PRESS BRIEFING BY UNAIDS EXECUTIVE DIRECTOR

PRESS BRIEFING BY UNAIDS EXECUTIVE DIRECTOR

A new initiative of major foundations to expand the scope of mother and child HIV programmes was the direct result of the Secretary-General's call to action and of the special session of the General Assembly, Dr. Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) told correspondents at a Headquarters press conference this morning.

"This is in itself an extraordinary achievement -- how we can move mountains", Mr. Piot said of the collaborative nature of the five-year,

$100 million programme, called MTCT-Plus, which would extend the care provided by existing mother-to-child transmission (MTCT) programmes in developing countries.  Mr. Piot was joined this afternoon by Gordon Conway, President of the Rockefeller Foundation, and Allan Rosenfeld, Dean of the Mailman School of Public Health of Columbia University in New York, which was coordinating the project.

Mr. Rosenfeld said that the programme would build on the experience of the MCTC projects which were reducing, through a single dose of Nevirapine, the enormous number of infants infected with HIV through their mothers -- some 600,000 every year in sub-Saharan Africa alone.  Many of those children, however, soon become orphans.  "It's been tragic that we treat the mother to prevent transmission and then we say, essentially, goodbye to the mother because we have nothing else to offer her.  We know she is then going to die in some time in the not-too-distant future", he said.

The MTCT-Plus programme would develop protocols to treat those mothers, Mr. Rosenfeld continued.  It would focus first on sub-Saharan Africa, but would also be working in Asia, Latin America and the Caribbean.  Specifically, it would be treating both opportunistic infections, particularly tuberculosis, and also, where indicated, introducing anti-retroviral drugs -– for the first time in poor settings -- in resource-poor countries.  Given a measure of success, it would also eventually be called upon to treat fathers, and inevitably become a family programme in time.

In that way, said Mr. Conway, the programme would help pave the way for the larger challenge of treating all HIV-affected adults in developing countries.  "It's a bit like finding a way through the Northwest Passage", he said, "where we've got out front a small icebreaker -- which is our programme -- and behind a larger armada of ships under the leadership of the Secretary-General.  That's the kind of relationship we're going to have with the global fund."

In responding to the Secretary-General's call, in fact, the consortium decided to use the flexibility of private foundations to its best effect by creating a project that could both treat and at the same time provide a model for wider international efforts, Mr. Conway said.  Foundations that have made a commitment so far include those of Bill and Melinda Gates, William and Flora Hewlett, Robert Wood Johnson, Henry J. Kaiser Family, John D. and Catherine T.

MacArthur, David and Lucille Packard, Rockefeller and the United Nations.  Around $60 million had already been pledged.

The 100 or so existing MTCT-prevention sites in Africa, from which would be chosen the pilot sites for MTCT-Plus, were administered by the United Nations Children's Fund (UNICEF), Elizabeth Glaser Pediatric AIDS Foundation, Médecins Sans Frontières (MSF) and other organizations.  Mr. Rosenfeld added that, in coordination with such organizations and the United Nations fund, it was hoped that the treatment of the individuals involved would continue after the five-year span of the programme.  HIV treatment, after all, was lifelong.  "It would be immoral to stop it."

In response to correspondents' questions about the site selection process, Mr. Rosenfeld said that the first year's sites would be those which were most prepared to participate in pilot operations.  By the middle of the first year a second request would be issued, for proposals to significantly expand the programme.  Within two to three years, there should be between 50-100 sites.  Two or three sites in South Africa were expected to be chosen in the first group, as that country had several advanced MCTC projects.  Also being considered, for later stages, were sites in Haiti, where political considerations were thought to be hindering bilateral and international HIV programmes.

Asked how drugs would be obtained by the programme, Mr. Rosenfeld said that generics and low-price arrangements were being considered.  Donations would not allow long-term planning, unless they were offered on a continuing basis.  Nevirapine, in fact, was available free for the next four years.  The programme was working closely with UNAIDS to develop large-scale drug purchasing strategies.

A correspondent asked what percentage of children contracted HIV through breastfeeding.  Mr. Rosenfeld said that estimates varied widely, centring around 10 per cent.  Unfortunately, in developing countries, the benefit of replacing breast milk by infant formula was outweighed by the dangers of diarrhoeal disease and malnutrition, due to contaminated water and bottles. 

When another correspondent asked about the rate of decline in mother-to-child transmission due to MTCT programmes, Mr. Piot said that the impact in Africa had so far been marginal because the small pilot programmes had only recently begun.  In Thailand, the number of infants born with HIV had been halved between 1997 and 1999.

However, said Mr. Conway, in industrialized countries, mother-to-child transmission had been effectively controlled through widespread screening, the use of infant formulas, caesarean sections and other measures.  Only 200 had babies born with HIV in the United States last year, a figure reached every few hours in Africa.  "It's probably one of the most obscene inequities in the world today", he said.

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