Expected to draw more than 20,000 researchers, policymakers and grassroots workers, the International AIDS Conference is the 18th since acquired immune deficiency syndrome came to light in 1981.

For almost all this time, the conferences have been the theatre for frustration and sometimes anger. Doctors would reel off the latest setbacks in the quest to treat and prevent the AIDS virus, while activists pounded the drum for money and action by Big Pharma.

Today, though, the mood is brighter than ever. Indeed, many AIDS warriors are talking cautiously of a foe that is on the way to being contained and one day will be rolled back.

"One day, we will have to turn our minds on how to wipe out the virus," Jean-Francois Delfraissy, director of France's National Agency for AIDS Research (ANRS), said in an interview.

The optimism comes from the success of antiretroviral drugs, the "cocktail" of drugs that, like a boot pressed firmly on the throat of a killer, keeps HIV suppressed.

For millions, this medication has transformed the human immunodeficiency virus (HIV) from a death sentence to a chronic but manageable disease.

Even better, antiretrovirals are also emerging as a policy tool for prevention. Lowering viral levels to below perceptible levels massively reduces the risk of handing on the pathogen between sex partners or from a pregnant mother to her child.

There is also hugely encouraging news about male circumcision for preventing the spread of HIV to men, and even a few glimmers of hope from the lab, where scientists are toiling for a vaccine and virus-thwarting microbicide gel.

"We really are at an important crossroads," Gottfried Hirnschall, new director of HIV/AIDS at the UN's World Health Organisation (WHO), said in an interview.

"It's all coming together. We no longer have this treatment-versus-prevention conversation. The question now is about making the best of the resources we have, and in the most intelligent way."

Many terrible problems remain, Hirnschall cautioned.

More than 33 million people live with the virus and each year 2.7 million more cases of HIV occur. Stigma, ignorance and discrimination, in many places, are entrenched. Millions of poor, needy people have yet to clutch the drug lifeline.

To help them, a key question in Vienna is how to finetune the use of antiretrovirals and mesh them with low-cost medical support, using nurses or medical orderlies as substitutes for doctors.

Doctors may be advised to start prescribing anti-HIV drugs at an earlier stage of infection, a tactic that would save more lives and, say some, be a cost-saver too, as healthy people are more productive for longer.

Yet does the world have the will, at a time of belt-tightening, to foot the bill for treating people sooner?

This year, 25 billion dollars has to be mustered for fighting AIDS in poorer countries, according to a UNAIDS estimate. So far, there is a funding shortfall of 11.3 billion, according to an analysis published last week in the US journal Science.

That means a 2006 vow by UN members to provide "universal access" to HIV drugs, prevention, treatment and care by the end of 2010 is set to become one more headline-making political promise that fell flat.

"The success of ARVs (antiretrovirals) made it so people think HIV is no longer there," said Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS in Vancouver, Canada, and president of the International AIDS Society, which is organising the conference.

"Politicians basically react on a short-term agenda. Since HIV treatment became effective, people are not under the same pressure that they used to be."

The Vienna conference will also turn the spotlight on Eastern Europe, where the epidemic is being driven especially by intravenous drug users.

Russia and Ukraine, the two hotspots of infection, are under pressure to scrap policies that criminalise drug users and to encourage needle-exchange programmes and help to wean addicts of heroin by using methadone, a safer substitute for opiates.

VIPs attending include former US president Bill Clinton, Microsoft tycoon and philanthropist Bill Gates, rock star Annie Lennox and Hollywood actress Whoopi Goldberg.

HIV/AIDS: Factfile
Paris (AFP) July 15, 2010 - Following is a factfile ahead of the 18th International AIDS Conference, running in Vienna from July 18-23:

WHAT IS AIDS? Acquired Immune Deficiency Syndrome, which first came to light in 1981, is the term for a progressive weakening of the immune system. The body is exposed to pneumonia, tuberculosis, fungal disease and other opportunistic infections, as well as specific types of cancer, that ultimately are fatal.

WHAT CAUSES IT? The cause of AIDS is the human immunodeficiency virus (HIV), a retrovirus suspected to have leapt the species barrier from animal primates in central Africa. HIV is found in blood, semen, vaginal secretions and breast milk. It enters the body through cuts or sores or by directly infecting cells in the mucous membranes in the genitals or anus. The main modes of infection are unprotected sexual intercourse, shared use of drug syringes, from a mother to her unborn child and transfusion of contaminated blood.

