By Robert Evans

GENEVA (Reuters) - The world is not ready for the full social and economic impact of AIDS, which has killed more than 20 million people in the past quarter century, the World Health Organization warned Tuesday.

The U.N. agency said unless nations pulled together to defeat it, AIDS would destroy any hope of a better life for tens of millions, including non-sufferers, living in abject poverty around the globe.

The world at large "is far from ready for what is to come" -- catastrophic social and economic consequences for many communities and countries if the epidemic continued unchecked, WHO said in its annual report.

"Although it has seemed a familiar enemy for the last 20 years, HIV/AIDS is only now beginning to be seen for what it is: A unique threat to human society whose impact will be felt for generations to come," it said.

It was already undermining the U.N. Millennium goals of eradicating by 2015 extreme poverty and hunger, reducing infant and maternal mortality and the spread of other diseases, and achieving universal primary education, it added.

WHO's annual report on key aspects of international health -- this year focusing on AIDS, the leading cause of death among 15-59 year-olds worldwide -- is to be presented at the agency's annual assembly next week.

The 170-page report, entitled "Changing History," injected a small note of optimism into the overall gloom emerging from its AIDS statistics -- 34-46 million people infected, with five million joining them every year.

A concerted international effort to get the latest treatments to sufferers and promote ways to avoid infection could turn the tide, it said, even though no vaccine was in sight despite years of research.

It cited many cases -- in the Caribbean, Latin America, Africa and Asia -- where the latest anti-retroviral drugs had pulled sufferers back from the brink of death and restored them as active citizens contributing to their national economies.

But of the six million people in developing countries who need the therapy, only 400,000 got it last year, the report said. More than 90 percent of victims live in just 34 countries.

The report said although Africa is home to two-thirds of all people living with the disease, it accounts for only 11 percent of the world's total population of some six billion.

About one in 12 African adults is infected.

HIV/AIDS -- a virus believed to have originated with animals -- destroys the body's immunity systems, leaving it almost defenseless against a range of diseases, including major killers tuberculosis and pneumonia.

© Reuters 2004. All Rights Reserved.

By JONATHAN FOWLER, Associated Press Writer

GENEVA - Small clinics should be opened across developing countries to treat HIV-infected people, boosting the onslaught against AIDS and helping improve general health, the World Health Organization said Tuesday.

"We are living in a time of unprecedented opportunities for health," said WHO Director-General Lee Jong-wook in urging community-based treatment be added to disease prevention and care for sufferers.

"Future generations will judge our era in large part by our response to the AIDS pandemic," Lee said in his introduction to the 169-page annual World Health Report. "By tackling it decisively we will also be building health systems that can meet the health needs of today and tomorrow. This is an historic opportunity we cannot afford to miss."

The report said small-scale AIDS treatment programs are an ideal way to spend the US$20.5 billion which has been gathered from donors, by WHO, the U.N.-administered Global Fund to Fight AIDS, Tuberculosis and Malaria, and other programs launched by the World Bank and U.S. President George W. Bush. They provide a much-needed and lasting boost to health care in poor nations, said WHO.

Lee noted many anti-AIDS programs focus on disease prevention and care for sufferers but place too little emphasis on treatment.

However, the report said, scaling up treatment can strengthen AIDS prevention.

The global battle against AIDS has shown the effectiveness of community-base care and provided clear lessons for governments and donors, WHO said

Where treatment has been made available, this has led to overwhelming demands for testing and counseling. Good counseling in turn leads to more effective prevention in those who are uninfected, and significantly reduces the potential for HIV carriers to pass on the infection.

Because anti-AIDS programs stimulate investment in broader +health+ services, they boost the fight against other killers, the report said. "The outcome can be better +health+ for generations to come," the study said.

The report features the case of Joseph Jeune, a 26-year-old farmer from Lascahobas, central Haiti, who has AIDS.

In March 2003, Jeune was emaciated and his parents had already bought his coffin. Six months later, thanks to antiretroviral drugs provided by an AIDS treatment program in a hometown clinic, Jeune had gained 20 kilograms (44 pounds) and is pictured smiling in the report.

The U.N.-backed AIDS program which has helped Jeune live a better life also enabled Haitian +health+ authorities to refurbish local clinics and recruit new staff. "They are receiving up to 10 times more patients for general medical care daily than before the project began," the report said.

Since its discovery in the 1980s, more than 20 million have died of AIDS, mostly in poor countries. The HIV virus  which causes AIDS is spread mostly through unprotected sexual intercourse between men and women.

