Plenary Session

Speakers:

• Stefano Vella, President, International, AIDS Society, How to Slow HIV Progression in Resource Scarce Environments
• Adeeba Kamarulzaman, Department of Medicine, University Malaya, Kuala Lumpur, Malaysia Challenges for Opportunistic Infection Prophylaxis and Management
• Praphan Phanuphak, Thai Red Cross AIDS Research Centre, Bangkok, Thailand Role of Clinical Research in Expanding Access to HIV/AIDS Treatment
• Celina D'Costa, Vice-President, Indian Network of People Living with HIV/AIDS, Kochi, India. Role of PLWHA in Development & Access to HIV/AIDS Care

Stefano Vella presented a fresh analysis of the barriers put up by people and governments when they are considering access to adequate treatment and care in resource-poor settings. He identified cost, conflict with other health priorities, and lack of health infrastructure, overly complex treatments regimens and resistance as traditional barriers. Each of these had been a problem in resource rich settings and he argued that it was just as possible to overcome them in resource-poor settings. He stressed that resource rich countries had set aside money to assist their health systems cope with the new demands that HIV/AIDS was placing on them, that they had worked HIV/AIDS into their health priorities, that they had spent time and money training health workers, that they had worked to standardise and simplify treatment regimes and they had acknowledged and attempted to deal with resistance problems. Vella argued that the lessons of the resource rich countries needed to be taken on board: These countries did not wait for the results of research before they began to treat and care for people. "Do not use the need for research as an excuse to delay the availability of treatments", he stressed.

Dr Kamarulzaman from Malaysia made several interesting new observations about opportunistic infection prophylaxis and treatment. She made a strong plea for early diagnosis of HIV as a key way to prevent opportunistic infection (OI). She presented figures demonstrating the high rate of late presentation of HIV in SE Asian countries and argued that earlier testing and diagnosis provides an opportunity to prevent OI and swell as to provide counselling, support and prevent the spread of HIV. She called for more research into stopping OI prophylaxis for people with sustained raised CD4 counts. She identified the following priorities: better access to VCT programs to assist in early diagnosis; increased expertise in management of HIV; cheaper oral and simpler OI diagnostic tests and better access to drugs for OI prophylaxis and treatment.

Professor Phanuphak from Thailand presented a strong case for sustainable clinical partnerships between resource rich and resource poor countries. He argued that the subjects of research need to be able to benefit directly from research, particularly that researchers had a responsibility to provide care, not just to measure results. He also criticised drug companies for putting restrictions on the distributions of low cost drugs to resource poor countries. He argued that countries needed to have the right to charge citizens who had the ability to pay for treatments. Celina D'Costa argued strongly for the involvement of people with HIV in the design and evaluation of treatment and care services. She argued for increased resource allocation, training for positive people and positive groups.