Copyright © AVERT

These are some of the most important events that occurred in the history of AIDS from 2003 to 2006.

2003 History

Reports in January suggested that the rate of HIV in Swaziland was the world's highest with almost four out of ten adults infected. Prime Minister Sibusiso Dlamini said that prevalence had risen to 38.6% from 34.2% in January 2002. Although this figure was just under Botswana's rate of 38.8%, health officials said that Swaziland's figures were already out of date.¹

Botswana was struggling to expand its antiretroviral treatment programme, largely because of a shortage of health workers. The government had hoped to provide drugs to 19,000 people by the end of 2002, but had enrolled only 3,200 by the end of January 2003.²

Jerry Thacker, a controversial Christian extremist chosen by the White House to sit on a presidential AIDS advisory panel and who once described the virus as the 'gay plague', was forced to withdraw his name after protests from gay rights groups.³

In his State of the Union address on 28th January, US president George Bush proposed spending $15 billion in combating AIDS in Africa and the Caribbean over the next 5 years. He called the scheme 'a great mission of rescue'.⁴

"This comprehensive plan will prevent 7 million new 'AIDS' infections, treat at least 2 million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS." President Bush⁵

Just two days later, US Health Secretary Tommy Thompson was elected as the new chairman of the Global Fund for HIV, TB and Malaria. It was hoped this move would prevent a conflict between the Bush administration and the international health community.⁶

In February, a rare case of female-to-female sexual transmission of HIV was reported. Doctors suggested the woman may have been infected through sharing sex toys after drug resistance tests found striking similarities between the HIV strains in her and her female partner.⁷

There had still been no dramatic increase in HIV transmission in Cuba since the beginning of the epidemic. The rate of infection was 0.03% and thought to be one of the lowest in the world. There had been virtually no transmission of HIV through injecting drug use, blood transfusion or from mother to child. The government had ensured that all HIV-positive mothers were treated with prophylactic AZT therapy and that their babies were delivered by caesarean section. The country had produced enough antiretrovirals to supply the country's patients.⁸

Globally the epidemic continued to expand, reducing world population estimates by 0.4 billion to 8.9 billion for 2050.

"The long-term impact of the epidemic remains dire… HIV/AIDS is a disease of mass destruction and we do not see a vaccine coming soon." - Joseph Chamie, director of the UNPD -⁹

An expert group reaffirmed that unsafe sexual practices were responsible for the majority of HIV infections in sub-Saharan Africa. This announcement was a response to claims made in 2002 that unsafe medical practises were to blame for an important portion of HIV transmission in Africa.¹⁰

Vaxgen announced that their AIDS vaccine had failed to reduce overall HIV infection rates among those who were vaccinated. The vaccine showed a reduction in certain ethnic groups, indicating that black and Asian volunteers may have produced higher levels of antibodies against HIV than white and Hispanic volunteers. However, many outside observers were sceptical of the ethnic group part of the study.¹¹ In November, the AIDS vaccine also failed in a clinical trial in Thailand.

"The outcome of this trial is one more reminder of how difficult it is to combat HIV and how important it is for the international public health community to redouble the effort to develop an effective vaccine." - Donald P. Francis, Vaxgen President -¹²

Researchers warned that the number of women being diagnosed with HIV in Europe was rapidly catching up with men. The researchers also noted that initiatives supplying drug users with clean needles had been effective in Europe. HIV transmission through injecting drug use was said to have been almost eliminated in France, Germany and the UK, and significantly reduced in Spain and Italy.¹³

In March the Treatment Action Campaign (TAC) filed manslaughter charges against the health minister and the trade and industry minister in South Africa. The TAC held the ministers responsible for the deaths of 600 people a day whose lives could have been saved if they had had access to antiretroviral drugs.¹⁴

Russia received an approval for a long delayed loan from the World Bank to tackle HIV/AIDS and TB. For its part, the Russian Government promised to match the loan with $134 million in new money over 5 years for HIV/AIDS and TB. This contribution from the government signalled growing recognition that both HIV/AIDS and TB epidemics represented a threatening crisis for Russia's development.¹⁵

The first of a new type of anti-HIV drug gained approval in the USA. Unlike all previously approved drugs, Fuzeon (also known as enfuvirtide or T-20) was designed to prevent the entry of HIV into human cells. The drug was not available as a pill and had to be injected. It could be used as part of combination treatment only by patients who had already become resistant to other antiretroviral drugs.¹⁶

