AIDS: A GLOBAL ASSESSMENT

Acquired immune deficiency syndrome is increasingly seen as a consuming global problem that may kill millions of people before the end of the century and profoundly influence human events well into the 21st Century, according to a survey by Times correspondents throughout the world.

From the nations that have already witnessed the suffering and deaths of thousands of AIDS patients to those where the disease remains rare, there is a growing--although by no means uniform--willingness to commit resources and to take strong, even Draconian, measures against the disease.

An increasing number of countries, from Belgium and Bulgaria to China and India, are blaming foreigners for the introduction of AIDS. As a result, some are testing foreign students and workers and would-be immigrants for the AIDS virus and deporting those who test positive.

Other nations, including Australia, Japan and many in Western Europe, have launched extensive AIDS education campaigns aimed at their own citizens. In Britain, moviegoers have been treated to a spectacle of a look-alike of Prime Minister Margaret Thatcher demonstrating the use of a condom, while billboards picture an exhausted couple asleep on a coffin-shaped bed over the caption, "Bang, bang, you're dead."

"On a political level, the evolution of AIDS as a global concern in the last year is really remarkable," said Dr. Jonathan Mann, an American who is director of the World Health Organization's special program on AIDS. "The whole perspective is changing in response to fears of what will happen if we don't deal with the problem."

"Twelve months from now, my guess is that AIDS will dominate every international agenda--economic, political or otherwise," said Dr. Donald A. Henderson, dean of the Johns Hopkins University School of Public Health and one of America's most respected international health experts.

While traditional scourges such as cancer, heart disease, tuberculosis and malaria are expected to continue to claim more lives in many areas of the world, AIDS--invariably fatal and often untreatable--carries the potential to wipe out economic and health gains that some Third World nations have painstakingly achieved over many decades, health experts fear.

In Zaire, one of the nations hardest hit and most intensively studied, "very conservative estimates" are that premature deaths of working age men and women from AIDS will decrease the projected gross national product for 1995 by 8%, according to economist Charles Myers of the Harvard Institute of International Development.

Researchers voice similar fears about young and middle-aged adults and about the future of mothers and their newborns in other Central Africa nations. In some places, 10% to 25% of pregnant women are infected with the AIDS virus and infant mortality from AIDS is estimated to be greater than total infant mortality from all causes in many Western nations.

"AIDS threatens to set back everything done in the last 10 to 15 years (to improve maternal and child health)," said Dr. Manuel Carballo of the World Health Organization.

To date, about 130 of the world's more than 160 countries have reported a total of about 56,000 AIDS cases. About 70% of the these cases--40,000--have been from the United States.

But these official reports grossly understate the true magnitude of the AIDS epidemic, particularly in Africa and the Caribbean where many cases are neither diagnosed nor counted, according to the World Health Organization, a specialized United Nations agency headquartered in Geneva with primary responsibility for international health.

Other countries may attempt to suppress information. That seems to be the case in Zaire, which has not officially acknowledged a single case of the disease even though it is widely recognized as one of the nations where the epidemic is worst.

In fact, Mann of the World Health Organization estimates that two to three times as many AIDS cases--or from 100,000 to 150,000--have actually occurred throughout the world and about half of these patients have already died from the disease.

In addition, between 5 million and 10 million people worldwide are estimated to be healthy or minimally symptomatic AIDS virus carriers. By 1991, Mann estimates that between 500,000 and 3 million of these infected individuals will develop AIDS.

In the interim, millions of additional people may contract the AIDS virus, the vast majority through sexual contact with infected individuals. Hundreds of thousands may be exposed through contaminated blood. Thousands of infected mothers may also transmit the virus to their newborns.

"AIDS is out of the box," said Dr. James Chin, a World Health Organization consultant with primary responsibility for global surveillance of the disease. "Even if we had an effective vaccine to prevent new cases today, it is something the world would have to live with over the next century."

AIDS is spreading throughout the world through three distinct patterns, according to Chin.

- In urban areas of the United States, Canada, Western Europe, Australia, Brazil and Mexico, the AIDS virus is usually transmitted through male homosexual contact or by intravenous drug users who share contaminated needles and syringes. There is relatively little heterosexual transmission of the AIDS virus in these countries.

- In urban areas of Central Africa nations such as Rwanda, Uganda, Zaire and Zambia and in Haiti the AIDS virus is primarily sexually transmitted between men and women and also by exposure to contaminated blood through injections and transfusions. Researchers believe that a high frequency of untreated venereal diseases, such as gonorrhea and syphilis, contribute to the high rates of sexual transmission of the virus in many of these countries.

- In areas of the world where AIDS remains very rare, such as Asia, the Middle East, Eastern Europe, the Soviet Union and most Latin American countries, foreigners account for a significant percentage of the officially acknowledged cases. The virus is often transmitted by people who have become infected abroad and by prostitutes who have had contract with infected foreigners. Many hemophiliacs were also infected through contaminated blood products in the early 1980s.

The Times survey found that despite widespread concern among governments about AIDS, there are dramatic differences in how societies are treating infected individuals.

World Health Organization officials, such as Mann, consider "the most important" prerequisite to successful AIDS control to be a "mature vision" of how to integrate AIDS virus carriers into society, instead of excluding them or making them victims of discrimination. But exclusion is precisely what appears to be happening in an increasing number of countries throughout the world.

