An international AIDS conference has exposed a gulf between scientists and politicians on how to tackle the deadly HIV pandemic.
Despite promises from governments around the world to pursue evidence-based policies, AIDS experts are frustrated at a refusal to adapt to new ways of looking at HIV and the people most at risk of contracting it.
It is a stance that displays discrimination and criminal negligence, says Julio Montaner, president of the International AIDS Society, who has led a drive at the conference to get politicians to wake up to the evidence.
"Yes we are treating five million people today, but there are 10 million people who need treatment, otherwise they will get sick and die. Not treating them amounts to criminal negligence," he told Reuters.
At the heart of scientists' frustration is the impressive progress made against the human immunodeficiency virus (HIV) that causes AIDS since it emerged in the early 1980s.
Advances in medicines have effectively turned an acute killer disease into a manageable chronic condition in many wealthy countries. Patients who take cocktails of AIDS drugs can often live normal lives - they work, have sex, bear children and can even look forward to meeting their grandchildren.
Sense of outrage
The message from scientists is: we've given you the tools and the evidence, now give us the money to use them.
Yet the political will to fund the AIDS battle is waning, they say.
"The world has become numb to the toll of 7,400 new HIV infections every day," said Michel Sidibe, director of the United Nations AIDS programme UNDAIDS. "We need to recover our sense of outrage."
The AIDS virus infects 33.4 million people globally. In sub-Saharan Africa, 22.4 million people have it. Eastern Europe has the fastest growing HIV epidemic in the world.
So while the disease has been contained in some groups, in others the epidemic is raging "out of control", according to one World Health Organisation expert. Other analysts at the conference described the situation as "like running after an accelerating train".
"Today, for every two persons starting treatment, five new infections occur," Francoise Barre-Sinoussi, the French scientist who won a Nobel Prize in 2008 for her work in identifying HIV in 1983, told the Vienna conference.
"The growing curve of the epidemic cannot be stopped without a strong and global commitment to combined HIV prevention measures, including treatment."
The Vienna conference has seen study after study on HIV prevention measures ranging from male circumcision to microbicide gels containing AIDS drugs.
Studies on Eastern Europe have found harsh laws and authorities' refusal to offer HIV services to injecting drug users are fuelling an underground epidemic there.
In Africa, researchers have demonstrated treatment programmes which cut costs by simplifying the ways in which patients get their drugs and earlier treatment.
UNAIDS has drawn up proposals called "Treatment 2.0" designed to improve efficiency in the global AIDS effort by developing more simplified drugs and delivery systems and using more community health workers.
But UNAIDS also reported that overall support for the AIDS fight from donor nations flattened last year amid the financial crisis.
In 2009, the G8 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.
The head of the Global Fund to Fight AIDS, Malaria and Tuberculosis, Michel Kazatchkine, says he is "really afraid" about the prospect of getting the $20 billion needed to continue the AIDS battle for the next three years.
"The big frustration is that we feel we have really responded to the call of proving certain efficiency models," said Nathan Ford, a Medecins Sans Frontieres doctor who works on AIDS treatment programmes in some of Africa's poorest countries.
"I get the sense that no amount of data is going to change things. The decision has already been taken - but that is not how global health should be run."
A replenishment conference is due on Oct. 5 in New York. Until then, Kazatchkine says there is time to show political leaders how the evidence is stacking up to show not increasing AIDS funding will be a decision that costs millions of lives.
"We have demonstrated the feasibility. Countries have shown that they can massively scale up. The case is strong. The funding decision is a political decision for the leaders of this world, and a political decision is a choice," he said. (Reuters Health/ Kate Kelland– 26 July 2010)