Peter Piot, the top U.N. official dealing with the disease, joined political leaders and hundreds of AIDS activists at a rally in the coastal city of Durban to show his support for a government that has made a break with the discredited AIDS policies of former President Thabo Mbeki.

“We are the first to admit that a lot still needs to be done,” said Baleka Mbete, the deputy president, as she lit a candle in remembrance of the victims.

South Africa has an estimated 5.5 million people living with the HIV virus – the highest total of any country in the world and more than one-sixth of the global total. About 1,000 South Africans die each day of the disease and complications like tuberculosis. Even more become infected because prevention messages haven’t worked.

And yet for years, Mbeki’s government downplayed the extent of the crisis. Mbeki himself doubted the link between HIV and AIDS. His health minister Manto Tshabalala-Msimang openly mistrusted conventional AIDS drugs and instead promoted the value of lemons, garlic, beetroot and the African potato.

Researchers from the Harvard School of Public Health last month calculated that government delays in introducing AIDS drugs between 2000 and 2005 cost more than 330,000 lives in South Africa. The study said that an additional 35,000 babies were born with HIV during the same period because authorities were reluctant to roll out mother-to-child prevention programs.

“We have to mourn the lives of those we have not saved,” said Barbara Hogan, the health minister who replaced Tshabalala-Msimang after Mbeki was ousted in October. She cited the example of an 8-year-old boy battling both AIDS-related TB and meningitis who was on a waiting list for drugs when he died.

“We could have saved his life,” Hogan said. She promised to improve HIV treatment and prevention programs, and to increase the supply of drugs to HIV positive women to stop them from passing the virus on to their unborn children.

South Africa has the biggest program for AIDS drugs in the world. And yet, about half the 800,000 people who need drugs are not receiving them. Experts estimate that within five years, about 5.5 million people with HIV will need medication to prevent their immune systems from worsening.

The government wants to halve new infections by 2011 and ensure that 80 percent of people with the disease get treatment and care.

But it faces a mammoth task. The Global Fund on AIDS, TB and Malaria has rejected a South African request for nearly $92 million over the next two years for AIDS projects and $68 million for TB prevention and treatment. AIDS campaigners blamed the former health minister for failing to respect the fund’s strict operating rules.

The Durban ceremony marked an unprecedented show of unity between government, big business, trade unions and activists. In the past, activists and doctors had to resort to the courts to force government to provide AIDS drugs.

Church bells rang for a minute’s silence at noon, and all banks agreed to cease business for that time. Murder trials were briefly interrupted. Trade union and business chiefs said they would have a 30-minute work stoppage to talk to their employees and encourage them to be tested – which still remains largely taboo among men. Cell phone services sent text messages to their teenage subscribers.

“With the young and working age dying in droves, South Africa’s death statistics resemble those of a country in a terrible war,” the Confederation of South African Trade Unions said.

This is the 20th World AIDS Day. Some 33.2 million people worldwide are living with HIV/AIDS; 2.5 million of them are children.

In Washington, the White House announced that the Bush administration had already met its goal of treating two million people living with HIV/AIDS in the developing world by the end of the year.

The Centers for Disease Control admitted this summer what many AIDS activists had believed for some time -  the number of new HIV infections in the US had been under estimated.  The CDC said that new HIV infections actually were 40 percent higher annually than previously had been estimated.

In the U.S., the number of people with HIV/AIDS now stands at 1.1 million. At least 56,300 people in the country are infected with HIV annually. Of the new HIV infections among males, 53 percent were in men who have sex with men (MSM).

Among this group, 46 percent were white, 35 percent were black, and 19 percent were Hispanic.

When age was examined among MSM aged 13 – 29 years, the number of new HIV infections in blacks (5,220) was 1.6 times the number in whites (3,330) and 2.3 times the number in Hispanics (2,300).

Blacks, and Hispanics were represented disproportionately in 2006 among those with new HIV infections.

