The New AIDS Memorial

SHANGHAI (Reuters) – A handful of Chinese drug firms are gearing up to beat foreign pharmaceutical giants at their own game, lobbying the government for approval to start producing the country’s first drugs to combat AIDS (news – web sites) at rock-bottom prices.

While the big foreign firms attach price tags of thousands of dollars a year to their drugs, upstart Shanghai Desano Co boasts it can make AIDS drugs that will cost cash-strapped Chinese sufferers just $360 annually.

Little-known private firm Desano has applied for approval to begin making two such dirt-cheap alternatives, saying they are just as effective as patented versions, a senior company official told Reuters on Thursday.

“We have a clear advantage in terms of capital costs. Our product is definitely superior in terms of price,” Desano’s senior manager Li Jinliang said in a telephone interview.

“Outside of China, foreign drugmakers would make a loss selling at these levels — we’ll break even.”

In contrast, Bristol-Myers Squibb sells two patented drugs Videx and Zerit for a whopping 870 yuan and 3,110 yuan per bottle respectively, enough for just two weeks.

COUNTER TO POLICY

If the government approves Desano’s products, as Li is confident it will by early next year, it would seem to run counter to current policy.

A senior Health Ministry official said on Tuesday China had no immediate plans to allow production of generic AIDS drugs for the domestic market.

Instead, it was negotiating a deal with foreign patent holders to bring their prices down.

State media have reported that officials have told Chinese pharmaceutical firms not to break Beijing’s WTO commitments on intellectual property rights by copying foreign patents.

But Li said Desano’s drugs, while modelled on patented formulas, are the culmination of two years of intensive in-house research. Desano currently operates a bioengineering and pharmaceutical development house staffed by 50 researchers.

“It’s our own development, but of course we have to refer to related reports from foreign sources. We couldn’t possibly start from scratch,” Li said. “We referred to patents in this area.”

LIFE AND DEATH

Smelling an opportunity, state-owned Northeast General Pharmaceutical Factory, which like Desano has been exporting raw drug components to South America and India for years, has also applied to produce generic variants of finished drugs.

“We now only export AZT. But we have applied for sales in China. Once approved, we will be able to open the domestic market as well,” a Northeast General official told Reuters.

A Bristol-Myers spokeswoman said she was unaware of plans by any Chinese firms to market AIDS drugs to China’s HIV (news – web sites) carriers — estimated at one million by the United Nations (news – web sites).

Health experts say the short supply and exorbitant cost of AIDS drugs in China are symptomatic of the government’s slow response to a lurking HIV problem which the United Nations has reckoned will soon balloon into a major epidemic.

In China, the cost of a drug can mean the difference between life and death. Many AIDS victims find treatment scarce and prohibitively expensive, with a year’s course of a cocktail of AIDS drugs used in the West often costing $10,000 in China.

But there are signs the government is starting to take the AIDS threat seriously and China’s first national AIDS conference was held in Beijing this week, attended by top Chinese and UN health officials and major foreign drug firms.

UN AIDS chief Peter Piot has urged China to bring the price of treatment down through negotiations with Western firms.

But some firms aren’t waiting around to see if prospective negotiations work out.

“China’s AIDS situation is very murky in a lot of areas,” Li said. “The government is heightening its awareness campaign and encouraging state enterprises to get into this field. A lot of firms are starting to eye this market.”

“We’re just waiting for approval before starting clinical trials,” he said.

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Friday November 16 5:23 PM ET 
UN Official: Development Key to Fight Against AIDS
ROME (Reuters) – Economic development and easing patent laws to allow cheaper drugs are key to combating AIDS (news – web sites), a senior United Nations (news – web sites) official said on Friday.

“AIDS is an extremely complex problem, and the main solution to the problem is development,” said Marcela Villarreal of the Rome-based UN Food and Agriculture Organisation (FAO).

“Development means people become less vulnerable as they have better nutrition, education and access to health services,” Villarreal, chief of FAO’s population programme service and an authority on AIDS, told Reuters.

Cheaper treatment is a vital means to combat AIDS in the developing world where drugs are out of the reach of most people, she said.

She welcomed an agreement at World Trade Organisation talks this month to allow poor countries to skirt WTO rules on pharmaceutical patents to obtain cheaper drugs.