Moreover, many countries have yet to plan for the impact on hospital and social services of the large numbers of additional AIDS patients expected in the next several years. The epidemic has already overwhelmed the health care system in Haiti and parts of Central Africa. As a result, many AIDS patients die undiagnosed or without what would be considered in the United States simple treatments for infection and routine compassionate care.

Western European nations and Canada are joining the United States in making the partially effective anti-AIDS drug AZT available to patients. But AZT has no role to play in the developing world and in many Eastern European nations, both because of its high cost and because laboratory facilities are often not available to detect or treat the drug's potentially severe side effects.

There are also dramatic differences in educational and other measures taken to prevent the spread of the disease, which often are encumbered by social taboos and by the influence of the Roman Catholic Church and Islamic religious groups.

For example, in Norway, a penis-shaped cartoon figure replete with bow tie and encased in a condom looks out from posters posing the question: "Are you dressed for all occasions?" In most countries, however, such a frank public advertisement for an important means of preventing the transmission of the AIDS virus is out of the question. Indeed, the words "AIDS" and "homosexuality" are not even publicly mentioned in some Arab nations.

The same issue arose in Spain, where the sale of condoms was illegal until nine years ago. Before the festival of the running of the bulls at Pamplona last month, posters throughout the city urged revelers to keep safe by paying homage to a mythical "St. Condom." But the local government withdrew a promise of $8,000 to help distribute 12,000 condoms because of concerns that devout Catholics might be offended.

Meanwhile, AIDS continues to inspire discrimination, fear and even panic.

In Japan, after the first death of a woman from AIDS earlier this year, the Tokyo government started a telephone counseling service. In two days, the hot line received more than 160,000 calls.

In South Korea, a nation with only one reported AIDS case, newspapers have alleged, incorrectly, that food products imported from countries with many AIDS patients may be dangerous. Men have also been warned in the mass media not to get shaves in barbershops because of the danger of cuts in the skin that could transmit the disease.

Near Athens, workers at a state mental institute this spring isolated a Soviet refugee who had tested positive for the AIDS virus and refused to serve him food.

After his release, the man, whose plight had been publicized, was recognized by a group of people as he sat on a public bench. They forced him against a wall and held him there with long sticks until police came to his rescue.

And in Brazil, Marco Antonio Lindo, a merchant in the town of Monte Alegre de Sol, killed his wife and three children with poison, then hanged himself because he feared he had AIDS and had given it to his family. Lindo, it turned out, did not have the disease.

A region-by-region report of the response to the AIDS epidemic begins on the facing page.

SOUTH KOREA Officials periodically conduct AIDS virus tests on the estimated 12,000 prostitutes "serving" U.S. military personnel stationed there.

NICARAGUA The government quietly urges businesses to provide information on the sexual activity of homosexual, bisexual and promiscuous heterosexual employees.

FRANCE The government is preparing an AIDS education mailing to 24 million homes.

BRAZIL The country lacks adequate beds, medicine and medical training for the burgeoning number of AIDS patients, says an anti-AIDS activist.

ZAMBIA A recent study predicts that 6,000 infants will die of AIDS this year in the south-central African nation.

AIDS CASES PER 100,000 POPULATION

While AIDS remains a rare disease on a worldwide basis, it is now frequently diagnosed in many areas of the world. These are the number of AIDS cases that have occurred per 100,000 population for selected areas for which data are available. For some nations, including those in Africa and Latin America, the statistics underestimate the actual number of cases.

Shaded areas represent countries with a significant number of AIDS cases, but accurate statistics are often not available.

CASES PER CASES POPULATION 100,000 WORLDWIDE 100,000-150,000 5 billion 2.0-3.0 UNITED STATES 39,263 239.3 million 16.4 New York City 10,229 9.2 million* 111.2 San Francisco 3,858 3.5 million* 110.2 Los Angeles 3,400 8.0 million* 42.5 OTHER COUNTRIES Bermuda 55 56,000 98.2 Uganda 1,138 15.5 million 73.4 French Guiana 58 82,000 70.7 Tanzania 1,130 21.7 million 52.1 Bahamas 86 231,000 37.2 Haiti 851 5.4 million 15.8 Guadeloupe 40 333,000 12.0 Rwanda 705 6.3 million 11.2 Trinidad and Tobago 134 1.2 million 11.2 Switzerland 266 6.4 million 4.2 Canada 1,052 25.4 million 4.1 Australia 523 15.6 million 3.4 Kenya 625 20.3 million 3.1 France 1,632 55.2 million 3.0 Denmark 150 5.1 million 2.9 Belgium 230 9.9 million 2.3 West Germany 1,150 61.0 million 1.9 Netherlands 260 14.5 million 1.8 Britain 870 55.6 million 1.6 Sweden 129 8.4 million 1.5 Italy 840 57.2 million 1.5 Brazil 1,835 135.6 million 1.4 Norway 45 4.2 million 1.1

* population figures include metropolitan areas. Sources: United Nations population statistics, 1987; U.S. Census Bureau estimates. AIDS: COMPARED TO OTHER HUMAN AFFLICTIONS?

Between 5 million and 10 million people worldwide are estimated to be infected with the AIDS virus and between 500,000 and 3 million deaths from AIDS are expected by 1991, according to the World Health Organization. Despite these sobering statistics, other diseases are likely to continue to afflict more people on a worldwide scale in the foreseeable future. CAUSES OF DEATH Estimated millions of deaths per year Heart and other degenerative diseases . . 13.3 million Cancer . . 4.3 Tuberculosis . . 3 Injuries and poisonings . . 2.7 Measles . . 2 Source: World Health Organization

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