The disease, which killed 3 million people last year, is now the leading cause of death and lost years of productive life for people aged 15-59 years worldwide. In the worst-affected nations of sub-Saharan Africa, life expectancy has plunged to just 36 years because of the disease.

The report said that countries in sub-Saharan Africa face economic collapse unless they bring their epidemics under control, mainly because AIDS weakens and kills adults in their prime — depriving communities of doctors, teachers and farmers — and orphans millions of children.

WHO said an estimated 36-46 million people now are living with AIDS — two-thirds of them in Africa, where one adult in 12 is infected.

"Without treatment, all of them will die a premature and in most cases painful death," said WHO. However, only 400,000 people in developing countries were receiving treatment by the end of 2003, it said.

Lee, a South Korean tuberculosis expert who previously ran WHO's Stop TB program, took office as chief of the 192-nation WHO last July.

He pledged then to boost the fight against AIDS and other global killers, and last September launched WHO's "Three by Five" program, which aims by 2005 to provide three million people in developing countries with antiretroviral drugs.

Lee also plans a training program for young medical professionals from poor countries, saying it will help hard-hit nations better tackle a range of diseases.

The study did not provide the 2003 death tolls for diseases other than AIDS.

After AIDS, the leading global killers the previous year were: heart disease, 1.3 million; tuberculosis, 1 million; stroke, 800,000. Road accidents killed 800,000 people, mostly in developing countries.

An Indian sex worker looks out from a tram during an AIDS awareness campaign. File photo by JAYANTA SHAW

China, where officials said at the weekend that AIDS was spreading rapidly, is also a major concern with 840,000 estimated HIV infections amid unreliable data in some areas, they added.

Senior officials from the World Health Organisation (WHO), UNAIDS agency and Global Fund to Fight AIDS, Tuberculosis and Malaria were speaking at a news conference to launch WHO's annual World Health Report.

The WHO's report warned the world was not ready for the full social and economic impact of AIDS, which has killed more than 20 million people in the last quarter century.

The United Nations agency said that unless nations pulled together to defeat it, AIDS would destroy any hope of a better life for tens of millions, including non-sufferers, worldwide.

South Africa has an estimated five million HIV sufferers -- the highest number worldwide -- against an official 4.5 million reported in India, according to Richard Feachem, executive director of the Geneva-based Global Fund.

"I believe the Indian statistics are underestimated and that already India has considerably more infected people than South Africa," Feachem said.

"What is much more alarming is looking at the future. With an epidemic growing so fast and a large population, it will become far, far larger than any epidemic in any other country," he added.

India is the world's second-most populous nation, after China, with more than one billion people.

Despite the threat, India had not put in place the necessary policies for preventing, testing and treating sufferers which were needed "if India is going to turn around the tidal wave of HIV/AIDS which is breaking over it," Feachem said.

TURNAROUND IN CHINA

China's State Council, or cabinet, on Sunday ordered urgent measures including school education and public awareness campaigns to help keep the deadly virus in check.

Lee Jong-Wook, WHO director-general who recently held talks with senior officials in Beijing, said China appeared determined to confront AIDS.

Chinese health authorities were working to fulfil a pledge to provide treatment free of charge, he said, adding: "This will obviously take some time until it is put in place, but it is very encouraging news and a turnaround."

Peter Piot, head of UNAIDS, said China's estimate of 840,000 sufferers seemed to be on the right order of magnitude.

"I would say it is safe to assume it is around one million," Piot said. "The data are quite good for some provinces, but not so reliable for others."

The WHO report said the world at large was "far from ready for what is to come" -- catastrophic social and economic consequences for many communities and countries if the epidemic continued unchecked.

The 170-page report, entitled "Changing History", is to be presented at the agency's annual assembly next week.

Of the six million people in developing countries who need anti-retroviral therapy, only 400,000 got it last year, it said.

By Gordon Bell

CAPE TOWN, South Africa (Reuters) - Nearly 7 percent of South African children aged between 2 and 9 are infected with HIV, a survey said Wednesday, offering grim new data for a country struggling with the world's worst AIDS epidemic.

The Human Sciences Research Council said parentless children were at highest risk, with an estimated 12.7 percent of orphans under 18 years old infected with the AIDS virus.

"The risk of HIV/AIDS among children has received little attention in South Africa ... it appears that children run a much greater risk of contracting the disease than previously thought," Olive Shisana, executive director of the state-subsidized council, said at a meeting of African AIDS experts in Cape Town.

Until now no research has been done on prevalence rates among children, many of whom lack adequate medical care.

