New AIDS medicines are not ready, prevention has shown its limitations and treatments are giving patients adverse side effects or are losing ground to an increasingly virulent virus.

More than 4,000 medical specialists will converge on San Francisco from Sunday to Wednesday for the 11th annual Conference on Retroviruses and Opportunistic Infections.

The conference will focus on how to apply research to medical treatment for an illness affecting 40 million people worldwide and killing three million a year.

Researchers will present 900 studies, including test results for new antiretroviral agents that have been studied for years but are not ready for commercial use.

One study will show how tritherapies -- the practice of combining of several treatments -- lose their effectiveness if they are diminished to make patients more comfortable.

Researchers will also present a much awaited study on the effects of a treatment to prevent the transmission of AIDS from a mother to a child, a critical problem in developing countries.

Specialists at the conference will examine the long-term side effects of treatments in developed countries. Side effects found in patients who have been treated for a decade include cancer and cardiovascular disease.

On prevention, the conference will look at the alarming situations in New York, prisons and the country's black population. More than one million Americans have HIV/AIDS.

VaxGen, a US biopharmaceutical company, will release details of its study on a candidate vaccine to combat the deadly disease, but the company has said the trial vaccine was ineffective. The company will also show results on another vaccine.

Researchers will discuss complications in HIV patients from developing countries who are infected with other diseases, including the herpes virus and tuberculosis.

The conference will dedicate several presentations to the establishment of AIDS treatment in the world's poorest countries, especially in sub-Saharan Africa, where three million new HIV infections were recorded in 2003. There were 1.2 million new HIV infections in the rest of the world.

It would also avert 52 million unintended pregnancies and prevent 505,000 children from losing their mothers, according to a new report by the United Nations Population Fund (UNFPA) and the New York-based AGI.

"It has a very long-term development impact," Camp said in an interview.

But rich countries, particularly the United States, have failed to live up to financial commitments they made at a 1994 conference in Cairo on population and development.

"As a result we are actually losing ground in some countries," Camp added.

The report is the first study of its kind to synthesize all the research of the last 25 years on the return on investment in sexual and reproductive health programs.

Developed countries are committing only about half of what they promised at the Cairo meeting a decade ago. Meanwhile, demand for the services, which include providing contraceptives, prevention of sexually transmitted diseases including HIV/AIDS and maternal and infant health care, is growing.

"Our report makes it clear that the global community can well afford to make the additional investment needed to close the gap in sexual and reproductive health," Camp told a news conference.

Sexual and reproductive health accounts for one-third of the global burden of disease among women, while HIIV/AIDS accounts for six percent. The need is greatest among the poorest.

Keeping women healthy and providing contraceptives to delay childbirth and allow couples to have smaller families also contributes to economic growth and equality, according to the report.

"Money invested in sexual and reproductive health services will be repaid many times over," said Dr Thoraya Obaid, executive director of UNFPA.

When President Bush  took office in 2001 he withdrew funding for the New York-based UNFPA. The Bush administration argued that by working in China the UNFPA was sustaining a Beijing policy of forced abortion in pursuit of its "one child per family" program.

But the UNFPA said its programs are run in Chinese counties where the policy is not pursued.

"We hope it (the report) will reach the Bush administration and also members of the U.S. Congress who appropriate funds," said Camp.

"We also hope it will reach European donor governments. Even though they are doing better than the United States in meeting their pledges, none of them are where they committed to be in 1994."

LONDON (Reuters) - Sexual antics of young British men and women on the Spanish holiday island of Ibiza could be endangering their health, doctors warned on Wednesday.

Around half the 1,500 people who arrived on Ibiza without a regular sexual partner said when questioned in a poll that they had sex with at least one person during their stay.

One in four young men and one in seven women had more than one sexual partner. Eleven percent of males and three percent of females said they had indulged in sex with six or more people during a typical 10-day stay -- and not all of them practiced safe sex.

"Although for most individuals the attraction of Ibiza was not specifically to have sex, the majority did have sex while on holiday," said Professor Mark Bellis, of Liverpool John Moores University in northern England, in a report in the journal Sexually Transmitted Infections.

Out of the 16 to 35-year-olds questioned in the three-year study, 38 percent of those who had sex failed to use a condom all the time, risking exposure to sexually transmitted infections (STIs), including HIV/AIDS.

"With over 250,000 young people from the United Kingdom each year visiting just Ibiza, this represents a substantial conduit for transmission of STIs between countries," said Bellis.

The researchers said action to protect the sexual health of millions of people traveling abroad is needed along with investment and cooperation from local health services, policy makers and the travel and nightlife industries.

A team of experts largely from the World Health Organization (WHO) and UNAIDS, in an article published in The Lancet medical journal, rejected a recent suggestion that Africa's epidemic is driven by unsafe health care injections and blood transfusions.

By reasserting widely-held views that heterosexual sex spreads HIV/AIDS in up to 90 percent of adult cases on the continent, they vindicated existing prevention programs which focus on teaching safe sex and use of condoms.

