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Bangkok Blues 

Lemons? Could anyone have imagined it would be that simple? I'm talking about the tiny bit of actual, practical, graspable treatment news that managed to escape the maelstrom of the 15th International AIDS Conference in Bangkok, Thailand, last week -- a conference that otherwise was given over almost entirely to criticism of U.S. AIDS policy under George W. Bush. The biannual summit of doctors, scientists, health-care workers, activists, politicians, patients and government officials is the largest of its kind in the world, the Mother of all AIDS gatherings, and this year Mother gave Bush and the boys a good whack with the paddle.

I'll get back to that in a minute, but first, the lemons. It seems that a scientist at the University of Melbourne in Australia, Dr. Roger Short, has discovered that plain, old, ordinary lemon juice "kills the AIDS virus in the lab." The government of Thailand, on Short's recommendation, is now funding clinical trials to see if it can kill it in you, too.

I say "you" in the generic sense, not assuming that anyone reading this is HIV-positive, as I am and have been for more than 20 years. I never expected to live this long, never mind in such good health as I've got. I also never expected that "Florida sunshine," as Anita Bryant used to call it, might be the answer for us all.

But things have changed mightily over the last two decades. The International AIDS Conference is normally anticipated eagerly by doctors and patients alike for what information it can give about advanced treatment strategies. Until 1996, at least, with the advent of protease inhibitors and combination therapy, this was the only thing on anyone's mind. Now, however, with patients who can afford the medications living longer and healthier lives, and with HIV itself spreading faster than ever across the globe, the focus has shifted from treatment to money and the best way to spend it -- so much so that this year's conference, entitled "Access for All," saw the worst science attendance of any summit before it. The United States cut its delegation by almost three-quarters on the order of Health and Human Services Secretary Tommy Thompson.

So, faute de mieux, they're going to try the lemon-squeeze on humans. According to The Age in Melbourne, "at least 400 Thai men and women" have bravely volunteered to pucker up for science. Dr. Short's experiments have already shown that "a solution of 20 percent lemon juice reduced viral loads in the lab by 90 percent"; that it also kills syphilis, gonorrhea and chlamydia; and that "when he put lemon juice in a test tube with HIV-positive sperm, the sperm were permanently immobilized within 30 seconds."

My guess is a good shot of lemon juice would "immobilize" sperm with or without HIV, and that a lot of women tired of the pill or the diaphragm might want to start keeping it next to their beds. But, for the moment, it's going to be tested only as a means to prevent infection -- in other words, don't go injecting yourself with it. "Thai women taking part in the test will soak a sponge in lemon juice and insert it before sex," The Age reports, while Thai men, presumably, will keep doing what they've always done.

"The potential of this is huge," says a spokesman for the new project, which is called, remarkably, LemonAIDS. "If it proves to be effective, it would be wonderful."

Yes, it would. It would be the kind of easy, accessible, goddamn flippin' miracle we on the fighting lines of AIDS have been anticipating for years. On the other hand, if the juice actually works as a prophylactic, and if all the other reports from Bangkok this year can be taken as a guide, the giant pharmaceuticals will be patenting lemons in no time, and you'll be paying $3000 a pop for them at the supermarket next year.

Call me cynical, but I don't think we're out of the woods yet. Just consider the statistics: Twenty million people around the world have already died from HIV infection; 2.9 million of them died last year; 8000 of them will die in the next 24 hours. An estimated 37.8 million people worldwide are still living with the virus, with new infections clocking in at the rate of 14,000 a day. The United Nations Joint Program on HIV/AIDS (UNAIDS) estimates that $12 billion will be needed next year for worldwide treatment and prevention efforts, twice what is currently being spent. Give it two more years and $20 billion will be needed for the same thing.

It gets worse. "The face of HIV/AIDS is now that of a woman, and a young woman at that," says Terri Bartlett, vice president for public policy at Population Action International in Washington, D.C. Young people -- 15- to 24-year-olds -- account for nearly half of all new HIV infections worldwide. In parts of Africa, 25 percent of all women are infected by the time they are 22. "In Kenya and Zambia, adolescents who are married are becoming infected faster than sexually active unmarried teens," because, in so many cultures, sexual fidelity is expected and demanded only of wives.

Even in the United States, where the worst sort of health care is likely to be better than what you'll find in most of the developing world, and where programs are well established both to help prevent and to help treat HIV disease, the rate of new infections among women is exploding faster than efforts to keep up with it. Among newly infected persons in the U.S., one in four is now a woman. And still the Bush administration is promoting "abstinence" rather than demonstrated prevention techniques as a means of combating the epidemic.

True, back in June, George W. Bush was finally persuaded to utter the word condom before "a church-affiliated group" in Philadelphia. Eighteen months after it was first announced, the President's much-touted, $15 billion "Emergency Plan for AIDS RELIEF" has barely left the ground, and then only with the provision that a full one-third of all the money spent must be given over to "abstinence education" and other programs that stress "chastity" over reality.

This insane approach to AIDS prevention is unsupported by any statistical evidence of success in the real world. The vast majority of women on the planet are not in a position to call the sexual shots -- "abstinence" is not an option for a teenaged girl in South Africa, a sex-worker in Thailand, a drug addict in Bucharest. And this was just one of the criticisms leveled at the U.S. in Bangkok last week.

Another concerned the Bushmen's attempts to protect their huge campaign donors in the pharmaceutical industry. Last September the World Health Organization ruled, in a landmark decision, "Poor nations may ignore registered patents in times of national health crises." Since then, several of them have done exactly that, manufacturing generic versions of AIDS medications and distributing them either free of charge or at a greatly reduced cost.

Now, in what one Bangkok critic calls "an astounding patchwork of cynicism and pandering to special interests," the U.S. is working to negotiate "bilateral trade agreements" with developing nations that, while delivering all sorts of financial goodies to people in power, would also require the reinstatement of the medical patents currently owned by Abbott Laboratories, Bristol-Myers Squibb, Eli Lilly, etc. A statement read in Bangkok on behalf of French President Jacques Chirac described this effort as "tantamount to blackmail." Even our staunchest "coalition" ally, Great Britain, has denounced it, at the same time declaring that Britain will not play along in the "abstinence" charade.

Worst of all, Bush's team still insists on taking a "unilateral" approach to the AIDS crisis, refusing to donate more than $200 million next year to the United Nation's Global Fund to Fight AIDS, Tuberculosis and Malaria, the brainchild of UN President Kofi Annan and a fund that is designed to distribute AIDS money equitably to all the countries that need it.

Bush will hand out his $15 billion only to pre-selected nations, mainly in the Caribbean, that are "amenable to American rules about where and how the money will be spent." In Bangkok, the civilized world was enraged.

"Once again, we have isolated ourselves from the global community," says Rep. Barbara Lee, a Democrat from California. She has introduced a new bill in Congress -- the "New U.S. Global HIV Prevention Strategy to Address the Needs of Women and Girls Act" -- which recognizes that "women and girls are often powerless to abstain from sex, ensure their partner's faithfulness or insist on condom use even within marriage." The bill also notes "that condoms are the only [preventative] technology available right now to deal with the pandemic."

Tell it to the Bush boys -- at the polls this November.

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