But she said that the availability of low-cost drugs for AIDS treatment could discourage research if pharmaceutical giants see their profits fall.

Brazil’s commitment to provide generic drugs free of charge to HIV (news – web sites)/AIDS sufferers is a positive step as it recognises the contribution of patients to society, Villarreal said.

But she warned that cheaper drugs had to be accompanied by effective health systems in which full dosages were guaranteed

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Wednesday November 14 2:37 PM ET 
China’s Gay Activists Cheer New Openness on AIDS
By John Ruwitch

BEIJING (Reuters) – In a country that has long kept homosexuals in the closet and AIDS (news – web sites) under wraps, gay activists in China at last have something to cheer about. The Chinese Psychiatric Association dropped homosexuality from a list of psychiatric disorders this year.

And this week, the first national conference on AIDS has gone some way to bring into public view a problem of potentially catastrophic proportions for the gay community.

Gay activists hope the next step will be AIDS education and awareness programmes among the homosexual community, which can be prone to high-risk behaviour for AIDS.

“At least people are making a connection between homosexuals and AIDS, regardless of whether it’s good or bad,” said Zhang Yi, who organises gay nights at a Beijing bar.

His remarks suggested that for gays in China, any recognition of their existence, even in the context of AIDS, was a step in the right direction.

But Zhang and others say that after years of discriminating against homosexuals, Chinese officials have little idea how to approach the community. Gays themselves are still reluctant come out of the closet.

“Out of 100 of my friends, maybe only five let their families know they are gay. Maybe none,” Zhang said.

The government appears willing to do something to address AIDS in the homosexual community, said one activist affiliated with what he called Beijing’s oldest, and only free, gay and lesbian hotline.

“They know this group of people is very important and there is a lot of work to be done in this group. But they haven’t fully found a way to do that,” he said.

“And that’s because many people have never had contact with and don’t understand this group. And if they don’t understand it, or can’t come into contact with it, then it’s impossible to do this work sincerely,” he noted.

The United Nations (news – web sites) estimates China has about 1 million carriers of HIV (news – web sites)–the virus that causes AIDS. Chinese health officials put the figure at 600,000, but there were still only 28,133 HIV cases officially registered in the country by the end of September.

Zhang Baichuan, a doctor from the northeastern port city of Qingdao who is involved in pioneering AIDS education and awareness programmes for gay men, said the highest levels of the government already backed some AIDS programmes among homosexuals.

“Their understanding of gays is already basically connected with international standards,” he said.

Last month, the official Xinhua news agency said vice-minister of health Yin Dakui had urged special attention to strengthening AIDS education among China’s homosexuals.

“This is a positive message,” said Wan Yanhai, an activist who runs the Beijing-based AIDS Action Project.

Despite that, however, China still does not publish statistics on homosexuals, which Wan estimated at about 100 million people, or more than 7% of the population.

And earlier this year the government attributed more than one in five of the 28,133 confirmed HIV/AIDS cases to unknown reasons, which possibly includes homosexual activity.

As with many issues in the world’s most populous country, the gap in understanding between the central government and local administrations is vast when it comes to issues related to homosexuality, Zhang Baichuan said. Ignorance and prejudice are also widespread.

“My work is supported by the government. But for cultural reasons, I’m afraid change comes very slowly,” he said.

But Zhang Yi said in Beijing, at least, that was changing.

“It’s a lot more open now than it was even 3 years ago,” he said. Police now rarely barged into the city’s gay bars and harassed patrons, he pointed out.

“As long as nobody’s doing anything bad, getting involved in politics or at odds with the nation, the police don’t care,” he added. 

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Asean adopts Malaysia’s HIV/AIDS initiative

BANDAR SERI BEGAWAN: Asean leaders adopted yesterday a Malaysia-initiated declaration on HIV/AIDS calling for regional action to increase access to affordable drugs. 
In an immediate reaction, AIDS activists around the region applauded the declaration, saying people living with HIV/AIDS could continue to make positive contributions to society. 

The leaders said in the declaration that strengthening regional mechanisms would also provide sufferers with access to care, treatment and information. 

Joint regional action will also see monitoring and evaluating the activities at all levels, systematically-conducted periodical reviews and information sharing with the full and active participation of non-governmental organisations, community-based organisations, people living with HIV/AIDS, vulnerable groups and care-givers. 