Yet despite massive education attempts, one in five people infected with the AIDS virus doesn’t know it according to the CDC, even though two years ago the government urged making HIV tests as common as cholesterol checks.

Eleven states that once required special consent for HIV testing have changed their laws, a key step to making an HIV test part of the standard battery that patients expect.

Still, many family physicians are ill informed about the ease of today’s rapid tests, which can cost as little as $15.

No more than 100 of the nation’s 5,000 emergency rooms routinely test for HIV in patients who aren’t critically ill, said Dr. John Bartlett of Johns Hopkins University, who co-chaired last month’s Forum for Collaborative HIV Research meeting. Yet because so many HIV patients are poor or uninsured, ERs are the health-care setting most likely to find them.

With a deepening financial crisis worldwide, there are concerns HIV/AIDS funding will be cut.

“We need President-elect Obama’s ‘Yes We Can’ approach to be applied to AIDS”, said Deborah Williams, chair of the Board of the Global Network of People Living with HIV/AIDS in a statement.

“We have witnessed bold and inclusive campaigning. We need that same leadership to end exclusionary practices in the US and other countries, dedicate sustainable resources to scale up treatment and other services, and involve all stakeholders in developing and implementing a truly effective global effort.”

Yet there are some encouraging signs.

Early results from a federal survey suggest 2.4 million more people in 2007 than in 2006 said they had been tested at some point for HIV.

New York City’s Health and Hospitals Corporation, the nation’s largest municipal health system, has nearly tripled HIV testing – and late diagnoses dropped by about a third. New York’s state Medicaid program has increased testing by 30 percent.

They argue that the world has entered a post-AIDS era in which the disease’s spread has largely been curbed in much of the world, Africa excepted.

“AIDS is a terrible humanitarian tragedy, but it’s just one of many terrible humanitarian tragedies,” said Jeremy Shiffman, who studies health spending at Syracuse University.

Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada, goes further. He argues that UNAIDS, the U.N. agency leading the fight against the disease, has outlived its purpose and should be disbanded.

“The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake, … too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory,” he wrote in the British Medical Journal in May.

Paul de Lay, a director at UNAIDS, disagrees. It’s valid to question AIDS’ place in the world’s priorities, he says, but insists the turnaround is very recent and it would be wrong to think the epidemic is under control.

“We have an epidemic that has caused between 55 million and 60 million infections,” de Lay said. “To suddenly pull the rug out from underneath that would be disastrous.”

U.N. officials roughly estimate that about 33 million people worldwide have HIV, the virus that causes AIDS. Scientists say infections peaked in the late 1990s and are unlikely to spark big epidemics beyond Africa.

In developed countries, AIDS drugs have turned the once-fatal disease into a manageable illness.

England argues that closing UNAIDS would free up its $200 million annual budget for other health problems such as pneumonia, which kills more children every year than AIDS, malaria and measles combined.

“By putting more money into AIDS, we are implicitly saying it’s OK for more kids to die of pneumonia,” England said.

His comments touch on the bigger complaint: that AIDS hogs money and may damage other health programs.

By 2006, AIDS funding accounted for 80 percent of all American aid for health and population issues, according to the Global Health Council.

In Ethiopia, Rwanda, Uganda and elsewhere, donations for HIV projects routinely outstrip the entire national health budgets.

In a 2006 report, Rwandan officials noted a “gross misallocation of resources” in health: $47 million went to HIV, $18 million went to malaria, the country’s biggest killer, and $1 million went to childhood illnesses.

“There needs to be a rational system for how to apportion scarce funds,” said Helen Epstein, an AIDS expert who has consulted for UNICEF, the World Bank, and others.

AIDS advocates say their projects do more than curb the virus; their efforts strengthen other health programs by providing basic health services.

But across Africa, about 1.5 million doctors and nurses are still needed, and hospitals regularly run out of basic medicines.

Experts working on other health problems struggle to attract money and attention when competing with AIDS.

“Diarrhea kills five times as many kids as AIDS,” said John Oldfield, executive vice president of Water Advocates, a Washington, D.C.-based organization that promotes clean water and sanitation.