An estimated 5.3 million of South Africa's 45 million population are infected with HIV, making the country the hardest hit by the epidemic.

The South African government, accused by activists of reacting far too slowly to the crisis, this year launched its first public program to distribute life-prolonging antiretroviral drugs.

The survey, based on a study of 3,988 youths, found that an estimated 5.4 percent of children aged between 2 and 18 were HIV positive, with the highest prevalence -- 6.7 percent -- among ages 2 to 9.

An estimated 4.7 percent of children 10 to 14 years old were infected. Young girls in that age group were most at risk with 5.9 percent infected compared to 3.5 percent for boys.

Shisana said one of the possible causes of high HIV prevalence among children was a lack of care and supervision, partly a result of parents dying of AIDS.

"The risk of being HIV-positive is much higher for children whose mother and father have died," she said.

The percentage of child-headed households had increased marginally from statistics in the state's 1999 household survey, she said.

The research found "0.6 percent of households claim to be headed by children aged between 14 and 18, up from 0.25 percent. It is an increase but not as high as one would have expected given the HIV epidemic," Shisana said.

© Reuters 2004. All Rights Reserved.

By Maggie Fox, Health and Science Correspondent

WASHINGTON (Reuters) - The U.S. government should pay to treat all low-income Americans infected with the AIDS virus, at a cost of an extra $5.6 billion over the next 10 years, a committee of experts recommended on Thursday.

The committee at the Institute of Medicine, which advises the federal government on health issues, said the proposed low-income treatment program would pay for itself by reducing future health costs.

All U.S. citizens with the human immunodeficiency virus (HIV) who make less than $22,500 a year should be eligible, the report recommended. It said the program should pay for HIV drugs that can keep patients healthy and for the supportive care that goes along with it.

"The federal government should establish and fully fund a national program for treatment of individuals with HIV infection that would administered by the states," committee chair Lauren LeRoy, president of Grantmakers In Health, a nonprofit health educational organization, told a news conference.

Total public spending on HIV and AIDS is about $7.2 billion a year in the United States, LeRoy said.

The new federal program would take over what states currently spend on HIV and AIDS through Medicare and Medicaid, and would end up costing only about $500 million extra annually, she said in an interview.

In the first year, she said, almost 59,000 new HIV patients would be able to get lifesaving drugs, and over 10 years their death rate would fall by 56 percent.

A GOOD BUY

"We also estimate that around 3,000 new HIV infections would be averted each year," she said. "It is considered a good buy."

The AIDS virus infects an estimated 43 million people worldwide and has killed more than 25 million since it first began spreading in the early 1980s. HIV has infected about 950,000 people in the United States and 40,000 more become infected each year.

HIV infection cannot be cured, but a cocktail of drugs can keep it from progressing to AIDS -- the destruction of the immune system that leaves patients vulnerable to a range of infections that eventually kill them.

"Although these programs provide antiretroviral drug therapy and other services to thousands of needy HIV-infected people, thousands more go without necessary treatment because of eligibility requirements and limitations in covered benefits," the Institute said.

The Kaiser Family Foundation, a nonprofit health research group, describes HIV health coverage in the United States as "a quilt with many holes." It says it is difficult to navigate through the different programs that are available.

"An estimated 42 percent to 59 percent of the almost one million people living with HIV/AIDS in the U.S. are not in regular care," Kaiser said in its most recent report.

"The fact that about 40,000 new AIDS diagnoses and 16,000 deaths occur each year further indicates that our current system is failing to ensure adequate health care for persons living with HIV infection," the Institute added.

© Reuters 2004. All Rights Reserved.

The proposal by the U.S. Food and Drug Administration would ensure the quality of drugs purchased by the United States, the Health and Human Services Department said in a statement.

"We are clearing the way to quickly deliver quality, life-saving HIV/AIDS drugs to people who desperately need them in developing countries," HHS Secretary Tommy Thompson said.

"Fixed-dose combination products and co-packaged products are an important tool in improving the quality of health care in developing nations," he added.

U.S. Global AIDS Coordinator Randall Tobias said drug patent issues that apply in developed nations should not impede purchase of these drugs for developing nations.

The FDA guidance will apply to new products that combine already approved individual HIV/AIDS therapies into a single dosage, known as fixed dose combinations, as well as to new co-packaging of existing therapies.

"The president has made clear that his goal is to put effective treatment into the hands of those who need it in the hardest-hit developing nations and to provide these life-saving services as widely as possible," Tobias said.