HOW DOES HIV WORK? HIV destroys key white-blood cells called T-helper lymphocytes. It does this by latching onto a molecule known as CD4 on the cell's surface. The virus then penetrates the cell, hijacking its enzyme-making machinery in order to replicate itself. Baby viruses then burst out to infect other T cells.

HOW LONG DOES IT TAKE? The time from initial infection to full-blown AIDS in untreated patients is about nine years, but the time can vary according to the individual. From AIDS to death generally takes between six months and three years.

WHAT IS THE TOLL? At least 25 million people have been killed by AIDS since the disease came to light in 1981. According to the UN agency UNAIDS, at the end of 2008, around 33.4 million people were living with HIV, 22.4 million of them in sub-Saharan Africa. In 2008, 2.7 million people became infected, a 30-percent fall compared with the peak of HIV's spread 12 years earlier.

IS THERE A CURE? There is currently no cure for HIV, but there is a treatment that can suppress the virus to very low levels. Antiretroviral drugs, a combination of two or three medications that inhibit viral reproduction or stop the virus from fusing with the CD4 T cell, are a lifesaver for millions. But they can also have powerful side effects, including diarrhoea, nausea and cramps, and carry a risk of treatment failure. There are more than 20 antiretroviral drugs today. In poorer countries, 9.5 million people are in immediate need of the therapy, but only four million have access to it.

HOW CAN HIV BE PREVENTED? For sexual intercourse, a latex barrier (a male or female condom) is highly effective. Trials in Africa have shown that male circumcision, which removes mucous cells from the foreskin, can roughly halve the risk of infection for the man, although there is no protection for an uninfected woman. Mother-to-child transmission can be combatted by treating the mother-to-be and the newborn with antiretrovirals. Contamination by blood transfusion is now rare in most countries, thanks to screening of blood donations. Needle exchange programmes, in which a used syringe is swapped for a clean one, can help reduce transmission among drug addicts.

WHAT ABOUT A VACCINE? The search for an HIV vaccine is arguably the toughest challenge of all. Trials of prototype vaccines have shown negligible protection or none at all. However, some encouraging work has been achieved in the lab in identifying antibodies -- natural frontline troops in the immune system -- that could hopefully be primed to recognise the virus. The effort for an HIV-preventing microbicide gel, which could be used in anal or vaginal intercourse, has a similar report card.

SOURCES: UNAIDS; www.avert.org; US National Institutes of Health (NIH); World Health Organisation (WHO); International AIDS Vaccine Initiative (IAVI).

HIV/AIDS in figures
Paris (AFP) July 15, 2010 - Here are the latest estimates of the global HIV/AIDS pandemic, published last November by the UN agency UNAIDS.

Figures are for the end of 2008. An update is expected later this year.

1) TOTAL INFECTIONS IN 2008:

WORLD: Around 33.4 million people living with HIV, in a range of 31.1 million to 35.8 million.

BY REGION:

Sub-Saharan Africa: 22.4 million

South and Southeast Asia: 3.8 million

East Asia: 850,000

Latin America: 2.0 million

North America: 1.4 million

Western and Central Europe: 850,000

Eastern Europe and Central Asia: 1.5 million

Caribbean: 240,000

Middle East and North Africa: 310,000

Oceania: 59,000

2) NEW INFECTIONS IN 2008:

WORLD:

2.7 million people became infected in 2008, unchanged from 2007.

BY REGION:

Sub-Saharan Africa: 1.9 million

South and Southeast Asia: 280,000

East Asia: 75,000

Latin America: 170,000

North America: 55,000

Western and Central Europe: 30,000

Eastern Europe and Central Asia: 110,000

Caribbean: 20,000

Middle East and North Africa: 35,000

Oceania: 3,900

3) AIDS DEATHS IN 2008:

WORLD:

Around two million people died from AIDS-related causes in 2008, unchanged from 2007.

BY REGION:

Sub-Saharan Africa: 1.4 million

South and Southeast Asia: 270,000

East Asia: 59,000

Latin America: 77,000

North America: 25,000

Western and Central Europe: 13,000

Eastern Europe and Central Asia: 87,000

Caribbean: 12,000

Middle East and North Africa: 20,000

Oceania: 2,000

Source: 2009 AIDS Epidemic Update

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