The leaders also urged their dialogue partners, international organisations and donor agencies to support greater action, co-ordination and participation in the development and implementation of the actions contained in the declaration. 

“We also urge them to support efforts to establish global HIV/AIDS and health funds and ensure that countries in the region would have equal opportunity to access the fund,” the declaration said. 

In 1999, Prime Minister Datuk Seri Dr Mahathir Mohamad called for a regional summit to discuss the pandemic and during the Asean summit in Singapore last year, the leaders agreed to have a special session on HIV/AIDS at the summit here. 

The primary objective of the session is to mobilise solidarity and peer political support to make HIV/AIDS a national priority and collaborate on inter-country/cross-border issues and exchange of technical expertise. 

Malaysian AIDS Council president Datin Paduka Marina Mahathir said if all the 10 Asean member countries could come together on the issue of drug prices, they would be much more effective. 

Indonesian AIDS activities Yacintha Desembriartista said people living with HIV/AIDS needed care and support not only to improve their quality of life but also to be able to work to look after themselves. 

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Wednesday October 24 2:14 PM ET 
South Africa’s Mbeki Wants More Data on AIDS Threat
By Brendan Boyle

CAPE TOWN (Reuters) – President Thabo Mbeki said Wednesday his government would not alter its approach to the HIV (news – web sites)/AIDS (news – web sites) pandemic sweeping South Africa until it had assessed new data on the disease and gathered additional information.

“I do not believe that at this particular moment, the government is going to do anything to change the policy position that it has announced in this regard,” Mbeki said in response to questions in parliament.

Mbeki has been criticized at home and abroad for his reluctance to acknowledge a direct link between HIV and AIDS or that the disease constitutes an emergency in South Africa.

South Africa is estimated to have more people with HIV-AIDS than any other country in the world, with close to 5 million people or one in nine of the population, according to U.N. estimates.

Mbeki has also blocked the use of key antiretroviral drugs in the public health system, including those that can reduce the risk of mothers passing on the disease to their newborn, on cost and safety grounds.

This is despite top drug firms offering some of these drugs — which can prolong the life of those who are HIV-positive — at prices lower than those in the private sector.

PROTESTS AFTER REPORT BLOCKED

In a recent television interview, Mbeki stunned the scientific community by claiming that accidents and violence killed more people than AIDS.

The state-appointed Medical Research Council said in a study released last week that AIDS would account for a third of all deaths this year and that without government intervention and a change in sexual behavior, it would kill between 5 million and 7 million people by 2010.

The report said about 195,000 people would die of AIDS-related diseases this year, compared to 65,000 to 80,000 deaths as a result of accidents and violence.

Mbeki initially blocked publication of the report, but sanctioned its release after a storm of protest from churches, labor unions and AIDS activists.

Wednesday, he said the report had been submitted for review to a panel including ministers, the government statistics office and scientists.

“We are not considering any reapportionment of funding until that social cluster of ministers and these other processes are concluded. We will then decide how to proceed with regard to this matter,” Mbeki said.

Opposition leader Tony Leon said the treatment of AIDS accounted for only 0.6 percent of total national spending on health. But Mbeki responded saying his government needed more data on causes of death. 

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Friday November 02 02:38 AM EST 
Gays Shrug Off Fear of AIDS
By Randy Dotinga
HealthScoutNews Reporter
THURSDAY, Nov. 1 (HealthScoutNews) — A new study suggests that homosexual men in San Francisco are doing their best to forget that AIDS (news – web sites) poses a threat to their lives. In focus groups, gays say they rarely talk about the disease, even with those who are infected. 

“People told us loud and clear that HIV (news – web sites) is off the radar,” says study co-author Steve Morin, professor of medicine at the University of California at San Francisco. 

While the men said they hear more about the risks of smoking than of unsafe sex, they said better education would help. Many suggested that advertising campaigns focus on reasons to avoid AIDS, not just messages about using condoms. 

University researchers interviewed 55 gay men over the summer in a project commissioned by the San Francisco Department of Public Health (news – web sites). Officials wanted to gauge the attitudes of gay men amid projections that suggest the number of newly infected HIV cases will rise significantly in the city this year, Morin says. 

