Former US President Bill Clinton, taking advantage of his celebrity status, is trying to accomplish something he failed to do while in office: Defeat the worldwide Aids epidemic.

As a featured speaker and personality this week at the 16th International Aids Conference in Toronto, Clinton is playing on his charisma to mobilise support and increase funding for the fight against HIV, which has killed 25-million people and today infects almost 40-million worldwide.

Clinton, addressing an overflow crowd of 6 000 with Microsoft Corp. founder Bill Gates yesterday and in a speech today, is making a bid to provide leadership in fighting the 25-year-old epidemic. He is pressing drugmakers to lower prices, negotiating discounts with generic manufacturers and lobbying poor nations to shore up inadequate health services.

“It's a breathtaking human tragedy,” Clinton said during the session with Gates, whose Seattle-based foundation is spending $2-billion on Aids.

“Most people don't die of it in rich countries anymore, and most people in poor countries do, and it's unacceptable.”

Clinton, who turns 60 on Aug. 19, is working through the nonprofit foundation he started after leaving office in 2001. The New York-based organisation collected $68,6-million of contributions last year, according to the foundation's annual report.

Some AIDS advocates say that, while Clinton's work is making a difference in Africa today, he could have done more before he left office. The number of people infected worldwide with HIV/Aids more than doubled to exceed 30-million in the eight years Clinton was president.

“If he would have done a multi-billion dollar initiative in the beginning of his second term, as folks were advocating for at the time, the whole trajectory of the African epidemic would have been different,” said Paul Zeitz, a former official of the United Nations' UNAIDS program who is executive director of the Washington, D.C.-based Global Aids Alliance. “He did not do as much as he could have done.”

The first such US initiative was announced by President George W. Bush in 2003. Bush's program, which began passing out drugs in 2004, calls for spending $15-billion on Aids treatment over five years.

Clinton yesterday defended his presidential record on AIDS during the session with Gates. Journalist Charlayne Hunter-Gault, who has worked for Cable News Network and Washington-based National Public Radio and moderated the discussion, read a statement and question from an audience member that suggested Clinton hadn't done enough.

“That ain't so,” Clinton said. “I did make a lot of mistakes when I was president, but that wasn't one of them.”

After his speech today, Clinton said one mistake during his presidency was refusing to use federal money for needle exchange programs for intravenous drug users to prevent HIV infections.

“I was wrong,” Clinton said in a media briefing. “The evidence shows that it doesn't lead to increased drug use.”

The death rate for people who got AIDS in the US, which at the time had one of the highest fatality rates in the world, fell 70% during his presidency, Clinton said.

The William J. Clinton Foundation's Aids work includes providing training for nurses in places such as Kenya and India and helps countries build and improve health-care facilities. The organisation also acts as a broker between generic-drug makers and the governments of developing countries.

The foundation began working with countries in Africa and the Caribbean four years ago to guarantee bulk orders of generic HIV drugs to ensure the volume that the manufacturers say they need to cut costs. Clinton said the agreements have helped lower the price of drugs to as little as $120 a year. The treatments can cost more than $12 000 a year in the US. The Clinton Foundation is “engaged in very serious negotiations with the drug companies”, said Stephen Lewis, who is United Nations Secretary-General Kofi Annan's representative for AIDS issues in Africa. “All the magic of the Clinton name and all of the persuasive apparatus and authority that he brings to it are helping to bring down prices,” he said.

The organisation also helps lower costs for generic-drug makers by sending in chemists and other consultants to help the companies save money on manufacturing.

In one case, the chemists analysed the ingredients used to make efavirenz, sold by Merck & Co. in the developing world as Stocrin, and discovered that leaving out a particular solvent would cut production costs, said Anil Soni, director of pharmaceutical services for the foundation.

The new method should lead to a further reduction in the drug's price next year, he said. Right now, a year's supply of efavirenz, made by companies including Indian drugmakers Ranbaxy Laboratories Ltd. and Cipla Ltd., costs $240 when ordered in bulk through agreements arranged by the Clinton Foundation.

Clinton said he learned during his time at the meeting in Toronto that his foundation needs to do more to ensure that when people in developing countries become resistant to the drugs they are taking right now, they'll need to have access to inexpensive second treatments.

“We've got to get more drugs in the agreement,” he said today at the media briefing.

Clinton also said the meeting showed him the shortage of health-care workers in poor countries is dire. Aids activists interrupted both of his appearances at the conference to make sure he got the message. Clinton said his foundation is trying to address the situation, in part with a program in Kenya.

“We're hiring them and training them to treat the Aids patients,” Clinton said. “By the end of the year, we will have about 1 000 of them transitioned on to the national payroll in the next two years.”

The kind of focus that Clinton brings to addressing obstacles in fighting AIDS is crucial, said Sam Wangila Wafula, a programme support officer for the African Medical & Research Foundation in Nairobi, Kenya, who was at the meeting.

“He's done a great job in Kenya where we've been having a shortage of health care personnel,” Wafula said.

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