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Outlook Is Pessimistic at AIDS Conclave

TIMES MEDICAL WRITER

A sense of foreboding pervaded the gathering Sunday of more than 11,000 scientists, journalists and AIDS activists and patients from 128 countries for the 10th International Conference on AIDS.

Asia has so far escaped most of the ravages of the disease, but that situation is changing rapidly--almost literally in front of the delegates’ eyes.

During the last year alone, the number of cases in Southeast Asia has increased more than 700%, from 30,000 to 250,000. In northern Thailand, 8% of pregnant women and 20% of military recruits are infected with HIV, the virus that causes AIDS, according to Dr. Michael H. Merson, head of the World Health Organization’s Global Programme on AIDS. In Bombay, 30% of prostitutes are HIV-positive, as are fully 50% of intravenous drug users in some regions of northeast India, he said.

The World Health Organization expects the number of HIV-positive individuals in Asia, 2.5 million now, to quadruple to 10 million by the turn of the century. Dr. Naoko Yamamoto, chief executive of the conference, said it is important to “bring the world’s leading experts on AIDS to a region that is rapidly becoming the center of the global AIDS epidemic.”

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Those experts are not bringing words of good cheer. Advances in treating AIDS are few and far between, and most experts expect few revelations in Yokohama. “There will not be major breakthroughs (announced) here,” said Dr. Peter Piot of the World Health Organization.

At the first of these conferences, held nine years ago in Atlanta, researchers predicted the development of a vaccine by 1986. On Saturday, in contrast, Dr. George Lundberg, editor of the prestigious Journal of the American Medical Assn., predicted that “no successful method of treatment or prevention will have been fully implemented” at the end of the next century and that “AIDS will still be a serious endemic disease throughout the world” then.

While other experts think that’s an extreme expression of pessimism, the pace of research has been so slow that the conference sponsors are abandoning their yearly format in favor of holding the gatherings every other year. The next meeting will be in Vancouver, Canada, in 1996.

Unlike the pace of research, the pace of disease is quickening. Worldwide, the estimated number of AIDS cases has gone up 60% in the last year, from 2.5 million in July, 1993, to about 4 million today, according to the World Health Organization. The total number of HIV-infected individuals is 17 million.

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The pace of increase is somewhat slower in the United States, according to figures released Saturday by the Centers for Disease Control and Prevention. Through the end of June, CDC had received reports of 401,749 cases of individuals with AIDS, 243,423 of whom had died. In the last 18 months, 47% of new cases were among gay men, 28% among intravenous drug users and 9% among heterosexuals who contracted it through sex. The proportions of cases among females, African Americans and Hispanics all increased slightly.

Japan has a low incidence of AIDS so far, according to Dr. Simpei Ozaki of the Japan Ministry of Health and Welfare. Through the end of June, he said, the country had 764 cases of AIDS reported to the government and 3,075 HIV-positive individuals. Three out of every five of those cases were related to the use of contaminated blood in transfusions and blood products in hemophiliacs.

Now that the problem of contaminated blood has been brought under control by testing, Ozaki said, the biggest number of new infections has been among “female foreign residents"--the euphemism for prostitutes from Thailand and other developing countries, most of whom contracted the virus in their home countries.

Ozaki insisted that the number of new infections reported among such women dropped substantially last year. Japanese journalists, however, said the women simply stopped reporting new cases, both because they were getting in trouble for their reports and because they were not receiving treatment from the national health system.

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Japanese AIDS patients have also complained recently about discrimination in a homophobic society, alleging that they have been turned away from some hospitals. Ozaki conceded the charges, noting that “current arrangements are not satisfactory.” His ministry intends to establish “model hospitals” to demonstrate appropriate AIDS care in all the country’s 47 prefectures, or states, he said, but so far only eight are operating.

That homophobia and fear of AIDS has so far apparently not proved to be a problem for the meeting, however. The government went out of its way beforehand to make it clear that AIDS patients and HIV-positive individuals were welcome to attend, and special classes in dealing with such people have been held for the staffs of Yokohama hotels. So far, the only complaints have been about the high cost of staying here.

Delegates to the conference, which has been widely publicized here, were greeted Sunday with a lively opening ceremony that featured a laser show and computer graphics on a large screen behind the speaker’s podium. The kickoff event was attended by Prime Minister Tomiichi Murayama and Crown Prince Naruhito.

Among those addressing the session was Toshihiro Oishi, one of the few Japanese to publicly admit being infected with HIV. Japan is “a difficult society for us PWAs (people with AIDS) to live in,” he said.

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A nation with a budding AIDS problem is India. The world’s second most populous country had only 768 reported AIDS cases through the end of June, according to Dr. Prasanta K. Choudhuri, president of the Indian Medical Assn. But he conceded that the number of cases is probably substantially underreported and that the incidence is growing at “an alarming rate.” He predicted that the country will have 5 million HIV-positive individuals and 1 million AIDS cases by the turn of the century.

One of the country’s main problems, he said, is that the quality of condoms--the best method for preventing spread of the virus during sex--"leaves much to be desired.” The devices, he said, have a nasty habit of breaking. Foreign manufacturers are being brought in to help local suppliers, he said.


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