In April the US Centers for Disease Control and Prevention (CDC) announced a new initiative called Advancing HIV Prevention (AHP), designed to reduce the number of new HIV infections in the US. For two decades before AHP, the CDC mainly targeted its prevention efforts at persons at risk of becoming infected with HIV. In contrast, the new initiative would focus mainly on people already infected with the virus. AHP proposed making HIV testing a routine part of medical care and putting more resources into partner tracing. The recently-licensed rapid HIV test would play a key role in the new initiative.¹⁷

The US Senate approved President Bush's international AIDS bill in May, setting a timetable for spending $15 billion over five years.¹⁸

A team of Belgian researchers reported on the probable origins of HIV-2. They concluded that the virus had probably transferred from sooty mangabeys to humans in Guinea Bissau during the 1940s.¹⁹

South Korean Lee Jong-wook took office as the new Director-General of the World Health Organisation (WHO) and named HIV/AIDS as his top priority in his first speech.²⁰

Meanwhile concerns were mounting over the Global Fund's sustainability as it faced a serious funding shortfall.²¹

New HIV/AIDS figures were released in India in July, and it was estimated that between 3.82 and 4.58 million Indians were HIV positive.²²

In September the WHO declared that the failure to deliver treatment to nearly six million people with HIV/AIDS in developing countries was a global public health emergency. Only about 300,000 people in developing countries received the drugs at all, and in sub-Saharan Africa, where 4.1 million people were infected, just over 1% or about 50,000 people had access to antiretroviral treatment.²³

Vatican cardinal Alfonso Lopez Trujillo stated that condoms were not safe and did not protect against the transmission of HIV.

"I simply wished to remind the public, seconding the opinion of a good number of experts, that when the condom is employed as a contraceptive, it is not totally dependable, and that the cases of pregnancy are not rare. In the case of the AIDS virus, which is around 450 times smaller than the sperm cell, the condom's latex material obviously gives much less security." - Cardinal Trujillo -²⁴

In response the WHO said that it was "totally wrong" to claim that condoms did not protect against HIV and:

"It is quite dangerous to claim the contrary when you realize that today we are facing an epidemic which has already killed 20 million people and 42 million people are infected today."²⁵

There was a sharp rise in trafficking of heroin through central Asia. This caused an increase in drug addiction and cases of HIV in many impoverished states including Tajikistan. Since the fall of the Taliban, who had banned the growing of opium poppies (the raw material for making heroin), production had skyrocketed in Afghanistan.²⁶

In the US, estimates suggested there had been fewer than 100 AIDS diagnosses among children during 2002, compared to nearly 1,000 in 1992. The dramatic reduction was due to widespread use of antiretroviral drugs and avoidance of breastfeeding.²⁷

In November the UN World Food Programme said it would shift its humanitarian aid effort in southern Africa from traditional emergency food supply to a greater response to HIV/AIDS including providing nutritional support, awareness campaigns, food baskets and other services to HIV-positive people.²⁸

Many drug manufacturers lowered their prices of antiretroviral drugs in resource-poor countries during 2003. Although these price reductions were welcomed by many countries and organisations, it was understood that 'lower price medicines alone will not deliver treatment'. What was also needed was the ability of countries to deliver these drugs, building of stronger health systems and training of more health care workers in resource-poor countries.²⁹

South Africa approved the long-awaited provision of free antiretroviral drugs in public hospitals in November. The cabinet instructed the Department of Health to proceed with implementation of the plan, which envisaged that within a year there would be at least one service point in every health district across the country, and within five years, one service point in every local municipality.³⁰

UNAIDS warned that the efforts to stem the world's AIDS epidemic were 'entirely inadequate'. It was estimated that every day in 2003, around 14,000 people became infected with HIV. It was estimated that 40 million around the world including 2.5 million children were living with HIV/AIDS.³¹

Meanwhile India's health minister said that there would never be a widespread AIDS epidemic in the country.

"I will prove all experts wrong. We are taking on the disease from all fronts. We are tackling it very bravely." - Sushma Swaraj -³²

On World AIDS Day the WHO announced a new plan called '3 by 5' to provide HIV/AIDS treatment for many resource-poor countries. The plan had many different elements, but the WHO were not planning to provide the drugs themselves. The WHO was hoping to have 3 million people in resource poor countries on AIDS drugs by the end of 2005.³³

"Nothing close to this has ever been tried. It's not like finding babies with diarrohea and treating them for a week, or adults with tuberculosis and treating them for six months - both of which have been major efforts by the WHO in recent decades... HIV infection is a chronic disease. The 3 million - and the millions who will come after them - will have to take their medicine for years, until they die."³⁴

Also on World AIDS Day, Wen Jiabao became the first Chinese premier to shake the hand of an AIDS patient. Mr Wen's handshake broadcast in close-up was the most dramatic of a series of government moves that demonstrate a new determination to fight AIDS.

