Experts Alarmed by HIV Spread, Hopeful on Prevention

In January 1995, 2% of drug users in Ukraine were infected with the AIDS virus. Less than a year and a half later, the proportion had grown to 55%, a U.N. official said Saturday.

The virus is still spreading alarmingly throughout the world, with more than 21 million people infected and nearly 6 million already dead, Dr. Peter Piot, the head of the U.N. Program on HIV/AIDS, said here before today’s opening of the 11th International Conference on AIDS.

But intensive anti-AIDS efforts are beginning to make some headway in countries such as Thailand and Uganda that have been devastated by HIV, the human immunodeficiency virus that causes the disease.

“For the first time, there is a real hope that prevention will have an impact in developing countries,” he said.

Piot spoke as the American Medical Assn. released its first set of guidelines to help U.S. physicians intervene in their patients’ risky behaviors--guidelines that some say should have been formulated 10 years ago.

The AMA announced it will distribute the guidelines for AIDS prevention and management to more than 200,000 doctors by the end of the year.

“The guide gives physicians ways to identify patients at risk and provides information for patients that will help them make educated choices about drug use and sexual behavior,” said Dr. Nancy Dickey, chairwoman of the AMA’s Board of Trustees. It emphasizes the importance of frank discussions with patients about sexual behavior and drug use.

It is just as important to determine a patient’s use of intravenous drugs as it is to learn cholesterol intake or how much the patient smokes, said Dr. Harvey J. Makadon of Harvard Medical School, who chaired the panel that developed the guidelines.

Canada has had such guidelines since 1988, and “they have had a substantial impact on behavior changes and social attitudes,” said Brent Allen of AIDS Vancouver, an activist group.

The AMA presentation was halted briefly by an ACT UP demonstration protesting the decision last week by the AMA’s House of Delegates to endorse mandatory HIV testing of pregnant women. That controversial decision was passed by a 185-181 vote after a long debate.

ACT UP argues that mandatory screening will force women who do not want an AIDS test out of the health care system and may lead to denial of care. “There are many instances of health care providers refusing to treat women living with HIV,” said Elisa Luna of the National Assn. of People With AIDS.

The United Nations’ Piot described the plight of children facing the disease. Nearly 1 million of the world’s HIV-positive people are children, he said, “a fact that is not well appreciated.” Among the 8,500 new infections diagnosed every day, 1,400 of them are in children, who usually die within their first year of life, he said.

“This is truly affecting the future of the world,” he said.

The worst problem is in Africa south of the Sahara Desert. That region, according to U.N. figures, has 63% of the world’s HIV-positive population and 80% of its HIV-positive women. It is the only region where infected women outnumber men.

India has the most HIV-positive people of any country--more than 3 million, and the incidence is climbing rapidly, the U.N. figures show. And China has had a dramatic rise in the classic sexually transmitted diseases, which are a major risk factor for AIDS, as well as an increase in drug abuse.

Most of the new cases in Africa and Asia are the result of heterosexual activity. Elsewhere, as in Ukraine, drug abuse is a primary problem. It is “out of control” in Spain, where two-thirds of drug abusers are HIV positive, Piot said. Vietnam has had an “explosive spread,” he said.

But there are signs of hope. In Uganda, the prevalence of HIV infection among pregnant women has dropped 30% since 1990. In Thailand, the proportion of HIV-positive males who deal with prostitutes declined from 23% in 1990 to 10% in 1993. Experts attribute the gains to profound behavioral changes, including having fewer sexual partners, postponement of first sexual encounters and increased use of condoms.

Prevention has also been successful in the United States, according to Dr. Helene Gayle of the U.S. Centers for Disease Control and Prevention. Yearly increases in new cases now average about 5%, compared with 85% at the beginning of the epidemic, she said. New cases in San Francisco alone have dropped from 8,000 per year a decade ago to 1,000 per year now.