“Everybody talks about AIDS at cocktail parties,” Oldfield said. “But nobody wants to hear about diarrhea,” he said.

These competing claims on public money are likely to grow louder as the world financial meltdown threatens to deplete health dollars.

“We cannot afford, in this time of crisis, to squander our investments,” Dr. Margaret Chan, WHO’s director-general, said in a recent statement.

Some experts ask whether it makes sense to have UNAIDS, WHO, UNICEF, the World Bank, the Global Fund plus countless other AIDS organizations, all serving the same cause.

“I do not want to see the cause of AIDS harmed,” said Shiffman of Syracuse University. But “For AIDS to crowd out other issues is ethically unjust.”

De Lay argues that the solution is not to reshuffle resources but to boost them.

“To take money away from AIDS and give it to diarrheal diseases or onchocerciasis (river blindness) or leishmaniasis (disfiguring parasites) doesn’t make any sense,” he said. “We’d just be doing a worse job in everything else.”

First story. One of my best friends, a middle-age man with whom I worked on AIDS issues in the 1980s, sent me an e-mail several months ago saying that he had recently tested positive for HIV.

He acknowledged that he was extremely embarrassed to be confessing this fact: The message we had all promoted then – as now – was to have only “safe sex” and to use “a condom every time.”

“I must have neglected to use a condom,” he said simply.

Second story.

I was at my local grocery store during the late summer when I ran into a casual friend I’ve known from the bars, a man somewhere in his late 40s, I’d guess, and we stopped to chat. He said he recently found out that he was HIV-positive, which he confessed surprised him.

“I thought I was safe because I was exclusively a top,” he said. “But apparently not.”

I gathered that he was already taking an antiviral combination, which suggested that his T-cell count was low, so he may have been infected some time ago.

Third story. A good friend, an older man, told me that early this fall he had his first HIV test in several years and was surprised to learn that he was HIV-positive. Not only that but his T-cell count had sunk to the 100-150 range, clearly qualifying for an AIDS diagnosis.

“I did what I considered ’safe sex’ and assumed I was uninfected. I never had any symptoms that I recognized as being HIV-related,” he told me. “But then I noticed that I was getting tired easily and wanted to take naps throughout the day. I thought that was just a function of getting older, but evidently not.”

These men are all Americans, fellow Chicagoans. And, most of all, friends. World AIDS Day will be observed on December 1. Do I care about AIDS among people I do not know and will never see or meet?

Only marginally.

What I do care about is gay men in the U.S., in my city, in my neighborhood. In short, I care about my friends, present and potential. Anyone who cares as much about total strangers in foreign lands as he does his friends and people in his own community has a strange idea about the value of personal relationships.

I lived through the first wave of AIDS, 1981-1996. I lost a lot of friends during that time. Suddenly it feels as if I am beginning to live through a second wave of AIDS infections–not necessarily resulting in deaths this time, at least in the medium term, but decisively altering people’s lives.

When people’s T-cell levels decline to a certain point, they have to begin an anti-viral drug regimen that involves taking one to four drugs every day at the same time every day. If they travel, they have to pack their drugs and make sure nothing interferes with their drug regimen. They have to do this for the rest of their lives. And some of the drugs have inconvenient side effects, from nausea or wooziness to diarrhea to unpleasant dreams. But taking the drugs is better than not taking them.

It seems vitally important to remind people that AIDS is still a threatening presence in the gay community.

I have read estimates that 20 percent of those infected do not know it. I have seen no statistical support for that estimate and I am sure the number is far higher – 40 percent? 50 percent?

Recall that the Centers for Disease Control acknowledged not many months ago that for years it had under-estimated the number of people annually infected with HIV by more than 40 percent.

Every year, every day, young gay men come out and begin engaging in sex. They may think they are invulnerable, they may be heedless, or they may never see a safe-sex message or have had the term “safe sex” spelled out for them. When I have visited bathhouses or back-room bars, I have seen people of all ages and ethnicities engaging in unprotected sex.