"This was like breaking the ice… It's something that a lot of people working in the AIDS field inside China and outside have been hoping for and waiting for." - Joel Rehnstrom, the co-ordinator in China for UNAIDS -³⁵

The Chinese government announced a policy of 'Four Frees and One Care', which promised free antiretrovirals to poor city dwellers and to everyone in the countryside; free voluntary counselling and testing; free drugs to prevent mother-to-child transmission; free schooling for AIDS orphans; and care and economic assistance to the households of people living with HIV/AIDS.³⁶

According to new estimates, the number of people infected with HIV in the UK increased by almost 20% between 2001 and 2002, from 41,700 to 49,500, of whom 31% were undiagnosed.

"World AIDS Day reminds us that the problems we face with HIV are not going away, despite it being a disease that is largely preventable." - Kevin Fenton, a public health consultant -³⁷

2004 History

In January Brazil's government reached a deal with pharmaceutical companies to reduce the price of HIV/AIDS drugs by around a third. It was believed that the deal saved the government about $100 million in 2004 and cut the average treatment cost per patient to a new low of $1,200.³⁸ Also, 10 million free condoms were given out to people in Brazil during the carnival season as part of an AIDS-prevention campaign.³⁹

In February, President Bakili Muluzi of Malawi announced that his brother had died from AIDS. This was intended to highlight issues of stigma and discrimination related to HIV/AIDS. President Muluzi made the announcement as he launched the first AIDS policy in a country where an estimated 15% of the 15 million population were HIV-positive.⁴⁰

The Global Fund to Fight AIDS, Tuberculosis and Malaria suspended payments to three HIV/AIDS programmes in Ukraine, citing concerns over slow progress and management problems. It was the first time in its history that the Global Fund had stopped funding to a scheme that it had supported.⁴¹

In parts of Russia and Eastern Europe, HIV was spreading faster than anywhere else in the world. A survey by the United Nations Development Programme estimated that almost one in 100 Russians were HIV-positive and that AIDS could claim up to 20.7 million lives by 2045.⁴² The head of the UN Development Programme, Mark Malloch Brown, criticised Russia's efforts to combat the virus:

"President Putin mentioned it last May, but one speech is not enough and one reference in a speech is not enough." ⁴³

Stephen Lewis, the UN special envoy for HIV/AIDS in Africa warned that the WHO's attempt to get three million people onto treatment by the end of 2005 was compromised by lack of financial support from the world's richest countries.

"There has never been a more determined plan of action… If 3 by 5 fails, as it surely will without the dollars, then there are no excuses left, no rationalizations to hide behind, no murky slanders to justify indifference. There will only be the mass graves of the betrayed." - Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa -⁴⁴

In March, the US Food and Drug Administration approved the first oral fluid rapid HIV test.⁴⁵

South Africa began a programme to give out free HIV/AIDS drugs after years of confusion and delays. The program started in South Africa's richest province, Gauteng, where five major hospitals, including Chris Hani Baragwanath, the largest in Africa, were selected to administer the drugs.⁴⁶

"To me, it means a lot," said the frail man, whose girlfriend and 2-year-old daughter have also tested positive for HIV. "I have a child to raise... I want to take her to her first day of school, and I can only do that if I am healthy." - 27-year-old HIV-positive South African man -⁴⁷

A study found that the HIV prevalence rate in Uganda had been reduced by 70% since the early 1990s. It was estimated that half a million Ugandans were HIV positive in 2004, compared with 1.5 million a decade before. It was believed that the reduction in HIV prevalence was due to people having fewer sexual partners as well as to effective prevention efforts in local communities.⁴⁸

"In Uganda people became engaged with the epidemic at the community level. Local care groups, religious movements, non-governmental organisations and care networks all spread the message. Families, friends and neighbours began talking about HIV prevention and care, and sexually transmitted diseases stopped being a taboo subject."