An estimated one in three gay men in San Francisco is HIV-positive. Although numbers for this year aren’t available, projections say 2.2 percent of the gay men in the city will get infected in 2001. That’s double the rate of 1997. 

The university released the results of the study at two medical conferences this month. Researchers expect they will be published later in a medical journal. 

In the survey, men who were HIV-negative said their perceptions of AIDS have changed over the last four years. They now see AIDS as a “manageable” disease, something more of an “inconvenience” than a killer, Morin says. 

Medical officials have been warning for some time that changing attitudes about AIDS may threaten public health. The diagnosis of AIDS, which develops some time after HIV infection, used to be a near-certain death sentence. But now, medications can keep people alive for years. 

“You don’t see as many people who are sick and dying, the obituaries, the Kaposi’s sarcoma lesions, the people unable to walk, the funerals,” Morin says. “Those things kept HIV in the mind. With the decline in those, it’s less visible.” 

The men surveyed also said they rarely talk to their friends about the disease, a finding that surprised researchers. “We were not expecting to find this deterioration of friends talking to each other,” Morin says. 

Even those infected with HIV aren’t warning their friends to be careful. Those men used to talk to their friends and urge caution, saying “Look what happened to me,” Morin says. “But as they feel better and healthier, they don’t have the same types of discussions.” 

But just as their attitudes about AIDS have changed, the men also have new perspectives about the best ways to reach people like themselves. They weren’t interested in messages about wearing a condom or the importance of being honest about one’s HIV status. “There was considerable concern that people lie,” Morin says. 

The men supported campaigns based on slogans like “Friends Are Good Medicine,” which encouraged gay men to help each other stay healthy. They liked campaigns that challenged gay men to challenge their assumptions about safe sex, and they supported more publicity about rising AIDS infection rates. 

Health officials should consider the findings when they design new HIV prevention campaigns, Morin says. 

The results are not surprising, considering that public health officials always are fighting battles to keep people from falling off the wagon once they quit something like smoking or unsafe sex, says Michael Allerton, HIV operations policy leader for Kaiser Permanente Health Plan doctors in Northern California. 

“You have to constantly and continually move and change strategies as times change. It’s not a one-shot, everybody’s-done deal,” he says. 

What To Do 

HIV hasn’t gone away by a long shot. Although a new generation of drugs may fend off full-blown AIDS, taking them involves a difficult, uncomfortable and expensive regimen. 

To get the latest information about how AIDS is transmitted and how to avoid infection, check the Centers for Disease Control and Prevention. 

For more information on AIDS around the world, see the World Health Organization.

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Brazilian Women Ravaged By AIDS
Infection Rate Rises In Culture of Denial 
By Anthony Faiola
Washington Post Foreign Service
Sunday, September 30, 2001; Page A34 

LONDRINA, Brazil — Adriana Dorta easily recognizes the stunned, terrified faces of women walking through the doors of the AIDS foundation where she counsels new patients. In this quiet city in the heart of southern Brazil’s fertile, coffee-growing region, the number of women infected with the virus that causes AIDS increased 10-fold during the 1990s. Many of them, like Dorta, 29, were the loyal wives of unfaithful husbands.

They lived in a world of denial. Dorta let her hair fall out, dropped to less than 70 pounds and became paralyzed in her left side before agreeing to be tested for a disease she believed afflicted only homosexuals, prostitutes and intravenous drug users.

“Housewives have become accustomed to denial in this macho country where we pretend that our husbands’ love affairs — and, in my case, the beatings my spouse gave me — aren’t really happening,” Dorta said.

After receiving treatment, she has recovered her lustrous black hair and regained some of her lost mobility. But she knows the infection remains. Her husband of 13 years died of AIDS-related complications in 1999.

“I laughed when the doctor first told me I had AIDS,” she said. “I thought, what a ridiculous man this is! AIDS doesn’t happen to married women who are faithful to their husbands. But it is happening. My Lord, is it happening! It’s becoming an epidemic within an epidemic.”

Although Brazil, Latin America’s largest country, has one of the most progressive anti-AIDS programs in the world, women — and housewives in particular — are becoming infected at an alarming rate. A recent government survey showed that the number of new AIDS cases reported among women shot up 75.3 percent from 1994 to 1998, compared with a 10.2 percent increase among men. The vast majority of women catching the virus are heterosexual and do not use intravenous drugs. Although some are prostitutes, experts say many are married or in long-term relationships.

