According to the World Health Organization’s latest estimates, 14 million people have contracted HIV since the epidemic began, and more than 2 million have developed AIDS. If current trends continue, both numbers will triple by the end of the ’90s. The billions of dollars that developed countries are now shoveling into AIDS research won’t affect those trends any time soon. Yet there are cheap, proven strategies for slowing the spread of the virus. Dr. Michael Merson, head of the World Health Organization’s Global Program on AIDS, told the Berlin gathering that by tailoring educational campaigns to local communities, distributing condoms and clean needles, and treating the sexually transmitted diseases that foster the spread of HIV, health agencies could quickly cut the rate of new infections by half throughout the developing world.
The lesson may hold just as true at home. In the United States, AIDS now ranks as the second leading cause of death among 25- to 44-year-old men and the sixth leading cause among young women. The number of infected Americans has held steady in recent years, but according to a 22-state survey released by the Centers for Disease Control and Prevention (CDC) last week, the shape of the epidemic is changing. Though safe sex has slowed the rate of new infections among gay men, the virus is growing ever more entrenched in poor urban communities, particularly among teens, women and blacks (chart).
How should AIDS be fought in these circumstances? The people at greatest risk are IV drug users, their sex partners and their children. Numerous studies, including several presented last week, have shown that when addicts can exchange used needles for clean ones, their infection rates decline dramatically. Dr. Don Des Jarlais of New York’s Beth Israel Medical Center has documented local reductions of up to 50 percent-reductions that could, over time, help free entire communities from the virus. Yet more than 40 states effectively encourage the sharing of needles, by treating them as contraband.
Sex acts: By the same token it’s well known that common sexually transmitted diseases (STDs) make people far more susceptible to HIV infection, by causing breaks in genital tissue. People are up to 100 time more likely to contract HI during a single sex act if they have lesions from a disease such as syphilis or herpes. Yet those diseases have recently been allowed to fester in this country Syphilis incidence has double since 1984 alone. The disease i cheaply and easily treated with antibiotics, but since the emergence of AIDS, conventional STDs have garnered less attention and funding. In constant dollars, the government now spends just half what it did in 1943 to control syphilis.
During the election campaign, Bill Clinton made much of his commitment to fighting AIDS, but his administration has yet to launch any bold initiatives. The president has not yet appointed the “AIDS czar” he promised, let alone restructured the Office of AIDS Research along the lines of the Truman-era Manhattan Project. (Many researchers believe that is just as well.) Faced with congressional opposition, Clinton has abandoned his pledge to stop barring people with HIV from entering the United States. And though his proposed federal budget includes a tiny funding increase for STD control ($103 million, up from $90 million last year), it falls far short of the $200 million that public-health officials deem essential.
Two hundred million dollars may sound like a lot of money, but the government spent $1.3 billion on AIDS-related medical research last year-and the Clinton administration proposes spending $1.5 billion next year. That huge commitment reflects both the political savvy of the gay community and our Of enduring faith in technological are…fixes. State-of-the-art laboratories, full of brilliant scientists racing to understand a deadly medical mystery, have a lot more popular appeal than storefront clinics in bombedout neighborhoods. Both have their place. But storefront clinics have the advantage of being able to combat AIDS today.
< b> A PLAGUE’S CHANGING COMPLEXION
Researchers glimpsed the future of the epidemic by comparing people with HIV to those with full-blown AIDS. The 22-state study shows infections declining among gay men but rising sharply among blacks, teens and women.
Percentage of those Percentage of HIV- with AIDS are… infected who are… Gay men 62% 39% Blacks 30% 43% Women 10% 17% Heterosexual 7% 10% Teens Less than 3% 1%