A survey of US media coverage of the AIDS epidemic revealed that the number of AIDS-related stories peaked in 1987 and rapidly declined in the early 1990s, despite these being the peak years for AIDS deaths. The stories increased slightly in 1991, when Magic Johnson spoke publicly about his HIV status. The number of stories revived again in 1996-7 with the introduction of combination therapy.⁴⁹

In May, five Bulgarian nurses and a Palestinian doctor accused of deliberately infecting children with HIV were sentenced to death by a Libyan court. The medical staff had been detained in 1998 and the trial had started in 2000.⁵⁰

The US porn industry was hit by fears of HIV outbreak among its stars. By May, five porn actors had been found to be HIV-positive.^{51 52}

President Bush's $15 billion initiative to combat the global AIDS pandemic, by now known as PEPFAR (President's Emergency Plan For AIDS Relief), began full implementation in June, having received its first funding in January. PEPFAR was to concentrate on fifteen focus countries, all of them in Africa except Guyana, Haiti and Vietnam (which was a late addition to the list). The initiative set a goal of providing AIDS treatment to 200,000 people living in the focus countries by June 2005.⁵³

A new UNAIDS report estimated that 37.8 million people were living with HIV at the end of 2003, including 17 million women and 2.1 million children under 15 years old. It was estimated that there were nearly 8,000 AIDS deaths per day during 2003. These were slightly lower than previous estimates because improvements had been made to the estimation process, but without doubt the epidemic was still expanding. The number of AIDS orphans had risen to 15 million, of whom 12.1 million lived in sub-Saharan Africa.⁵⁴

The WHO announced that, by the end of June, 440,000 people in developing and transitional countries were receiving antiretroviral treatment, an improvement of 40,000 since the end of 2003.⁵⁵

The Bill and Melinda Gates Foundation announced that it would donate $50 million to the Global Fund, bringing its total Fund contributions so far to $150 million.⁵⁶

The South African Treatment Action Campaign and its leader, Zackie Achmat, were jointly nominated for the 2004 Nobel Peace Prize, but were not chosen to win.⁵⁷

In November the Global Fund said that it would delay launching its fifth round of grants for five months because of a funding shortfall. Some commentators said the US was not providing enough support for the Global Fund because it preferred its own PEPFAR initiative.⁵⁸

Botswana's antiretroviral treatment programme, which had made dramatic progress during 2004, was providing medication to around 36,000 and 39,000 people by the end of the year - around half of the number who needed the drugs.⁵⁹

Women, Girls, HIV and AIDS was chosen as the theme of World AIDS Day 2004. Events to mark the occasion took place around the world, including in China, where Premier Wen Jiabao called for "unremitting efforts" against the epidemic, and the Executive of the Global Fund warned of catastrophic consequences should such efforts fail.^{60 61 62}

"Today the face of AIDS is increasingly young and female... We will not be able to stop this epidemic unless we put women at the heart of the response to AIDS." - Peter Piot, head of UNAIDS, on World AIDS Day⁶³

2005 History

At the start of the year, UNAIDS published a report predicting the future of the global AIDS epidemic. Three very different scenarios highlighted how much would depend on the responses of governments, donors and civil society.⁶⁴

Also in January, both the WHO and PEPFAR published figures detailing numbers of people receiving AIDS drugs. PEPFAR said it had helped to provide treatment to nearly 155,000 people in its fifteen focus countries by end of September.⁶⁵ The WHO said that the total number receiving treatment in all developing and transitional countries had risen to 700,000 by the end of 2004, meaning that the 3 by 5 initiative had achieved its latest target.⁶⁶

The US Food and Drug Administration (FDA) for the first time approved a generic AIDS drug made by a foreign company. PEPFAR had decided not to trust any drug that had not been approved by the FDA, which meant that all PEPFAR-funded programmes had had to stick to the more expensive brand-named products. However in January the FDA gave its approval to two drugs made by the South African company Aspen Pharmacare. This came just weeks after a product of the US company Barr Laboratories had become the first ever FDA-approved generic, and was predicted to mark a turning point in providing cheaper treatment in Africa.⁶⁷

Nelson Mandela announced that his eldest son Makgatho had died of AIDS, aged 54.

