Children with HIV/AIDS in developing countries are "needlessly" dying because of "ignorance" and a lack of suitable pediatric medications, the international medical aid organization Medecins Sans Frontieres said in a statement on Tuesday, the AP/Yahoo! News reports. The announcement came one day before the opening of a three-day conference MSF is hosting with UNICEF and the World Health Organization that will address improving treatment for the approximately 2.5 million children worldwide living with HIV/AIDS.

In this pathbreaking collection, international activists and scholars reveal how plans implemented by the World Bank, the World Trade Organization, and other first world interests drastically limit access to medical care and essentially sentence millions to disease and premature death. Edited by affiliates of Health Alliance International - a nonprofit organization associated with the University of Washington School of Public Health and Community Medicine - Sickness and Wealth provides a historical context for understanding the complex interrelationship between health, politics, and capitalist globalization.

Health authorities in Guinea Bissau said on Monday that a cholera outbreak in the Bijagos archipelago, off the capital, Bissau, had infected 58 people, killing three. The outbreak started in a fishing community in Orangozinho Island among fishermen from neighbouring Guinea and Senegal, Julio Sa Nogueira, Secretary-General of Guinea Bissau’s Health Ministry, told reporters on Monday.

Africa needs up to $2.5 billion a year to fight malaria, or 10 times the donor funds pledged for a campaign against the disease, the World Health Organization said Tuesday. The mosquito-borne disease kills more than 1 million people a year around the world -- more than 90 percent of them in sub-Saharan Africa, the WHO said in a statement issued from its regional office in Brazzaville, Republic of Congo.

HIV/AIDS treatment preparedness - encompassing advocacy, literacy and community mobilization for people living with HIV/AIDS and other affected communities - is central to realizing the target of providing antiretroviral treatment to 3 million people in developing countries by the end of 2005 ('3by5') and optimizing the impact of longer term plans, resources and delivery systems for HIV/AIDS treatment.

The World Health Organization (WHO) recently released the first set of comprehensive data comparing the prevalence of HIV/AIDS in poor countries with the rates of antiretroviral (anti-HIV) drug access in those nations. The data are striking and disheartening, yet have received little press coverage. Indeed, at the time of their release, some American newspapers ran editorials indicating that antiretroviral access has received "too much attention".

Two problems are implicit in such a contention. The first is political. AIDS is very much a symptom - albeit the most extreme symptom - of the large diseases of inequality and poverty that result not only in HIV, but also in hunger, hemorrhagic fever and housing problems. The same credit and political obstacles that have led to gender discrimination in housing and employment have led women into prostitution and relationships based on sexual dominance [1, 2].

The same structural adjustment programs and neoliberal economic policies that have crashed farming sectors and forced thousands into migration are the same policies that have led migrants to the barracks of minefields to live with depression, alcoholism and the subsequent solicitation of prostitutes [3-5]. And so to address AIDS appropriately would be to appreciate that it does not simply receive "too much attention", but that the attention it receives should be drawn towards its base - and this includes the inequalities in healthcare access that are symbolized by antiretroviral access disputes.

The second problem with the new popular line of thought on antiretrovirals is a statistical problem. The recently-released WHO data are striking but perhaps not surprising. If "too much attention" has been focused on drug access, then why are only six-tenths of a percent of the 1.6 million infected people in Tanzania able to access antiretroviral medications? Why are only 1.5% of the 2.4 million in Mozambique and the Congo able to gain such access?

In a country like Zimbabwe, where one of every four adults is infected, only one of every fifth can access an antiretroviral medication. As one scrolls through the WHO's data, the numbers of infected persons continue to be expressed in seven digits, while the percent of those gaining access to antiretrovirals continues into smaller and smaller decimal ranges.

Some persons have stated that countries like those I have listed above lack the necessary infrastructure to deliver antiretroviral therapy [6]. The persons who make such claims do so in order to close conversations and prevent creative solutions from entering the public health community. But others who are determined to open new doors for patients have definitively responded to the "infrastructure line" - in Haiti, Paul Farmer's group has shown better treatment rates in the poorest sector of the Western Hemisphere than at Harvard's teaching hospitals [7, 8]; in the warring regions of the Congo, Doctors without Borders has seen better results than their colleagues at hospitals in France [www.msf.org">.

The adherence of patients in poor settings to antiretroviral medications is often higher than that in the U.S. and other wealthy nations [9] - both because the groups that have worked in the poorest of places have incorporated community health workers into programs that are constructed with the advice of the poor (as opposed to employing a highly institutionalized and decentralized mode of care seen in the U.S., where a poor patient needs to travel to a dozen offices to complete welfare paperwork), and because generic medicine producers have combined the key antiretroviral medications into a single once-a-day pill [10].

Ah, but won't these generics undermine research and development (R&D)? That would be true, if the patent-based industry these generics compete against were to have done such R&D. But in reality, the top AIDS medicines were researched primarily through taxpayer funds distributed through the National Institutes of Health to government and university laboratories, then sold for tiny royalties to the American and European pharmaceutical industry [11, 12].

