U.N. Agency Expects Jump in AIDS Cases

More than nine times as many adults are expected to come down with AIDS in the 1990s as have already become ill in the history of the epidemic, according to startling figures presented Sunday by the World Health Organization on the opening day of the largest-ever international conference on AIDS.

In addition, three times as many people are expected to become infected with the AIDS virus in the 1990s as have become infected in the 1980s, the decade in which cases were first identified. Five million people worldwide already carry the human immunodeficiency virus (HIV), which causes AIDS, the health organization estimates.

“The HIV/AIDS situation in the decade of the 1990s will be more serious, and perhaps much more serious, than that which we have experienced in the 1980s,” said Dr. Jonathan Mann, director of the organization’s AIDS program. Mann cited the results of a recent World Health Organization analysis of the direction of the epidemic over the next 11 years.

The organization’s researchers, in making their predictions, relied on reports on statistics it received from 155 governments as well as individual researchers worldwide. It is the most comprehensive effort yet to predict the course of the epidemic to the end of the century.

Bilingual Demonstration

Mann made his comments during an opening session that was delayed one hour by a raucous demonstration by several hundred people with AIDS and AIDS-related conditions. The protesters, shouting, stomping and waving banners and signs, paraded to the podium of the conference hall and presented, in French and English, a “Montreal manifesto.”

The 10-point declaration called, among other things, for an international code protecting the rights of infected people to medical care, jobs and civil liberties. It also demanded faster access to promising treatments, an end to the use of inactive placebos for purposes of comparison in experimental drug trials and the elimination of misconceptions about how the disease has spread.

The protest had been approved in advance by the conference organizers, who say they have gone to great lengths to include people with AIDS in the meeting, giving them for the first time a significant role in designing the curriculum and shaping its emphasis on the social, ethical, economic and legal issues raised by AIDS.

Disease Spreading

In his address to many of the estimated 11,000 scientists and others expected to attend the weeklong Fifth International Conference on AIDS, Mann attributed the predicted rise in cases to several factors. These include the fact that HIV infection is now spreading beyond countries and regions already infected to areas of the world previously spared.

For example, the infection rate among intravenous drug users in Bangkok, Thailand, has leaped from 1% in 1987 to more than 40%, Mann said.

The virus also appears to be spreading rapidly among female prostitutes in southeastern India, and among the general adult population throughout the larger cities of West Africa.

Yet zeal for fighting the disease may be waning, Mann warned.

“Around the world, there is evidence of growing complacency among some--and growing fatalism among others,” he said. Mann predicted that complacency could reduce the commitment of resources to fight AIDS, while fatalism could lead to “proposals for simplistic and extreme solutions.”

As of June 1, about 157,191 AIDS cases, from 149 countries, had been reported to Mann’s Geneva-based organization. But the organization estimates the actual number at more than three times that figure, or nearly 500,000 cases, because of poor reporting.

Largest Share From U.S.

The largest share of the reported cases has come from the United States, where more than 90,000 people have been reported to have the disease. African countries have reported nearly 25,000 cases, and European countries nearly 22,000.

Mann predicted that a total of more than 6 million adult cases will have occurred by the year 2000.

Mann also said the number of new AIDS cases are rising sharply--from 70,000 between 1980 and 1985 to 300,000 between 1986 and 1988 to a projected 700,000 new cases between 1989 and 1991.

Conference delegates from 87 countries poured into Montreal this weekend, jamming airport terminals, currency exchange offices and hotels. Nearly 1,000 scientific papers are to be presented, in addition to 3,546 summaries of research to be displayed in a forest of printed posters.

While the presentations will include more biomedical research than was presented at any of the four previous annual international AIDS meetings, organizers of the Montreal conference say there is for the first time a special emphasis on “the social challenge” posed by the disease.

Dr. Alastair Clayton, director of Canada’s Federal Center for AIDS, said the Canadian government had worked with Canadian and U.S. border officials to assure that people with AIDS or infected with the virus would not be prevented from entering the country to attend the conference.

Organization Policy

The World Health Organization, a co-sponsor of the conference, has developed a policy under which it will neither co-sponsor nor contribute to any AIDS meeting that does not include patient participation. The agency has no similar policy for any other disease.

“While many tragedies and struggles leave no visible trace once they are passed, no imprint on the world’s spirit, we know that AIDS in the 1980s has altered us--in our world, in our countries, in our communities, and in our hearts,” Mann concluded in his address.