"With FDA review, we will have a gold-standard assurance that a combination product will be safe and effective," he said.

The HHS' Thompson said under the proposal, approval of permits could happen within two to six weeks after applications have been received.

For companies making products for which another firm owns the U.S. patent rights, the FDA would issue a tentative approval if the product meets the agency's standards.

© Reuters 2004. All Rights Reserved.

By LAURAN NEERGAARD, AP Medical Writer

WASHINGTON - The Bush administration on Sunday will promise rapid approval of AIDS drug combinations that could be used for lower-cost treatment in Africa, despite criticism that requiring stricter standards could delay care to the world's poor.

The new system, being disclosed at a World Health Organization meeting in Geneva, is open to foreign makers of generic drugs, which makes those approved eligible for purchase under the $15 billion U.S. global AIDS program.

That is "a real change in policy," said Dr. Peter Piot, executive director of the U.N. AIDS organization, who has been closely watching the U.S. debate.

"This is a big market for them," he said of foreign generic makers. Thus, "I see an incentive for brand-name companies to get their act together to pursue fixed-dose combinations, too."

Stephen Lewis, the U.N. special envoy on AIDS in Africa, also praised the decision.

"This is an unexpected and excellent move," he said before flying to Geneva. "The United States has been raising unacceptable questions about the legitimacy of generic drugs for treatment of AIDS and now they seem to have reversed their position and accommodated the force of world opinion."

"Fixed-dose combinations" put into one pill several expensive treatments already sold in the United States by brand-name companies. Foreign companies have begun manufacturing low-cost generic versions of anti-HIV drugs and combining them into single pills.

The World Health Organization has signaled which combinations are appropriate for use in its international push to get lower-cost HIV treatment to developing countries.

U.S. officials have argued for more stringent standards: formal Food and Drug Administration approval of the one-pill combinations and of "co-packaged drugs," where one-time doses of different medicines are put together in blister packs for easier distribution and use abroad.

AIDS advocacy groups and members of Congress have blasted that position as a front to ensure sale of more expensive patented medicines that will delay if not block lifesaving treatment in regions hit hardest by the epidemic. Since patients already swallow multiple pills in treatment cocktails, WHO's assessment of which can be combined is plenty of evidence, the critics say.

"Anything that will help get affordable, easy-to-use medicine to people with HIV in developing countries is positive, but the danger here is that the United States is using quite a unilateral approach, which could lead to undermining the role of the World Health Organization in standard setting," said Rachel Cohen, a spokeswoman for the humanitarian group Doctors Without Borders.

But Cohen said she the U.S. approach could still lead to further delays in the availability of medicines that are already saving lives in Africa and elsewhere in the developing world.

Under the new plan, the FDA promises special fast reviews that could permit approval of combination or co-packaged products within two to six weeks after receiving applications, significantly faster than the usual six-months or longer review.

No scientific studies of the drugs in patients will be needed, only data showing that putting three medicines into the same pill does not affect their chemical makeup or how they are absorbed by the body, administration officials said.

"We must apply real discipline to ensure that the products we provide in poor nations are safe and effective," White House global AIDS coordinator Randall Tobias said. "The new expedited process provides us with a solid foundation for purchasing drugs that work."

"This opens the marketplace," Health and Human Services Secretary Tommy Thompson said.

Both brand-name manufacturers and foreign generic makers can apply. FDA approval for the foreign generics would not allow their sale in the United States because of patent laws but would allow purchase for distribution in developing countries.

"Will it be this fast? I hope so," said the U.N.'s Piot. "There is also a question of willingness of generic producers to apply."

SOFIA (Reuters) - Angry Bulgarians burned a three-meter high gallows in central Sofia on Saturday to protest the death sentences imposed on five Bulgarian nurses for infecting Libyan children with the HIV virus.

The protesters also released six white doves in the capital as tens of thousands of medics staged silent protests in front of hospitals across the country in support of the condemned nurses, who say they are innocent.

A court in the Libyan port of Benghazi sentenced the five women and a Palestinian doctor to death by firing squad in early May for deliberately infecting 426 Libyan children with HIV, the virus which causes AIDS.

"By burning this gallows we burn the evil and the evil that the Libyan court has allowed to happen," Alexander Tomov, leader of a leftist political party whose members called the protest, told state agency BTA.

Bulgaria has slammed the verdicts as "unfair and absurd," a view backed by the West.

The condemned have filed appeals amid speculation that Libyan leader Muammar Gaddafi, seeking to mend ties with the West, would intervene to reverse the verdicts.