That industry has been the most profitable in the world for fourteen years - making profits as a percentage of revenue approximately three times the rate of the rest of the Fortune 500 [13, 14]. Eighty-five percent of the top therapeutic drugs on their market had their R&D conducted through taxpayer funding [14]. And the industry's own R&D is surprisingly unproductive, with over half of new drugs on the market being reformulations of old medicines, carrying little or no therapeutic value according to the Food and Drug Administration's rankings [14].

This should be unsurprising to those who view the industry's tax records, obtainable through the Securities & Exchange Commission. These records reveal that the patent-based industry spends, on average, 27% of its revenue on marketing and only 11% on R&D [12, 15, 16].

The effects of generic competition to help break this monopoly are striking in terms of improving medicine access [17], but what the WHO shows is that these generics have not reached far enough. In January of 2005, the provisions of the Trade-Related Aspects of Intellectual Property Rights (TRIPS) agreement passed by the World Trade Organization (WTO) will begin to kick-in, limiting the ability of key generic providers to supply poor markets, as described extensively elsewhere [18, 19]. Recent trade agreements written by the U.S. Trade Representative (USTR) have further restricted competition, ironically while claiming to be promoting "free trade" [20].

But what the WHO data reveal is that certain key institutions controlling antiretroviral expansion projects have been far more successful in this hostile context than others. The most transparent group - the Global Fund for AIDS, TB and Malaria - although not without its own problems, has enhanced access for the most number of people, including those in 63 countries. The group is notable for receiving public commentary and making its processes of change public and visible.

Yet in comparison, groups that have worked with little public input and much secrecy - the Clinton Foundation and the World Bank group - have garnered press coverage while accomplishing comparatively little. The Clinton group, in spite of its fanfare, has reached only 18 countries with its drug deals; the World Bank has assisted 3 in procuring antiretrovirals, mostly for technical assistance purposes (the nature of which is unclear). And U.S. government based programs, in spite of their purported funding levels, have similarly poor coverage, with the President's AIDS Initiative reaching just 14 nations, excluding many with the highest burdens of disease. At every level, then, the issue of how effectively criticism from those most affected by this disease reaches those most in power ultimately reciprocates in terms of efficacy in treating the poor.

From the perspectives of those who cannot leap to Geneva, such high-level bureaucracies may seem out of reach, and the problems therefore too out of control to effect. Yet a group of university students is assisting in changing that idea, demonstrating that multiple levels of action are necessary and can be effective in addressing this problem. On Saturday October 9th, a group of students called Universities Allied for Essential Medicines (UAEM) released an "Equitable Access License" (EAL) with provisions designed for universities to reshape the manner in which they sell (often taxpayer-funded) university research to pharmaceutical companies [www.essentialmedicines.org">.

The provisions are based out of an earlier movement at Yale University, which resulted in a 40% decrease in the price of the key AIDS drug stavudine in South Africa. But recognizing, once again, that AIDS medicines are symbolic of a larger, systemic problem, the students have written the EAL to apply to all devices and medicines of public health importance. This is particularly crucial in the context of the USTR's recent trade agreements, which have not only included the types of provisions that lead to the spread of infectious disease, but also are likely to continue altering the food importation patterns of nations in such a manner that the recently-observed elevations in diabetes and cardiovascular disease in poor nations are likely to escalate [21].

The EAL may appear as a technical project - and it is - but its spirit has more to do with morality than with the details of intellectual property law. The word "morality" rarely appears in discussions of AIDS, since such conversations are usually clouded by questions about whether AIDS is a "development issue" (and I would suppose it is), whether AIDS is a "legal quandary" (I suppose everything can be made into one of these), and whether AIDS is a "national security issue" (what type of people need this kind of argument to address a pandemic?).

At its core, these kinds of statements avoid the more basic, and perhaps more truthful, reality that AIDS will be a moral issue for as long as the politics of this Syndrome are defined by inequalities. In the face of such a truth, progress seems to be made by pushing at every level - from universities to global institutions - and observing what trends in the behaviour of the powerful can improve the livelihoods of the poor.

*The WHO's data can be obtained at:

* Sanjay Basu is at the Yale University School of Medicine.
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The Oak Institute for the Study of International Human Rights Fellowship, hosts a Human Rights Fellow to teach and conduct research while at residence in the College and organises lectures and other events centred on the fellow's area of expertise. The purpose of the fellowship is to offer an opportunity for prominent practitioners in international human rights to take a sabbatical leave from their work and spend a period of up to a semester as a scholar-in-residence at the College.

The U.S. Agency for International Development plans to give Zambia $24 million to combat AIDS and malaria and improve the quality of drinking water, the U.S. embassy in Lusaka, Zambia, said last Tuesday in a statement, the Associated Press reports. The money will be used to fund health education programs - coordinated by the government and the Society for Family Health - over the next six years Zambia on Tuesday banned free condom distribution in schools just as USAID announced its funding for HIV/AIDS programs, with condom distribution a "key part of the strategy," Reuters reports.