"Let us give publicity to HIV/AIDS and not hide it, because [that is] the only way to make it appear like a normal illness."- Nelson Mandela⁶⁸

Publication of death certificate data from South Africa revealed that the total number of reported deaths had increased by 57% between 1997 and 2002. Among those aged 25-49 years, the rise was 116% in the same six year period.⁶⁹ Based on an analysis of a sample of death certificates, the South African Medical Research Council estimated that nearly two-thirds of deaths related to HIV had been misclassified (wrongly attributed to other causes) during 2000-2001.⁷⁰

In April, the US Institute of Medicine published the results of an extensive review of data relating to the use of the drug nevirapine. It found that the drug was a safe and effective way to prevent mother-to-child transmission of HIV, and that news stories suggesting otherwise had distorted the facts.

"It is conceivable that thousands of babies will become infected with HIV and die if single-dose nevirapine for mother-to-infant HIV prevention is withheld because of misinformation." - National Institute of Allergy and Infectious Diseases -⁷¹

Brazil turned down $40 million offered by PEPFAR because it refused to agree to a declaration condemning prostitution. The director of Brazil's HIV/AIDS programme said the government had taken the decision "in order to preserve its autonomy on issues related to national policies on HIV/AIDS as well as ethical and human rights principles".⁷²

A new set of international treatment figures were published by the WHO in June. They revealed that the 3 by 5 initiative was a long way off track, because only 970,000 people (15% of those in need) were receiving treatment, compared to a target of 1.6 million. The WHO admitted that it would be unlikely to achieve its goal of 3 million by the end of the year.⁷³

PEPFAR said it had exceeded one of its own targets by helping to provide treatment to 235,000 people in its focus countries by the end of March.⁷⁴ The figure given for Botswana was disputed by the country's health officials. They said the US was claiming credit for helping thousands of people whose treatment had in fact been funded overwhelmingly by the Botswanan government.⁷⁵

Speaking at the 2005 National HIV Conference, the acting director of the CDC announced a new estimate of HIV prevalence in the USA. The CDC had calculated that between 1.039 million and 1.185 million Americans were living with HIV at the end of 2003, of whom 47% were black. One in four HIV-positive people did not know they were infected. Other studies presented at the conference showed that new infections among African Americans were rising, and the total number of new cases was remaining stable at around 40,000 per year.⁷⁶

In the UK at least, 2005 had been hailed as the ‘Year of Africa’ - the year in which real progress would be made towards relieving poverty and disease in that continent. The UK held the presidency of the European Union for the second half of the year, and in July the UK hosted the G8 (Group of Eight) summit of world leaders in Gleneagles, Scotland. Prime Minister Tony Blair promised that the main themes of the summit would be Africa and climate change. The meeting was preceded by massive "Live8" pop concerts around the world, and other events associated with the Make Poverty History campaign.

At the summit the leaders promised to double aid to Africa by 2010, and to cancel the debts of 18 poor countries, but no progress was made in improving trade justice, which many groups considered to be the most important issue. However, the leaders were praised for pledging to ensure as near as possible to universal access to antiretroviral treatment worldwide by 2010.⁷⁷

South Africa's latest antenatal clinic survey showed that 29.5% of pregnant women were HIV positive at the end of 2004. According to the report, the total number of people living with the virus had risen to an estimated 6.29 million - far more than in any other country.⁷⁸

The Global Fund to Fight AIDS, TB and Malaria in August suspended all grants to Uganda following concerns about possible corruption within the country's health ministry. Uganda's suspension was lifted in November, after an agreement was reached with the ministry over better financial management. Meanwhile the Fund announced its global AIDS programmes had exceeded targets for 2005.^{79 80 81}

By August, nine generic antiretroviral drugs had been approved by the American Food and Drug Administration (FDA). However several African countries refused to allow the drugs to be imported until they had also been approved by the WHO.⁸² PEPFAR would not begin distributing generic drugs until near the end of the year.⁸³

PEPFAR's approach to HIV prevention (described as "ABC") came under increasingly heavy fire from commentators who said it was motivated by ideology, and was focusing too much on abstinence until marriage while downplaying the role of condoms. Among the fiercest critics were Professor Duff Gillespie, a public health expert and former senior USAID official, who called PEPFAR's policies "outrageous and stupid", and Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa, who said the approach to HIV prevention would "cause a significant number of infections which should never have occurred". Two prominent US medical associations, the IDSA and the HIVMA, were also critical. However PEPFAR officials maintained that their approach to HIV prevention was balanced and based on evidence of effectiveness.^{84 85 86}

At the UN World Summit in September, the General Assembly followed the example set by the G8 leaders, by committing themselves to:

"Developing and implementing a package for HIV prevention, treatment and care with the aim of coming as close as possible to the goal of universal access to treatment by 2010 for all those who need it"⁸⁷

