Treatment for Aids barely exists for 90% of Third World patients. That may now change, says the scientist who discovered the Aids virus. Dawn Blalock reports
AIDS is no longer the disease it used to be, says the man who discovered the virus that causes it. There’s still no cure, but more effective treatments are transforming Aids from “a social phenomenon and a stigmatising mortal illness” to a medical problem, soon to join the ranks of other chronic illnesses, says Dr Luc Montagnier, the French physician who was catapulted to scientific stardom when he isolated the virus in 1983.
The diminutive, white-haired Montagnier toured South Africa last week, searching for a potential site to build a proposed Aids research centre to serve the whole of Southern Africa.
His grand design is for a network of Aids research centres in HIV “hot spots” to fight the virus on its fiercest front – the developing world.
“It is obvious that the world will not be rid of this epidemic if it is left to fester without intervention in … the southern hemisphere,” he says.
“Most of the spending [on Aids research] is in the developed world,” Montagnier notes. “Of course, if Aids had been just an African disease, there would not have been so much public attention and research.”
As more and more people manage to live full lives with Aids, and fewer people with HIV come down with full-blown Aids, the absolute death sentence appears less absolute.
Aids is “certainly serious” but treatable, if not yet curable, for patients in North America, Western Europe and Japan, Montagnier says. In the Third World, however, accessible treatment is non- existent for more than 90% of Aids patients.
That may change. With research funding in some European countries on the decline as the disease plateaus there, Montagnier’s research centres could signal a change of tack to Aids research that will concentrate on and be located in endemic areas, looking at the strains of the virus and cultural issues that are unique to Africa and other developing areas.
And the continent does present some unique problems. Africans, Montagnier says, are not exactly compliant patients. The Aids “cocktail” or “triple therapy” treatments are prohibitively expensive and for them to work, patients with HIV must be treated early and often.
“It’s difficult to understand that they must be treated every day, sometimes twice a day, without interruption. They say: `But I’m not sick.'” And another version of denial – the attitude that “this is a disease for poor black Africans” – is still being battled.
Just as his research base at the Pasteur Institute in Paris is connected to a small hospital, the research centre he envisages in South Africa would be the same, so that both patients and medical researchers have ready access to one another.
Montagnier casts a disapproving eye on researchers who are “bound to the laboratory” and have little or no contact with patients. “If you are working on a virus and don’t see patients, you could lose sight of the end result,” he warns. “Everything has to be for the final goal: to cure people.”
Compared to the rest of the Africa, HIV is a relatively late arrival here. Before 1990, there were almost no reported cases of HIV infection – a happy side-effect of South Africa’s apartheid-era isolation. “Now the country is very much open,” says Montagnier.
Local experts estimate that 8% to 10% of South Africans are HIV-positive – and the numbers are increasing explosively.
Though difficult to predict what will happen, Montagnier says it is likely that Aids in South Africa will follow the pattern already seen in other African countries such as Uganda and the Ivory Coast where the virus has been passed primarily through heterosexual contact: young adults are the most severely affected and the economic consequences can be dire.
Aids education campaigns are still not effective enough, and the hope that they are sufficiently advanced in South Africa to reduce transmission is “wishful thinking”.
“It’s very difficult to change behaviour in such a short time,” he adds.
Despite increasing pressures on already squeezed charitable resources here, Montagnier is enthusiastic about the financial prospects for the centre, drawn from a combination of government funding and private sector largesse.
He says a “strong willingness” from South African health officials and President Nelson Mandela, makes South Africa a likely place for the centre’s location. One has begun operating in Abidjan, Ivory Coast, and Montagnier foresees a centre based in Thailand to research the epidemic in South East Asia, followed by one somewhere in South America.
In a haze of cigarette smoke in the departure lounge at Johannesburg international airport, Montagnier sips water and relaxes while waiting for his flight back to Paris.
His schedule these days includes a lot of airport lounges and is a far cry from the all-nighters he used to spend in his Paris laboratory before the bug he discovered thrust him into headlines worldwide. Though “travelling and receiving honours” cuts into his research time, he insists the discovery did not change his life. “I was existing before Aids,” he says, and he believes in life after Aids.
He expects that within five years his projects and the prognosis for a viable Aids vaccine will be far enough advanced to enable him to tackle the next microscopic foe.