Global AIDS specialists begin gathering in Amsterdam today for the eighth International Conference on AIDS in a mood buoyed by the pace of scientific advances -- but tempered by the sobering reality that the pandemic is still raging out of control in many regions of the world.
In hundreds of papers and other presentations throughout the week, more than 9,000 scientists, clinicians and other specialists from 125 countries are expected to report steady progress in therapies, vaccine development and understanding the workings of the human immunodeficiency virus.
But the news from the developing countries, where acquired immune deficiency syndrome continues to spread unabated, is expected to be exceedingly grim.
"The global effort against HIV-AIDS has reached a dangerous impasse," said Dr. Jonathan Mann of Harvard University's AIDS Institute and the chairman of the meeting.
"A realistic analysis reveals that the gap between the expanding . . . epidemic and lagging national and international response is increasing rapidly, leaving the world more vulnerable to the spread of HIV."
Recently, Dr. Mann released a report from the Harvard-based Global AIDS Policy Coalition projecting that 110 million adults would be infected with HIV by the turn of the century, a figure three times that predicted by the World Health Organization. Dr. Mann is the former director of WHO's AIDS program.
Currently, as many as 2.6 million people worldwide are suffering from AIDS, and nearly 13 million are infected.
In the United States, as of June, there had been a cumulative total of 230,179 cases of AIDS since the epidemic began in 1981, and 152,153 deaths. About 1 million Americans are believed to be infected with HIV.
"The pandemic is moving right along, but the efforts against it are plateauing, and in some cases declining," Dr. Mann said. "While a tremendous amount has been accomplished, somehow have not been able to move it to the next level -- the one that would reassure us we're bringing it under control and care for people who need care."
It is especially frustrating because "we know we have the capacity to control AIDS [through prevention and education] and care for all affected," he added.
Dr. Anthony S. Fauci, who heads the U.S. government's AIDS research effort, agreed that the disease is spreading worldwide at a disturbing rate.
"If you look at what's happening in Africa and what will happen in Asia, you have reason to be very pessimistic," he said. "All the signs indicate that the pandemic is not slowing down at all."
On the scientific front, however, he and others said the news was much more encouraging.
"We're learning an incredible amount. . . . It's a very exciting and rapidly evolving field," said Dr. Fauci, who is director of the National Institute of Allergy and Infectious Diseases.
Since the first international AIDS meeting was held in Atlanta in 1985, the annual conference has evolved as the most important global forum for the exchange of knowledge about the deadly disease.
This year's meeting has already yielded some intriguing results. Yesterday, in a pre-conference session sponsored by the American Medical Association, researchers from the University of California, Los Angeles were to release the first international comparison of physicians' attitudes toward treating AIDS patients. The study found "significantly higher" levels of reluctance among medical residents in the United States than in either France or Canada, two other countries with a considerable AIDS caseload. The study will appear in the July 22 issue of the Journal of the American Medical Association.
Dr. Martin F. Shapiro, lead author of the study, said public perceptions of the epidemic "may profoundly affect physicians' responses to it."
Furthermore, the study showed that Americans were far more likely to view caring for AIDS patients as "dangerous." French physicians expressed the least reluctance to care for homosexual men, intravenous drug users and other AIDS patients, compared to Americans, who expressed the most.