Russian President Vladimir Putin promised that his country would allocate at least 20 times more money to fight HIV and AIDS in 2006 than it did in 2005. The President said that AIDS in Russia was a "serious problem", and that current spending of $5 million per year was "practically nothing for Russia on the scale of things".^{88 89}

In September the antiretroviral drug zidovudine (AZT) reached the end of its patent period in the US. This meant that any pharmaceutical company could now produce the drug legally and cheaply for the US market without having to pay royalties to the patent owner, GlaxoSmithKline. The FDA immediately approved four generic forms of AZT for sale within America.⁹⁰

Zimbabwe, one of the countries worst affected by AIDS, was suffering from a severe economic crisis made worse by droughts and the government's controversial land redistribution programme. One consequence was a sharp rise in the price of AIDS drugs in the public sector, from $7.70 per month in July to $46 per month in October. At the same time the state-run treatment programme was handicapped by a lack of foreign assistance, due to Western opposition to land reform and reported violence and intimidation during elections.

"People are giving up [their] drugs - they have to choose between feeding and educating their kids or taking ARVs" ⁹¹

Zimbabwean President Robert Mugabe was accused of further worsening the AIDS crisis in his country through his slum clearance campaign, which left thousands of families homeless. But UNAIDS announced that Zimbabwe's HIV prevalence rate had fallen over the previous five years, from around one in four to around one in five infected.^{92 93}

In 2005 skepticism about the cause of AIDS was still thriving in South Africa. The Democratic Alliance gave a list of the country's twelve most influential "AIDS dissidents" (people who question the theory that HIV causes AIDS), whom it said had an "ongoing and bizarrely powerful" influence on national HIV/AIDS policy. The list was headed by attorney Anthony Brink, the convenor and national chairperson of the Treatment Information Group and spokesperson for the Dr Rath Health Foundation, an organisation dedicated to promoting the use of vitamin supplements rather than antiretrovirals to treat AIDS. Also featured were President Thabo Mbeki and Health Minister Manto Tshabalala-Msimang.

"South Africa has become a safe haven for AIDS denialists and is the AIDS denialist capital of the world... Were it not for the influence of dissidents, South Africa would long ago have been able to take the steps that countries like Brazil and Thailand have taken to stop new AIDS infections, provide appropriate education and offer meaningful treatment to those already infected." - Democratic Alliance health spokeswoman, Dianne Kohler-Barnard -⁹⁴

By late 2005, it was clear that the World Health Organisation's 3 by 5 plan would fail to achieve its goal of 3 million people on treatment in resource-poor countries by end of the year. With refreshing honesty, the head of the WHO's HIV/AIDS programme admitted as much and said sorry.

"All we can do is apologise. I think we just have to admit we’ve not done enough and we started way too late." - Dr Jim Yong Kim

However, Dr Kim said the initiative should certainly not be deemed a failure:

"Before Three by Five, there was not an emphasis on saving lives... Many leaders in the world were saying we just have to forget about this generation of people who are infected, we're really thinking about the next generation... So something has happened that's extraordinary."⁹⁵

The WHO estimated that expanded access to treatment had saved between 250,000 and 350,000 lives during 2005. However, their estimates also revealed there were more new HIV infections and more AIDS deaths in 2005 than in any previous year.

"2005 is likely to be remembered more for the 3 million deaths and almost 5 million new infections it heralded than for the 300 000 lives saved through treatment for HIV"- Front cover of The Lancet Volume 366 Number 9500⁹⁶

2006 History

In January, the rock star Bono announced the creation of a new commercial brand designed to help raise money to fight AIDS in Africa. “Product RED” originally involved four large companies (Armani, Gap, American Express and Converse), each of which would sell special red products and donate a portion of the profits to the Global Fund. The first merchandise would become available in the UK in March.⁹⁷

The final results of the 3 by 5 initiative were revealed in March. By the end of 2005, only around 1.3 million people in low- and middle-income countries had been receiving antiretroviral treatment – less than half of the 3 million target. Though this result was highly disappointing, the WHO stressed that it still represented a more than three-fold increase within two years. Of the 152 countries involved in the initiative, only 18 met the target of 50% treatment coverage. Among the worst performers were Russia and India, and among the best was Botswana, where coverage had reached around 85%.