Clearly safe-sex messages have lost their impact or are not reaching them in a persuasive fashion.

Many people seem to care more about AIDS abroad than in the U.S. President Bush has sponsored billions of dollars in funding to prevent AIDS in third-world countries, but said little abut AIDS in the U.S. Some evangelical churches are involved in helping to combat AIDS abroad, but show no interest in AIDS in the U.S.

It seems clear that they are interested in helping heterosexuals abroad, but want nothing to do with homosexuals in the U.S.

So it continues to be up to us.

*****

Some of Paul Varnell’s previous columns are posted at the Independent Gay
Forum. His e-mail address is Pvarnell(at)aol.com.

About 33 million worldwide have HIV – thousands remain unaware that they have the virus.

Worldwide, World AIDS Day is marked by conferences, sporting events, galas, and grassroots and government-sponsored outreach programs – we remember it with our annual list of the most important HIV/AIDS stories of the year.

As the World AIDS Campaign announced, “whilst we have come a long ways since 1988, there is still much more to be done.”
1. International AIDS Conference in Mexico City
The 17th annual International AIDS conference convened in Mexico City this past August.

More than 23,000 prominent figures in the plight towards AIDS research, treatment, education, and awareness gathered in Mexico City in August to share their findings from the past year.

The attendees addressed worldwide issues from women and children with AIDS, to HIV and transgender persons, prisoners, and refugees.

AIDS 2008 International Chair and IAS President Dr. Pedro Cahn declared in his closing speech that, “this conference has given out a message of hope for all people living with HIV and AIDS.”

2. CDC reports AIDS spreading faster than anticipated
Also in August, a special HIV/AIDS issue of the Journal of the American Medical Association published its findings on estimates for new HIV infections in the United States.

The latest report, which compiled data from 2002-2006, showed that prior estimates of new infections were low.

The rate by which new viruses are spreading is actually 40 percent higher than previously believed, representing about 56,000 new cases of HIV in 2006.

The article noted that people in their 30s accounted for the most new infections and that 73 percent were men. The report also found that men who have sex with men represented 53 percent of all new cases.

3. Part of the U.S. HIV travel ban lifted
Congress voted in July to expand PEPFAR, the Emergency Plan for AIDS Relief, to provide an additional $48 billion dollars for the fight against AIDS, mainly in sub-Saharan Africa.

Perhaps even more poignantly, the bill also repealed the part of the travel ban preventing the free movement of HIV-positive people into the U.S. for 20 years.

In a radio address on July 26, President Bush spoke to the nation about the new legislation, declaring that, “fighting disease is one part of America’s larger commitment to help struggling nations build more hopeful futures of freedom.”

4. Call for a national AIDS strategy
More than 100 organizations from around the country have banded together to press President-elect Barack Obama to formulate a comprehensive national policy to address the AIDS crisis.

Krishna Stone, spokeswoman for the Gay Men’s Health Crisis (GMHC), believes that this coming together of forces is due to a growing “let’s look at what’s going on in our own backyard” mentality, instead of focusing all strategy on Africa.

The U.S. to date has no national strategy for fighting AIDS here at home.

6. Bono joins Starbucks to help AIDS victims
U2 star Bono made a surprise visit to a Starbucks managerial meeting this past October – surprising even his band members – as part of his continued efforts to raise money for The Global Fund, which provides support to help fight AIDS and other illnesses.

Starting in January 2009, the peppermint mocha twist, gingersnap latte, and espresso truffle will all be “red” beverages, with some of the profits allocated to help purchase anti-retroviral drugs and other necessities for those lacking the means to access proper HIV treatment.

7. Rapid HIV testing in an ER boosts diagnoses, screening
The Emergency Department at Henry Ford Hospital in Detroit conducted a study with alarming results.

They found that one in 50 people screened with new rapid-test HIV equipment were positive.

