The global toll is already staggering. According to the WHO’s latest estimates, some 4 million people have developed AIDS since the beginning of the epidemic – 1.5 million in the past year alone – and 17 million have contracted HIV (the AIDS virus). The rate of new infections has waned in Europe and the United States, with their secure blood supplies and vigilant gay communities. But such progress is overshadowed by the pandemic in Africa and the nascent explosion in Asia. Health officials figure that by the end of the decade 40 million people will have been infected worldwide – 90 percent of them in developing countries.
Asia’s experience is already confirming that prediction. HIV is still rare in Japan, where condoms are as common as sushi and IV-drug use is almost unheard of. But the virus is growing ever more entrenched in parts of Thailand and India. Dr. Prayura Kunasol, head of Thailand’s department of Communicable Disease Control, reported last week that the infection rate has hit 20 percent among young military recruits – and 8 percent among pregnant women – in the country’s northern Chang Mai province. AIDS patients now occupy half of Chang Mai’s hospital beds.
Officially, India has counted only 728 AIDS cases to date, but the country’s health-monitoring system is so humble that experts say the number is meaningless. Studies have documented infection rates of 50 to 75 percent among IV-drug users in some provinces. In Bombay the rate among prospective blood donors shot from less than 1 percent in 1992 to 5 percent last year. All of this makes rigorous blood screening essential. But as Dr. P. K. Choudhuri of the Indian Medical Association explained last week, testing facilities don’t exist outside major cities and towns, and most doctors know little about the disease.
The social forces driving the Thai and Indian epidemics aren’t unique to those countries; drug use and commercial sex are commonplace in Burma, Cambodia, Vietnam, Indonesia and Malaysia. Ironically, the blessing of economic expansion could actually make matters worse. Sexually-transmitted-disease rates are soaring in China, where new commerce has disrupted traditional village life and prompted large population shifts. HIV has yet to gain a large foothold there, but experts predict it will spread explosively when it does.
Medical science has scored some small victories since last year’s discouraging AIDS conference in Berlin. It’s now clear, for instance, that infected women can reduce the risk to their babies by taking AZT during the final trimester of pregnancy. And the U.S. Food and Drug Administration has approved a fourth drug (d4T) to combat HIV. Because the virus mutates as it reproduces within the body, it quickly develops resistance to individual drugs. But a wider range of treatments should yield a longer period of survival. Medical researchers hope that by combining various drugs, they’ll someday manage to control the infection indefinitely.
But as several scientists conceded last week, these advances will have little effect in the hardest-hit regions of the world – regions where women receive little prenatal care, antiviral drugs are beyond people’s means and doctors lack the diagnostic tools to use them effectively anyway. Prevention is complicated, too, for it’s always easier for public officials to deny or ignore the problem than to marshal resources needed to fight it. As last week’s conference made clear, the stakes just keep getting higher.
Since the mid-1970’s, HIV has infected more than 17 million people, most of them in Africa. With the epidemic now exploding in Asia, experts say the number of infections worldwide will exceed 40 million by the year 2000.
