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This will be a depressing week for the 11,000 participants at the 13th annual International AIDS Conference that is being held in Durban, South Africa. They will be told of a grim future, and see and hear for themselves horrific examples of the toll the epidemic is already taking. Their hopes may rise as researchers and drug companies report on progress they have made in combating the disease, but they will be frustrated by the innumerable obstacles — cost chief among them — to their use.

Researchers now believe that AIDS has been with us for decades, but the disease exploded in the last 20 years. Today, 34.3 million people are infected with HIV, the virus that causes AIDS. The disease has killed 18.8 million people, 2.8 million last year alone. The number of children orphaned by the disease is forecast to rise to 800,000 in 2005 and 2 million in 2010.

The disease is devastating Africa, where 85 percent of infected people live. The World Health Organization last month announced that average life expectancies fell six years for sub-Saharan Africa during the 1990s because of AIDS. In several African nations, 15-year-old boys have more than a 50-50 chance of dying of AIDS.

Its effects ripple across societies. It is cutting food production as villages shift from nutritious foods to less labor-intensive crops. Crime will increase as large numbers of infected youths realize that life is cheap and they have little to live for. The World Bank predicts that countries in which infection rates reach 20 percent experience a 2 percent decline in economic growth on a cumulative annual basis. It is no wonder that earlier this year the United States government said AIDS was a threat to national security and stability on the continent.

Hardest hit among the African nations is South Africa. It has the largest number of people living with HIV/AIDS in the world — 4.2 million people, 19.9 percent of the population, are infected. An estimated 200,000 AIDS orphans have the disease. One study predicts that infection rates among unskilled and semi-skilled workers could exceed 30 percent. HIV-AIDS could kill up 10 percent of the mining workforce annually, threatening the country’s largest source of export revenue. It is estimated that within six years, the cost of a bar of gold could increase by 10 percent because of the disease. High infection rates among youths will increase unemployment and income inequality, exacerbating strains that have already stretched the society to the breaking point.

Compounding the tragedy is the fact that research has uncovered ways to fight the disease. Drug-combination therapies have drastically cut mortality rates, but at $10,000 a treatment, they are too expensive for developing countries. Drug companies have agreed to price cuts and are likely to agree to more at Durban, but the products are still too expensive, especially in Africa, where three-quarters of the people live on less than 200 yen a day.

Alternative therapies must be pursued. Prevention is the most cost-effective option. It has been estimated that 110,000 HIV births could be prevented if all pregnant women were given a short preventative antiviral course. That would cost $54 million — a considerable sum, but a fraction of the cost that otherwise would be incurred.

Adopting this strategy requires three steps. First, governments have to make AIDS prevention and treatment a priority. They must recognize the threat for what it is and end the denial that typifies many national policies. In particular, governments must reject the “AIDS revisionists” who argue that the disease is not caused by HIV. Last week, 5,000 doctors and scientists around the world signed a declaration that said “the evidence that AIDS is caused by HIV-1 or HIV-2 is clear-cut, exhaustive and unambiguous.” There are many theories that purport to explain why governments have embraced the revisionists, but one thing is certain: Quack science is claiming innocent lives.

Second, drug makers must step up efforts to make treatments available at less cost. Finally, developed nations must do their part as well. As the U.S. has noted, the disease poses a threat to regional stability, and while Africa has been the focus of attention, Asia faces its own crisis. It is estimated that about 25 percent of world AIDS sufferers are in the Asia-Pacific region. To help out, developed nations must go further to forgive the debt of the developing world. This month’s G8 summit of leading industrialized nations should make a statement to that effect — and then follow it up with action.

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