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FACED WITH such a massive problem, what do you do?

In the July issue of the Journal of the American Medical Association, doctors from the Centers for Disease Control and Prevention called the world's response to AIDS "the moral challenge of this era." In their commentary, An Unequal Epidemic in An Unequal World, they write:

"The situation in Africa is different in scale and scope with a devastating, generalized HIV/AIDS epidemic superimposed on an eroding health infrastructure burdened by other health threats. A fundamental question is to what extent public health strategies can reverse Africa's current adverse health trends without long-term economic development or an HIV vaccine."

"As a human, itís very difficult to think that just because of an accident of birth, somebody in Africa or Asia does not have access to a reasonable quality of health care."

There is no vaccine and none near. The Global Fund to Fight AIDS, Tuberculosis and Malaria, created last year by the United Nations, estimates it needs $7 billion to $10 billion a year to slow the tide of AIDS in developing countries by 2005. To date, governments have committed less than $3 billion, including a U.S. contribution of $500 million.

The Bill and Melinda Gates Foundation, headquartered in Seattle, has become a world leader in the battle against AIDS, its efforts trumping those of most governments. The foundation has committed $100 million to the Global Fund, $126 million toward finding a vaccine and more than $425 million to other groups for HIV/AIDS research, prevention and education. Last month, the Gates Foundation announced an unprecedented initiative in India, committing $100 million to slow the spread of the virus on the subcontinent.

A significant slice of the Gates' money is aimed at helping women and girls defend themselves against infection. Projects include: $28 million to the Women's Global Health Imperative to test whether diaphragms can help prevent transmission of HIV; $5 million to the Seattle-based Program for Appropriate Technology in Health (PATH) to continue development of female-controlled prevention methods; more than $45 million to the Population Council in New York and Contraceptive Research And Development (CONRAD) in Washington D.C. to develop a microbicide, a kind of vaginal gel or suppository a woman could use covertly.

Why invest so much to invent products for women when latex condoms are readily available, cheap and a proven block against HIV?

"People have been trying that," says Dr. Christopher Elias, president of PATH and longtime advocate of microbicides.

What's been learned from the condom campaigns: Men will use protection with prostitutes, but not reliably with wives and steady girlfriends.

Yet even if something is found to arm women, it's hard to know if they'll use it, if it will be approved by governments or allowed by husbands, if it will be available or affordable.

If, if, if.

In places like Africa and India, AIDS is more than a disease. It is social stigma, sexual lust, poverty, politics, gender inequality and love, all tangled with a virus that mutates so rapidly, it has outfoxed all efforts to disarm it.

What's one pair of rubber gloves?



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