Researchers hope to inspire others to do HIV screening in their emergency departments, saying that this method, which is not widely practiced, will expose cases that would otherwise remain unknown.

Indira Brar, M.D., lead author of the study, reported,  “we know that people are more likely to modify risk behaviors and less likely to transmit or acquire infection if they know whether they are HIV positive or not. By offering more testing resources, as our study reflected, we can boost ways to diagnose infections and accelerate progress in reducing the HIV epidemic.”

8. Nobel Prize for Medicine awarded to discoverers of HIV
Francoise Barre-Sinoussi and Luc Montagnier were awarded the 2008 Nobel Prize in medicine this October for discovering the HIV virus.

The two French scientists uncovered the virus in 1981 by studying lymph nodes from patients with similar symptoms. They were able to isolate viral cells by 1984. AIDS now affects an estimated 1% of the global population.

The award was shared with Harald zur Hausen, who discovered HPV.

9.  Internet-based “living” AIDS quilt launched in New Orleans
A virtual, interactive “living quilt” was launched on the web recently in an attempt to increase awareness around the spread of AIDS among women, particularly minorities, in the South.

Two New Orleans-based groups – the Southern AIDS Coalition and the National Minority Quality Forum’s Test for Life campaign – headed up this effort to “empower, encourage, and educate.”

The quilt has different images of different women, including patients, doctors, assistants, and related others from the community. Visitors to the site can click on each image to read more about the person and watch a video about her individual story.

10. Doctors say marrow transplant may have cured AIDS
A 42-year old man living with AIDS underwent a bone marrow transplant normally used to treat cancer that may have rendered his HIV positive status negative.

The patient, an American taking up residence in Berlin, had been living with the disease for 10 years when he agreed to try this aggressive treatment option. He stopped taking his normal medications and was subject to intense radiation to kill infected cells in his bone marrow- a procedure that kills 20-30% of patients- after which they replaced his virus-ridden bone marrow with the 1 in 62 marrow that has tested HIV-resistant.

It’s not certain whether the virus will come back, but he’s tested negative for 20 months now and doctors are hopeful that he will remain virus-free.

“By combining HIV prevention with access to treatment, we can virtually eliminate new HIV infections in 30 years,” the National AIDS Fund said Thursday.

The fund is launching “Light to Unite,” a public awareness and fundraising campaign that it says is the largest public-private partnership focused on increasing awareness about the U.S. epidemic on World AIDS Day. 

“Light to Unite” is a collaboration between the NAF and Bristol-Myers Squibb to encourage individuals to get involved and make a difference in the struggle against HIV/AIDS.

Individuals can light a virtual candle online at www.LightToUnite.org while learning new facts about HIV/AIDS, and share their knowledge and personal experiences with others. They also can also make a donation to the National AIDS Fund on the website.  The fund says that one-hundred percent of the donated funds will be distributed to organizations that serve individuals and communities impacted by HIV/AIDS.

Light to Unite events will also take place in communities nationwide. 

Through its Community Partnerships, the National AIDS Fund supports over 400 direct service organizations across the country that provide important services, such as HIV prevention programs, HIV testing, referrals to treatment, and supportive services.

“We—individuals, foundations, and corporations—have the power to set a different course,” said Kandy Ferree, president and CEO, the National AIDS Fund. “Collaborations like Light to Unite change lives by increasing awareness, reducing stigma, and directing resources to the communities most impacted by HIV/AIDS.”

At least 56,300 people in the country are infected with HIV annually now — a number 40 percent higher than what was previously estimated although prevention has brought infections down from 130,000 a year since the height of the epidemic in the 1980s. In total over 1.1 million individuals are living with HIV/AIDS.

Over 50 percent of all new HIV infections are among those under age 25 and women now account for 25 percent of new HIV cases.

African American adults and teens are nine times more likely than whites, to receive an AIDS diagnosis. Although Latinos represent approximately 15 percent of the U.S. population, they have been accounting for 19 percent of AIDS cases. The Southern U.S. accounts for 46 percent of all new AIDS cases.