"Two years ago, political support and resources for the rapid scale-up of HIV treatment were very limited. Today ‘3 by 5’ has helped to mobilize political and financial commitment to achieving much broader access to treatment. This fundamental change in expectations is transforming our hopes of tackling not just HIV/AIDS, but other diseases as well." - WHO Director-General, Dr Lee Jong-wook⁹⁸

PEPFAR announced that it was helping to provide treatment to 401,000 people in its fifteen focus countries,⁹⁹ but this news was soon overshadowed by yet more criticism of the plan’s HIV prevention policies. A report by the Government Accountability Office revealed that, by allocating one third of its prevention budget to programmes promoting abstinence and fidelity, PEPFAR was forcing countries to cut funding for efforts to help high-risk groups and to prevent mother-to-child transmission.¹⁰⁰

A new study suggested that the rate of new HIV infections in Southern India might have declined between 2000 and 2004, perhaps because of changes in sexual behaviour. One of the authors, Professor Prabhat Jha, said their results contradicted previous assumptions:

“There have been many predictions, mostly based on guesswork, that India's AIDS problem will explode – as it did in southern Africa – but we now have direct evidence of something positive.”¹⁰¹

Reports that an HIV-positive orphan, Isaiah Gakuyo, had been violently murdered by his uncle sparked protest marches in Kenya. Before his death, the teenager had been mistreated and isolated by his relatives because of his infection.

“The boy was facing violence on a daily basis. We don't want this to happen again.” - March organiser, Inviolata Mwali M'Mbwari -¹⁰²

Dr Lee Jong-wook, Director General of the WHO, died after undergoing emergency surgery in May. Dr Lee had led the 3 by 5 initiative, and was especially passionate about achieving universal access to HIV/AIDS prevention, treatment and care.¹⁰³

At the end of May, twenty-five years after doctors first became aware of AIDS, UNAIDS published an especially comprehensive report on the global epidemic. Although the number of people living with HIV was still rising, there was new evidence of HIV prevalence declines in Kenya, as well as urban areas of Burkina Faso and Haiti.¹⁰⁴

The UNAIDS report also revealed that funding for the response to AIDS in low- and middle-income countries had risen from $300 million in 1996 to $8.3 billion in 2005, yet was still a long way short of what was required for meaningful action. Of the $18.1 billion that would be needed in 2007, only $10 billion was likely to be available.¹⁰⁵

June also contained the fifth anniversary of the UNGASS declaration, in which UN member states had set ambitious targets for combating HIV and AIDS worldwide. Another High-level Meeting was therefore convened to agree a new “Declaration of Commitment on HIV/AIDS”, which would guide the global response over coming years. The final document was criticised by some campaigners for being vaguely worded, and for omitting any definite spending commitments.

“I wish we could have been a bit more frank in our declaration about telling the truth that some groups – like sex workers, drug users and men who have sex with men – are more at risk… This is not a time for embarrassment, this is about telling it straight because it is about saving people's lives. Openness, honesty, frankness, giving people enough information, not being squeamish and telling the truth is really, really, important.”- Hilary Benn, UK International Development Secretary¹⁰⁶

The Vatican sparked excitement among AIDS campaigners when it suggested it was planning a review of its stance on condom use as a method of HIV prevention. However, it soon became clear that a major change in policy was unlikely, and that the Catholic Church would probably continue to oppose condom use in all circumstances.¹⁰⁷

The Gates Foundation – the world’s largest private source of funding for HIV and AIDS – received a substantial boost to its finances in June, when the billionaire Warren Buffet promised to donate $31 billion over ten years. Bill Gates announced that he would step down as head of Microsoft to concentrate on the work of the Foundation.¹⁰⁸

The first one-a-day pill for effectively treating HIV infection was approved for sale in the USA. A result of unprecedented cooperation between two major pharmaceutical companies, the pill, called Atripla, combined three types of drug widely used in first-line treatment. The advent of once-daily treatment represented great progress since the mid-1990s, when people with HIV usually had to take several pills every few hours.¹⁰⁹

In August, attention turned to the XVI International AIDS Conference in Toronto. One major talking point was how to accelerate the expansion of antiretroviral therapy worldwide, and in particular how to alleviate dire shortages of healthcare workers in the most needy countries. Delegates also discussed the pros and cons of routine HIV testing, whereby everyone attending medical settings is offered an HIV test, regardless of symptoms. The WHOand others suggested that wider use of this approach would increase take-up of treatment and help to counter stigma.

