIPS [trade-related aspect of intellectual property rights] and other agreements to make sure that anti-retrovirals are available not just at prices that people can afford but to make sure that they reach them. When I have been in Southern Africa, people have said to me: "We are grateful for what the EU is doing on AIDS but nobody comes and gives us a hand with our national health service."

We need to develop vaccines. The trial of vaccines needs support at this stage but vaccination efforts will need even more support when vaccines come into use. Ensuring availability will be a major challenge.

It is also important to lead the charge on the care side. The more successful we are in distributing drugs, the more you have an epidemic, not of people dying of AIDS but of living with AIDS. And if the experience of Europe is followed, they can live long years.

That is good news but in the meantime we need to care for people dying of AIDS. Palliative care has to become more of a priority. Here I am not talking about hospices in Africa but of having peripatetic health teams. This is partly a question of training and partly of financing and resourcing specialists for palliative and nursing teams and to some extent doctors.

Palliative care is a crucial element in dealing with AIDS, as we have found in the UK, where it started with cancer and went on to AIDS patients and now is being used to treat Parkinson's disease. Often, this involves having day care and helping people in their own homes. It concerns questions like applying creams when someone's skin becomes more sensitive.

People who think it is moral to take a judgment on people's lifestyles should also ask whether it is moral that 12 million AIDS orphans are denied help. When I was a health minister in the UK, I took the view that once somebody was ill you did not go back to their past history and ask 'how did you become ill?' Of course, you would try to change an unsafe lifestyle.

You have to do your best to change the policies of governments who take a slightly strange attitude to AIDS. At one point, the South African government was denying that AIDS was a problem. Sometimes strongly Christian and Muslim countries take particular attitudes on condoms. My view is that it is only normal that you should put patients first. There are many patients who are vulnerable, through no fault of their own. That goes for children, women and, in some parts of the world, it goes for men too.

In Europe about 10% of new cases of HIV/AIDS that are diagnosed belong to multi-drug resistant strains. In America the figure is 20% and in California 25%. Obviously, this is a major problem.

In Africa, some of the key questions are the use of safe drugs and the avoidance of black market drugs.

Counterfeit drugs are causing a major headache; this kind of fraud has severe potential to damage health. We need to have some sort of regime to deal with this; it might involve putting markers into drugs, for example. It cannot just be solved by having special packing as this can be counterfeited. This is an area which needs global action.

• UK Centre-Right MEP John Bowis is vice-chairman of the Parliament's delegation to the joint Parliamentary assembly for the EU and the African, Caribbean and Pacific bloc.

We have to keep developing new forms of prevention while at the same time spreading the existing methods, says Luisa Morgantini

One year ago, the members of the committee on development in the European Parliament witnessed the handing over of the HIV/AIDS file from the Dutch EU presidency, represented by Minister for Development Co-operation Agnes Van Ardenne, to her Luxembourgian successor Jean-Louis Schiltz.

A year after, the epidemic is still far from being under control. The total number of people living with HIV reached its highest level: 40.3 million. Despite recent, improved access to anti-retroviral (ARV) treatment and care in many regions of the world, the AIDS epidemic claimed 3.1m lives in 2005.

Africa is without doubt the region most affected by the virus. Inhabited by just 10% of the world's population, Africa is estimated to have more than 60% of the AIDS-infected population. In particular, sub-Saharan Africa is home to 25.8m people living with HIV, two thirds of all people living with HIV in the world.

Access to medicines for everybody has to be achieved. In fact, even if the anti-retroviral treatment exists, 93% of the infected population have no access to it. Also the stigma surrounding the disease must be fought: being affected by HIV/AIDS does not necessarily mean being condemned to die in the short term. Therefore, treatment programmes have to be urgently scaled up: training of human resources, adapted and available treatment and medical tools need to be ensured and for all this, increased funding needs to be made available.

In Brazil, which can be used as the example to follow, patients are being treated for free.

In many countries, resources are much more limited and it is then obvious that people who have to pay cannot have access to the care they need. Especially in the developing countries, it would be better to abolish patient charges for healthcare.

Medicines are not the only aspect of treating HIV/AIDS, but they are an important one. Mechanisms in place that aim at ensuring affordable medicines need to be thoroughly assessed. Non-governmental organisations such as M�cins sans Fronti�res have to spend $3,000 (�2,560) in the best case scenario for treating patients that need the latest ARVs. Needless to say that at such costs, treatment programmes are unsustainable. If the mechanisms in place do not guarantee affordable medicines, new efficient ones need to be implemented: a vaccine would of course be the ideal solution and given the size of this epidemic, efforts aiming at speeding up research need to be increased.

But HIV/AIDS is a complex issue and it affects all groups in society.

In the developing world today, young and married women are most at risk. Gender inequality prevents women from having the power in a relationship to insist that their partners use a condom or stay faithful. Women need some means to protect themselves from infection that does not need the active participation of the male partner and that is not necessarily contraception.

The EU has been active by defining a specific Programme for Action on HIV/AIDS, malaria and TB which is positive but several of the strategies implemented need to be assessed, some need to be increased and further steps need to be taken.

More efficient preventative measures need to be supported since promoting abstinence or refusing condoms (such as supported by some) will only fuel the spread of the epidemic.

While spreading the existing prevention methods, new forms of prevention need to be developed. As underlined in the last UNAIDS/WHO report AIDS Epidemic Update - December 2005, the development of new tools such as micro-biocides needs to be supported. They should provide additional options for the response and become part of comprehensive prevention strategies.

• Italian Left MEP Luisa Morgantini chairs the Parliament's committee on development.

Two MEPs describe their strategies to deal with HIV/AIDS. Article is part of a European Voice Special Report: 'HIV/AIDS'.

• Primary Source