The trend in Brazil mirrors the devastating toll AIDS is taking on women worldwide. In 2000, women made up 47 percent of the world’s 34.7 million adults living with the AIDS virus, compared with 41 percent in 1997, according to a United Nations report. U.N. specialists predict the number of women with AIDS will equal or surpass men by next year.

In Brazil and the rest of Latin America, the rate of infection among heterosexual women is growing faster than in any other group. Experts say the culture of machismo makes it difficult for powerless women to insist on condom use. Many men, particularly among the poor, still consider it emasculating to adhere to a woman’s request for safe sex. And a certain measure of acceptance of the straying husband puts wives at even greater risk.

The strong stigma of AIDS as a gay disease has led some infected men to seek treatment without telling their wives and families, or to simply refuse to be tested, choosing instead to die before being diagnosed. Cultural pressures against homosexuality, especially outside big cities, have led many gay and bisexual men into marriages with women.

This has posed a deadly problem for women in Brazil, a country lauded worldwide for its aggressive government program to develop generic versions of AIDS drugs and distribute at no cost the AIDS “cocktail” used to treat patients. Several state and municipal governments have launched AIDS awareness classes in schools and hand out free condoms.

But health officials concede that it has been a major challenge to change the cultural norms in a society well known for sensuality and male chauvinism. Until this year, newly married men had the right to divorce their wives if they discovered they were not virgins. For decades, Brazilian men who murdered their unfaithful wives routinely used a “defense of honor” argument to win reduced or deferred sentences. The Supreme Court abolished that practice in 1991.

“One of our biggest enemies in AIDS prevention is machismo,” said Paulo Roberto Teixeira, secretary of Brazil’s AIDS program. “We need to empower women, especially those living in poverty who have even less ability to negotiate sex with their partners. But we also need to educate wives of all classes, who often don’t see themselves with any risk factor. The solution will go hand in hand with feminism and women’s liberation. It is the only way.”

The government is trying to address cultural pressures by sponsoring AIDS education classes taught in corporate offices and community centers by women living with AIDS. But changing Brazilian sexual habits is no easy business.

During one class offered to phone company managers in Porto Alegre, a city of 2 million in Brazil’s deep south, women listened closely while men tended to take it more lightly. As instructor Maria Beatriz Pacheco, who contracted AIDS from her ex-husband, spoke seriously about the need for safe sex even among married couples, one swaggering manager in a suit and tie joked, “Come on, they haven’t invented the condom big enough for a Brazilian man.”

“We have so far to go,” Pacheco said. “Even if a wife knows her husband is cheating, it is more likely he will accuse her of infidelity for just suggesting he use a condom. We are trying to change that, but it will take a long time.”

In the more conservative countryside, many patients are diagnosed only after their cases have become advanced enough to warrant hospitalization. In Londrina, an agricultural city of 500,000 about 300 miles southwest of Sao Paulo, women now make up about 40 percent of the 1,200 known AIDS cases, compared to less than 10 percent in the early 1990s. But there are many, many more who fear being tested, and may die quickly as a result.

Women who are more open about their condition are ostracized. One of them is Silvana Gomes, 38, who contracted AIDS from her late husband, to whom she was married for 12 years.

“People know me in town now, and when I get on a crowded bus, everyone moves away from me and I sit alone,” said Gomes, who heads a support group for women with AIDS. “Other women see that response, and their fear of getting tested grows even greater. I just hope it also makes them press their husbands to use condoms.”

Married women who do face up to the disease find themselves dealing with a jumble of emotions. Some grow to despise their husbands. Others opt for forgiveness. Catarina de Madeira, 49, a graying Sao Paulo nurse, for instance, discovered that her unfaithful husband had infected her in 1997. She moved to Londrina, away from their friends and family, to care for her husband until he died last March.

“I feel a lot of emotions, but not anger and hate,” she said. “I loved my husband until the end. I don’t blame him; we are all human. But I suppose I made the choice to forgive largely because I don’t want to spend the rest of my life giving in to bitterness and rancor. Life is too short.” 

