Bill Gates is admittedly an optimist. At the International AIDS Conference in Vienna, which has been filled with gloom about funding shortages for desperately needed treatment, he outlined a plan today that could completely turn the epidemic around. The plan would use a combination of prevention approaches to cut new infections by 90 percent in the next 20 years, saving countless lives, said Gates, co-chair of the Bill & Melinda Gates Foundation.
"If the numbers fell this far in the hardest hit countries, it would change the face of AIDS," he told several thousand conference attendees. "New cases would plummet. Every person who is sick could be treated. The control of HIV would stand alongside the eradication of smallpox as one of the great public health victories in history."
It was just the message needed to help lift the spirit of the conference, where there have been prolific demonstrations by activists demanding that the developed countries that have frozen or cut back on their commitments to AIDS funding come through on their earlier promises. Gates was preceded by some 50 demonstrators in green Robin Hood hats and jerseys, who ascended the podium demanding "No retreat. Tax and treat," a reference to a "Robin Hood" tax on international financial transactions to pay for AIDS treatment.
Gates took it good-naturedly, saying new funding is certainly needed but that we could do a better job of spending the money we have - by discounting drugs further and cutting back on personnel and equipment costs involved in delivering them to patients.
He also pressed for scaling up existing prevention approaches, particularly circumcision, while focusing at the same time on developing some new ones. He said he was initially skeptical of male circumcision, which reduces transmission by 60 percent, believing few men would sign up for it.
"I'm glad to say I was wrong," he told the audience. Last year, he visited a circumcision clinic in South Africa serving more than 750 men a month. "I met a few of them, and they were all thrilled about getting circumcised," he said.
He also advocated, as have many others at the conference, putting more people on antiretroviral treatment as a way of preventing AIDS. People on treatment have very low levels of virus, and thus are significantly less likely to transmit the virus to others, studies have shown.
But Gates is also banking on some new technologies still in the testing stages. One is a microbicide - typically a gel that women can apply topically - containing an antiretroviral that can stop sexual transmission of HIV. The results from the first trial are expected to be announced tomorrow.
Another promising area of research is a daily pill or long-lasting injection that people could take before exposure to the virus. Researchers in London are poised to test an oral drug, rilpivirine, to see if it can be used as a long-lasting injection for this purpose, Gates said.
Finally, there is the hope for an HIV vaccine. In the past year, scientists have isolated some potent antibodies that can neutralize almost every strain of the virus. One researcher called it a "renaissance" for vaccine research, which has been disappointing thus far.
Gates and colleagues at the Imperial College of London combined all these approaches - circumcision, antiretroviral treatment, microbicides, pre-exposure treatment and a partially effective vaccine - into a computer model in two very different populations, rural Zimbabwe and urban Benin.
The results were dramatic - the 90 percent reduction in infections that he so dearly hopes for.
"If we do that, we will have matched our compassion with the growing capacities of science, and we will start to write the story of the end of AIDS."
Ruthann Richter is a Scope contributor and writer in the medical school's communication office. She is attending the International AIDS Conference in Vienna and is posting periodic updates on the happenings there. You can see all of her updates in our HIV/AIDS category.
