Time Has Come for New Phase in Fight Against Aids, Conference Told

Twenty-five years after the Aids pandemic began, the world has to move from crisis management to a sustained response that could mean keeping millions of impoverished people on costly drugs for 30 or 40 years, the head of UNAids was due to say yesterday at the start of the 16th International Aids conference.

In a speech prepared for last night's opening session, at which 20,000 delegates gathered, Dr Peter Piot said the fight against Aids had to move into a new phase. Some 1.5 million people in the developing world are now on antiretroviral drugs, although a further 5 million need them now and there are 4 million new infections a year. Getting medicines to all who need them - a 2010 target for the G8 - was a major goal, but the world also had to think further ahead, he said: "Twenty, 30 or 40 years from now, we want them all still to be alive. Who is going to pay for that? Let's start thinking in terms of decades and generations."

The first-line three-drug combination being rolled out in Africa has fallen in price to as little as $140 (£75) a year per patient. But second-line drugs, needed when the virus develops resistance to first-line medication, as has happened in the UK and US, are much more expensive.

Dr Piot said it was important to keep what he called the "exceptionality of Aids on the political agenda", because such a huge political effort was needed. He said Aids must not be seen as a normal medical issue, otherwise efforts such as preventing the spread of HIV would slacken.

Both treatment and prevention were needed, he said, and it was important to progress both scientifically and in speeding up social change.

A major issue for the conference, which is a forum for campaigners as much as for scientists, is likely to be the role of women in the developing world. The economic and social subservience of women is a big factor in the spread of the virus.

Stephen Lewis, the UN special envoy for HIV/Aids in Africa, said he was hoping the conference would herald "something absolutely irreversible on women".

Mr Lewis, the former Canadian ambassador to the UN who will speak at the close of the conference on Friday, said he hoped real change might come from a high-level panel on UN reform, of which Gordon Brown is a member, and which is weighing up plans for a UN women's agency.