© 2001 The Washington Post Company

Bishop Wong steps out of the hospital and into the waiting limo. Inside he 
asks the chauffeur for a bottle of disinfectant and proceeds to washing his 
hands with it until the skin turns pink.

“Oh, please, Lordship, you don’t catch it that way,” Dr. Rees mutters 
beside him, apparently annoyed by the overwhelming smell of alcohol.

“You realize how many AIDS patients are in there?” Bishop Wong’s voice 
quivers, “You’d think the whole district is in there! The place is cramped, 
people practically sleeping over each other, conditions are terrible, 
everyone is hungry! Each day the incoming sick race in number with the 
dead! What is happening to our country?”

“Shouldn’t you be asking Him?” Dr. Rees chuckles, “I don’t ask any 
questions myself because I don’t care about any answers. I’m seventy-seix 
years old and I’m trying to live out the last few years of my life with as 
little worries and cares possible. It’s nearly twelve o’clock, care for 
some lunch at Le Pendu?”
His Lordship tosses the bottle to the front seat, “Take us to le Pendu, 
Miguel,” he hands the chaffeur some money, “You can have your lunch at the 
eatery across the street.”

They take the table beside the huge glass windows and order half a bottle 
of red wine. Bishop Wong looks outside and sees Miguel crossing the street.

“Do you suppose he could be HIV positive?” His Lordship asks, “Do you 
suppose he could get it eating in those places?”

“You know what could be worse? He probably has hepatitis A,” Dr. Rees looks 
over the menu, “I’ll have the seared scallop with foie gras and the lamb 
herb de provence. But at least you don’t get it by giving Miguel head.”

The waiter turns to Bishop Wong, “Your order, Lordship?”

“The melanzane provolone and that is all.”

The waiter darts off and Dr. Rees tells the Bishop, “You can suspect him as 
well as you can suspect me.”

“My uncle and teenage niece are vistims of this pestilence, doctor, a 
pestilence that can fall on anyone. Including me.”

In minutes, the waiter returns with their delectable orders.

“You mentioned earlier, Dr. Rees, that you wanted to be free of any worries 
or cares at the end of your full and lusty life. Let me ask you, where were 
you ten years ago when only a handful of our people were afflicted with 
this dreadful disease?”

“Ten years ago I believe I was at the height of my career assisting the 
secretary of the Health Department. Our AIDS Awareness Campaign was just 
given a grant by the government. You and the secretary had quite a 
wrangling over that grant.”

“It was a lot of money, doctor, money that could have been given to AIDS 
research,” Bishop Wong empties his glass and pours himself another, “And 
the cleaning up of our hospitals. So, where is the good secretary now.”

“You can unleash your earlier suspicions now, Lordship.”

“Incredible twist of fate!” he exclaims.

“Fate indeed. And you were right about cleaning up our hospitals. Didn’t 
cross my mind then, ten years ago we were too busy cleaning up our brothels.”

Lamb deliciously passes against the good doctor’s palate and he smiles 
radiantly with gustatory satisfaction, “These simple pleasure can never 
replace the profits of my career.”

“But I vomited the ideas of your campaign, Dr. Rees,” His Lordship uttered 
betweeb melanzane provlone and gritting teeth, “I remember you employed a 
popular young actor to appear over national television, five times each 
day, just to say ‘I use a condom whenever I have sex.’ You confuse birth 
control with AIDS education as well as you confide AIDS education with 
casual sex. You realize millions of young people heard sex and not AIDS or 
condom in that commercial?”

“Two years later that became quite apparent I admit. We live in very 
decadent times.”

“And I especially abominate the time when AIDS became a fad, a publicity 
gimmick, at worst a status symbol. In street markets you hear people go, 
‘You have AIDS, wow, shouldn’t you be on TV working for the government?’ 
Did you ever stop to think about what that meant, doctor? God, look at our 
country now. Could there still be love in time of AIDS?”

“The former secretary could be breathing his last this very minute. Don’t 
vent your anger out on me, Lordship.”

“Not on you or the dying. Then who?”

“Maybe yourself,” it is something Dr. Rees did not want to say, “For not 
trying hard enough.”

Bishop Wong does not touch half his meal. He looks outside and sees Miguel 
heading back to the limo. He waits quietly for Dr. Rees to savor the last 
of his lamb and let out a gentle burp of pleasure.