Rural African communities are being "torn apart" by the HIV/AIDS epidemic, making farmers and other rural residents the "forgotten victims" of the disease, as prevention and support work is focused primarily in the continent's cities, according to health experts and political leaders speaking at a meeting of the U.N. Commission on HIV/AIDS and Governance in Africa in Addis Ababa, Ethiopia, AFP/News24.com reports.

Eighty-five countries last month signed a statement reaffirming commitment to reproductive health- and HIV/AIDS-related population and health goals agreed to 10 years ago at the 1994 International Conference on Population and Development in Cairo, Egypt, the AP/Philadelphia Inquirer reports. More than 250 world leaders - including presidents, prime ministers and Nobel Prize winners - endorsed the goals of ensuring a woman's right to education, health care and reproductive choices. Despite endorsement by the entire European Union, China, Japan, Indonesia, Pakistan and more than 12 African nations, the Bush administration refused to support the statement because it mentioned upholding "sexual rights" - a term that the administration says has no "agreed definition" in the international community.

The first issue of the Healthlink Worldwide newsletter, 'The Link', looks at the efficacy and appropriateness of HIV/AIDS communication - which become ever more critical as the epidemic's complexity and spread continue to grow.

The power of Transnational Corporations (TNCs) must never be underestimated. Corporate power has increased poverty and reduced many people to mere spectators in the development processes of their countries. The International Monetary Fund (IMF), the World Bank (WB) and the World Trade Organization (WTO) have been presented as the multilateral institutions designed to shape the financial and economic policies of the world “for a better life for everyone”. But they are the main architects of policies that have impoverished the third world. Corporate power has long been a global phenomenon where there is no global government accountable to the people of every country to oversee the globalisation process in a mode comparable to the national governments’ guided nationalisation processes.

Starting in the year 2000, free primary education has been rolled out each year in Lesotho and it is starting to revolutionize the country’s youth. At school, children are taught life skills and HIV/AIDS education and are given two meals a day through the World Food Programme’s school-feeding programme. At the Katlehong primary school, in Thaba Tseka, the schoolyard is jam-packed with over 150 chattering children, girls and boys, small and big. All of them had lost one or both parents to HIV/AIDS. Many of the children are heading households themselves.

Fifteen million children, including 12.6 million in Africa alone, have lost one or both parents to Aids. Many countries have taken steps to ensure that Aids orphans attend school; but new research by ActionAid and Save the Children shows that school attendance by itself does little to improve children's chances. Children are affected by the epidemic in many different ways. Some have lost family members; some are themselves chronically ill. Some live in refugee camps; others fend for themselves on city streets. The problems that children face include poverty, psychological trauma and social stigma. The two charities suggest specific educational initiatives to support children in all these situations and more. They urge education ministries to institute flexible approaches, which address the individual child's situation and needs.

Despite reports that the South African HIV/AIDS advocacy group Treatment Action Campaign had dropped its legal action against the South African government to force it to make its antiretroviral treatment program rollout plan publicly available, the group has not dropped its suit and is asking the government to "urgently" develop and publish an implementation plan, the SAPA/SABC News reports.

The sleepy town of Cabinda has a forlorn air about it, but few outward signs of the decades-long conflict that has plagued the oil-rich Angolan province. Although Cabinda produces 60 percent of Angola's oil revenues, the province, saddled with one of the highest HIV rates in the country, has been slow to respond to the epidemic.

Toll-free help lines in Tanzania have logged more than 22,000 calls inquiring about HIV/AIDS information and counseling services. Thirty per cent of the calls requested information on HIV transmission, 22 per cent on AIDS testing, 11 per cent on condom use and 6 per cent on AIDS treatment.

This briefing explores the logic of International Monetary Fund (IMF) loan conditions to developing countries and why the IMF insists that keeping inflation low is more important than increasing public spending to fight HIV/AIDS in Africa, Asia, Latin America, and Eastern Europe. In 2003, funding levels for HIV/AIDS prevention and treatment are estimated to have reached almost $5 billion; meanwhile financing needs will rise to $12 billion in 2005 and $20 billion by 2007. But if these large increases in foreign aid become available, will lowincome countries be able to accept them? Despite the fact that the global community stands ready to significantly scale-up levels of foreign aid to help poorer countries finance greater public spending to fight HIV/AIDS, many countries may be deterred from doing so due to either direct or indirect pressure from the IMF.

Cholera has broken out in Dakar, the capital of Senegal, for the first time in eight years, government doctors said on Tuesday. Doctor Bassirou Johnson, an epidemiologist at the Ministry of Health, told IRIN that 66 cases of the highly infectious water-borne disease had been reported in slum areas of the city since 11 October, but there had so far been no deaths.

A crowd of young Mozambicans gathered under the shade of a tree last week to discuss what they knew about HIV/AIDS, as part of a peer education programme underway in central Zambezia province. Some answered confidently but others were reticent, with the girls, especially, keeping their heads down when asked how HIV was transmitted.