The conference provided a platform for critics of the South African government’s response to AIDS. Activists protested at the country’s exhibition stand, which was dominated by unproven nutritional remedies, with almost no reference to effective medication. Conference co-chair Mark Wainberg said it was “unconscionable” that South Africa’s leaders would not talk openly about AIDS.¹¹⁰ Stephen Lewis (UN Special Envoy for HIV/AIDS in Africa) went further in his closing speech:

“South Africa is the unkindest cut of all. It is the only country in Africa … whose government is still obtuse, dilatory and negligent about rolling out treatment. It is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state... The government has a lot to atone for. I'm of the opinion that they can never achieve redemption.”¹¹¹

Shortly after the conference, more than 80 prominent international scientists wrote an open letter to South African President Thabo Mbeki calling on him to sack health minister Manto Tshabalala-Msimang, whom they blamed for “disastrous, pseudo-scientific policies” on HIV/AIDS.¹¹² Instead, the South African government set up a new inter-ministerial committee to take charge of the national AIDS response, to be headed by the deputy president, thus seeming to sideline the controversial health minister.¹¹³

To coincide with the Toronto conference, medical journal The Lancet produced a special issue with a red cover to help promote the Product RED brand. The 130-page journal was entirely devoted to AIDS-related articles, and included prominent adverts for Product RED merchandise.¹¹⁴ The Independent, a British newspaper, had been the first publication to produce a RED edition in May; it would repeat the stunt in September and December.¹¹⁵

In September, the WHO issued an emergency warning to health care professionals to be on the lookout for a new strain of tuberculosis, against which most existing drugs were ineffective. The WHO had been aware of XDR-TB (extreme drug-resistant tuberculosis) for several years, and it had been recorded in Asia, Eastern Europe and the United States. The alarm was raised when doctors reported 53 new patients in South Africa, 52 of whom died within 25 days. It was thought that most, if not all, of these people had been co-infected with HIV. Experts were concerned that they might be seeing the beginning of a devastating new epidemic.

“There is no point in investing hugely in [AIDS treatment] programmes if patients are going to die a few weeks later from extreme drug-resistant tuberculosis… This is raising the spectre of something that we have been worried about for a decade – the possibility of virtually untreatable TB.” - Dr Paul Nunn of the WHO¹¹⁶

In the USA, the Centers for Disease Control and Prevention (CDC) issued new guidelines recommending routine HIV testing for all adults and adolescents attending healthcare services. Routine testing had already proved highly successful in identifying HIV among pregnant women; the CDC hoped that more general use of this approach would help to cut the rate of new infections, and would result in more people receiving treatment before becoming very ill.¹¹⁷

Product RED was launched in the USA in October, by which time Apple and Motorola were also supporting the brand.¹¹⁸

Kevin De Cock, director of the World Health Organisation's HIV/AIDS department, expressed growing concern about HIV in Papua New Guinea. Adult HIV prevalence in this Pacific nation was estimated to be 1.8% - a level not usually seen outside Africa. The country's health minister said that some isolated pockets could have rates as high as 30%.

“Papua New Guinea probably is somewhat in a class of its own in this region.” - Dr. Kevin De Cock¹¹⁹

In December, South Africa’s deputy health minister Nozizwe Madlala-Routledge decided to speak out against her own government, admitting there had been “denial at the very highest level” over the country’s AIDS crisis. She also acknowledged that leaders had created confusion about treatment by appearing to promote nutrition as a viable alternative. Activists greeted these statements as a “defining moment” in the country’s response to HIV and AIDS.^{120 121}

The most important scientific announcement of the year was made in December, when the US National Institutes of Health revealed the results of two African trials of male circumcision as an HIV prevention method. The studies were halted early for ethical reasons because they had already provided clear evidence that the intervention reduced HIV transmission by around 50%. The WHO and other organisations suggested they would soon begin promoting male circumcision in areas with severe HIV epidemics. However, they also stressed that there were many difficulties associated with this intervention, including acceptability, demands on resources, and infections resulting from unsafe operations. Furthermore, it was clear that the benefit would be lost if circumcised men became over-confident, and began to engage in more risky sexual behaviour.¹²²

At their second trial within two years, five Bulgarian medics and a Palestinian doctor were again found guilty of deliberately infecting 426 Libyan children with HIV, and were again sentenced to death. This verdict was condemned by the USA, the European Union and the UN human rights office. Leading experts in HIV and genetic testing had declared that the healthcare workers were almost certainly innocent, and that poor hygiene had led to the children becoming infected.¹²³

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