No Good News on AIDS

The international meeting on AIDS in Montreal, like those that have preceded it, has served as a useful reminder of the realities of the pandemic:

--No cure is likely for many years.

--There is no substitute for monogamous relationships or safer sex practices, including the use of condoms and abstinence from anal sex, if risk is to be reduced.

--The cost of care is going to increase enormously for two reasons: The lives of infected persons can be significantly prolonged only with the use of costly new medicines, and the number of AIDS cases worldwide will increase at least nine-fold in the decade ahead.

--In the United States there is an urgent need for broader anti-discrimination legislation at the federal level to ease the fear of exposure that now discourages some high-risk persons from seeking the very tests for the human immunodeficiency virus (HIV). The tests make possible life-extending therapy for infected persons and reduced risk for others with whom they are in contact.

The Montreal meeting included troubling reports. There were indications of continued high-risk behavior even by informed individuals. There were reports of continued resistance to strategies of proven effectiveness, including distribution of condoms and exchanges of clean needles, promotion of needle-cleaning procedures and explicit educational programs for at-risk populations, particularly preteens and early adolescents. And there were contrasting reports, some showing unexpected progress in controlling rates of infection among intravenous drug users, others suggesting slippage in what had been stabilized infection rates among some homosexuals.

Nothing was more impressive, however, than the demonstrated inadequacy of the money being spent and the effort being made. In the United States, of course, that emerges as just one element of overall neglect of public health that is dramatized in deteriorating infant mortality rates and the exclusion of 37 million persons from insured health care despite radically escalating costs.