An estimated 26.6 million people in sub-Saharan Africa, the world's hardest-hit region, were living with HIV/AIDS at year-end, according to UNAIDS.

A Pennsylvania-based consultant, David Gisselquist, led a group of researchers who a year ago defied conventional views and blamed unsafe injections for causing up to 40 percent of adult cases of HIV/AIDS in the region.

But a team led by George Schmid, of WHO's department of HIV/AIDS, rejected the unorthodox findings after reviewing the same data as well as other studies.

"We concluded that epidemiological evidence indicates that sexual transmission continues to be by far the major mode of spread of HIV1 and that unsafe injections, while important to eliminate, do not contribute nearly the proportion of cases as has been suggested," Schmid told a news briefing in Geneva.

"Unsafe injections -- defined as the reuse of needles or syringes in the absence of sterilization -- are not sufficiently common to play a dominant role in HIV transmission in sub-Saharan Africa," he added.

Most injections in sub-Saharan Africa are given intramuscularly and blood contamination of needles after such use is "infrequent," according to the team of 15 which included experts from Belgium, Britain, Uganda and the United States.

Schmid endorsed WHO's estimate that unsafe injections account for just 2.5 percent of HIV/AIDS transmission in Africa.

"Ideally we would like to see further studies done to corroborate our conclusions and investigate more precisely the role of unsafe injections," he added.

Peter Ghys of UNAIDS, who took part in the study, said: "A lot of prevention programs that have been going on in Africa should be continued. With there being much more funding available, there is an opportunity to expand those programs." (Reporting by Stephanie Nebehay, editing by Philippa Fletcher.)

By Merritt McKinney

NEW YORK (Reuters Health) - Regional differences in the varieties of heroin available may explain why injection drug users in the western U.S. are much less likely to be infected with HIV, the virus that causes AIDS, than users in the eastern part of the country, new research suggests.

Unlike the powdered heroin that predominates in eastern cities, the "black tar" heroin that is most common west of the Mississippi tends to clog syringes, meaning that users are more likely to thoroughly clean their syringes and to dispose of them more frequently. This behavior may reduce the risk that HIV will be transmitted when people share needles, according to a report in a recent issue of the journal Substance Abuse and Misuse.

It's long been known that sharing the needles used to inject drugs can transmit HIV from one user to the next. But while a high proportion of injection drug users in eastern cities have become infected with HIV, the infection rates in injection drug users have been comparatively low in western cities.

"This paper shows a possible solution for a public health paradox that has been unsolved for 20 years, i.e., why did western U.S. heroin injectors not get the full brunt of (the) HIV epidemic?" study co-author Dr. Daniel H. Ciccarone of the University of California at San Francisco told Reuters Health.

In most cities west of the Mississippi, black tar heroin from Mexico was the dominant form of heroin used by injection drug users in the early- to mid-1990s, note Ciccarone and co-author Dr. Philippe Bourgois. In contrast, powdered heroin from South Asia and South America was more common in most Eastern cities.

New York City and Los Angeles are both large cities with considerable numbers of injection drug users, but in the early 1990s, HIV infection was much more common in New York's heroin-using population. While about 41 percent of injection drug users in New York were HIV-positive, only about 4 percent of users in Los Angeles were infected with HIV.

"Our article brings to light a startling and unrecognized issue: there are different types of street-market heroin and we do not fully know the implications of this," Ciccarone said.

Powdered heroin rarely clogs syringes, so people who use this type of heroin may be less likely to rinse needles than people who use black tar heroin. Because of the gummy nature of the black tar form of the drug, users must thoroughly rinse out syringes after each use to keep them from getting blocked. This rinsing may reduce the risk of HIV transmission by flushing out blood that could be infected.

Another reason that the use of black tar heroin may be less risky in terms of HIV infection, according to the report, is that this form of heroin is heated before use, which could kill HIV.

The authors also point out that injection of black tar heroin rapidly leads to a condition called venous sclerosis, which makes injecting into veins difficult. So instead of injecting directly into veins, users start injecting into muscle or under the skin. These methods may be less likely to transmit HIV.

In many parts of the U.S., HIV infections among injection drug users have stabilized or have begun to drop, but public health officials should not become complacent, according to Ciccarone.

"Will the HIV epidemic spark in places where powder heroin returns?" Ciccarone asked. The San Francisco researcher encouraged public health advocates to communicate with Department of Justice officials about changes in the heroin supply in order to prepare for the complications of those changes.

The impact of the heroin supply is not limited to HIV risk, according to Ciccarone, who noted that people who use black tar heroin are more likely to develop soft-tissue infections. If black tar heroin moves into a region, emergency departments and clinics should be advised to be on the lookout for patients with such infections, he said.

Another trend to watch for, Ciccarone said, is a possible increase in heroin from Afghanistan and Pakistan, which has occurred in Europe since the fall of the Taliban. Heroin from this region is in powdered form, so it may bring with it an increase in HIV infections, Ciccarone said. He added that this heroin has also been associated with outbreaks of bacterial disease in Europe.

SOURCE: Substance Use & Misuse, December 2003.

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