AIDS and the Danger of Complacency


December 28, 1990|By Jonathan Power

GENEVA. — THERE'S a dangerous lull in any battle, when the offensive has been mounted, the artillery has been brought up to the front and the enemy appears vulnerable.

Then the temptation to complacency is hard to resist. At that moment resolve can weaken, the opposing forces regroup and the chance of a great victory be lost.

The battle against AIDS, waged with such vigor the last six years, has reached this danger point. Quite suddenly there appears to be a loss of momentum. Media attention has begun to slacken. More seriously, within the medical-research and public-health establishments there is talk that the AIDS campaign has pre-empted a disproportionate share of scarce resources. AIDS budgets are beginning to be pruned.

This is troubling. We have no way of predicting whether the spread of the HIV virus will continue or whether there will be a natural plateau. But we know that at the moment -- unlike, say, cancer or malaria, diseases that worry us immensely -- AIDS is a spreading epidemic.

Vast areas of the world remain unreached by AIDS, but there is no reason to think they will not be touched. Sexual behavior is not so different in China and India, two countries with populations of over a billion but with relatively few AIDS cases, but so far the virus has not arrived in full force. Already warning signs are out. A recent survey of prostitutes in southeast India showed that between 3 and 7 percent were infected with HIV.

For 10 years we've underestimated the virulence of this virus. And there are a number of known problems that we ignore at our peril.

We know, for example, that 5 million people are taking drugs by injection. Only a small proportion of them are at present infected with HIV. Yet all of them are at serious risk of developing AIDS.

We know, too, that there are 100 million new cases a year of sexually transmitted disease. All of these are at risk of AIDS, even though only a small percentage now have HIV symptoms.

The World Health Organization predicts that by the end of the century there may be as many as 6 million AIDS cases, a tenfold increase over today's number. Even this estimate could prove to be too conservative if AIDS spreads rapidly through Asia.

Money spent on AIDS is necessary spending. The danger is ever present that the epidemic may explode and overwhelm us. This is one good reason for keeping our guard up. The other is that the war on AIDS works to strengthen important but sadly neglected or underfunded aspects of the health services in many countries.

Old fashioned arm-to-arm blood transfusions have now been replaced, even in developing countries, by blood banks where blood is routinely tested for a wide number of diseases, not only AIDS.

Sex education for young people is now more widespread both in countries which dabbled with it before and in countries where it was effectively forbidden because of religious and moral scruples. Today it is increasingly recognized that sex education, given all we've recently learned, is less a call to promiscuity and more a reinforcer of old codes of behavior -- fidelity, responsibility and commitment.

AIDS has pushed societies to pay more attention to phenomena it has traditionally swept under the carpet or ghettoized -- prostitution and drug addiction. We now know that the problems of affected groups -- moral, psychological, cultural and economic -- have to be dealt with directly and openly. Otherwise these people become repositories for the disease, threatening the rest of society even if the spread of HIV is controlled in the general population.

Because AIDS is increasingly concentrated among the poor -- in America among urban racial minorities and in Africa -- social self-preservation requires the development and expansion of public-health services that reach out to these groups.

It was Lord Shaftesbury 150 years ago who drummed home the message to a recalcitrant British upper and middle class that private well-being depends on public health. Without large-scale investment in city-wide sewerage systems, serving poor as well as bourgeois neighborhoods, the health of the whole society would be constantly threatened by typhoid and tuberculosis.

Today we have to adapt his thinking to the way we combat the AIDS epidemic.

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