By Karen Ocamb

Editor's Note: Since June 5, 1981, HIV/AIDS has killed more than 25 million people worldwide and infected 40 million. According to the United Nations, AIDS could kill 31 million people in India, 18 million in China, and possibly 100 million in Africa by 2025. A new UNAIDS 2006 report on the global AIDS epidemic indicates that the rate of HIV infections has stabilized according to Michael Weinstein, president of AIDS Healthcare Foundation, which operates free AIDS treatment clinics in the United States, Africa, Latin America/Caribbean, and Asia, For more information, go to www.aidshealth.org.

The real news is that we're turned a corner. In 2005 there were fewer new infections and fewer deaths worldwide than in 2004. That's the first year in the history of the epidemic that worldwide numbers are down. There are two reasons: money and hope based on people being treated. We now have the means to control AIDS globally - not to eradicate it, but to have fewer new infections and few deaths. We know what works.

In terms of the United States response to AIDS, looking at it domestically -- the federal war on safer sex and explicit discussions on male-to-male sex, bisexuality, the effectiveness of condoms -- is a major negative. But when [President] Bush made that statement in his State of the Union address about the global program on AIDS, it was major breakthrough. Say whatever you want about Bush, it was not something done by [former President] Clinton. Clinton felt Africa's pain but didn't do anything about it.

When they implemented the program, it was slow getting started. At first they hesitated to use generics [drugs], and they've been sending out mixed messages on condoms [pushing ABC: Abstinence, Be Faithful and last, Condoms]. The United States spends more money on condoms than everybody else combined, but in places like Uganda the big promotion is on abstinence. And while abstinence is perfectly fine for young girls, it is not an effective strategy with truck drivers and it's not an effective strategy with young people who are already sexually active. So, what's happened in the last two or three years has been that infections are now going up steeply again in Uganda. When I first went there six years ago, it was all condoms all the time. It was a very clear message. My own first hand observation is that it was the promotion of condom use that made a major difference. And when you look at a place like Brazil -- they've had an extremely effective program of safer sex education, condom promotion and access to treatment -- they've had great success.

The second problem is this whole thing about being faithful -- the B in ABC. Most people in the developing world have not been tested so one of the most dangerous places is the marital bed because if one of the persons, usually the male, has been sexually active outside the home -- if they don't use protection, then he's going to infect the wife. So the “Be Faithful” is problematic. If you have something that would be effective for women [like a microbicide]- that would be tremendous.

I think we're at an interesting turning point with AIDS in general. A lot of sacred truths are being called into question. There's almost no likelihood of having a vaccine even in the next 25 years, yet we spend millions of dollars on that. How many vaccines against retroviruses have been successful? None. I just don't think we're likely to see a cure, but the line between an anti-retroviral that can render a person virtually non-infectious and a vaccine becomes a very thin line.

Another thing is voluntary counseling and testing. It's not an effective model for our country and it's really silly when you try to apply it to rest of the world. We have clinics in India, which has the most number of people infected with HIV -- 5.7 million. We need to test, in the next two years, 200 million people. If we take a half an hour a test, that's not viable. The intervention with the counseling is needed when a person goes into treatment.

In our African sites where we do testing, the average positivity rate is 50 percent. So the most important thing is to get them into treatment immediately. And the big question for the next 25 years is going to be are we going to continue to provide the resources necessary to make access to treatment universal?

If I look out over whole global landscape, the biggest thing that's missing is testing -- 95 percent of the people in the world who are HIV positive do not know it, and the people who do know it are sick. The numbers are coming down now because of the treatment being available. In one of our sites in Africa, where we started testing after we were treating for a couple of years, we had a 3,700 percent increase in the number of people being tested.

We need to mainstream HIV testing into hospitals, clinics, doctors' offices, and prenatal care. We should give people the right to say they don't want it but it should be normalized. The gay community and the AIDS community have inadvertently reinforced the stigma of HIV by saying it's so different and we're subject to such discrimination that we can't be part of the overall healthcare system at all.

I think the contribution that the gay and lesbian community in the United State is making to the global fight against AIDS has been unrecognized and unappreciated. I think historically, that's going to be a very interesting aspect. You could almost make an analogy to Christians who helped Jews in Nazi Europe. A lot of times the gay community is criticized for being self-indulgent, but there's been a real expression of generosity by this community and I think that should be recognized. But I think that if we really want to control HIV and spare future generations, there's more we can do.