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Aids: A Global Assessment

August 09, 1987

Acquired immune deficiency syndrome is increasingly seen as a consuming global problem that may kill millions of people before the end of the century and profoundly influence human events well into the 21st Century, according to a survey by Times correspondents throughout the world.

From the nations that have already witnessed the suffering and deaths of thousands of AIDS patients to those where the disease remains rare, there is a growing--although by no means uniform--willingness to commit resources and to take strong, even Draconian, measures against the disease.

An increasing number of countries, from Belgium and Bulgaria to China and India, are blaming foreigners for the introduction of AIDS. As a result, some are testing foreign students and workers and would-be immigrants for the AIDS virus and deporting those who test positive.

Other nations, including Australia, Japan and many in Western Europe, have launched extensive AIDS education campaigns aimed at their own citizens. In Britain, moviegoers have been treated to a spectacle of a look-alike of Prime Minister Margaret Thatcher demonstrating the use of a condom, while billboards picture an exhausted couple asleep on a coffin-shaped bed over the caption, "Bang, bang, you're dead."

"On a political level, the evolution of AIDS as a global concern in the last year is really remarkable," said Dr. Jonathan Mann, an American who is director of the World Health Organization's special program on AIDS. "The whole perspective is changing in response to fears of what will happen if we don't deal with the problem."

"Twelve months from now, my guess is that AIDS will dominate every international agenda--economic, political or otherwise," said Dr. Donald A. Henderson, dean of the Johns Hopkins University School of Public Health and one of America's most respected international health experts.

While traditional scourges such as cancer, heart disease, tuberculosis and malaria are expected to continue to claim more lives in many areas of the world, AIDS--invariably fatal and often untreatable--carries the potential to wipe out economic and health gains that some Third World nations have painstakingly achieved over many decades, health experts fear.

In Zaire, one of the nations hardest hit and most intensively studied, "very conservative estimates" are that premature deaths of working age men and women from AIDS will decrease the projected gross national product for 1995 by 8%, according to economist Charles Myers of the Harvard Institute of International Development.

Researchers voice similar fears about young and middle-aged adults and about the future of mothers and their newborns in other Central Africa nations. In some places, 10% to 25% of pregnant women are infected with the AIDS virus and infant mortality from AIDS is estimated to be greater than total infant mortality from all causes in many Western nations.

"AIDS threatens to set back everything done in the last 10 to 15 years (to improve maternal and child health)," said Dr. Manuel Carballo of the World Health Organization.

To date, about 130 of the world's more than 160 countries have reported a total of about 56,000 AIDS cases. About 70% of the these cases--40,000--have been from the United States.

But these official reports grossly understate the true magnitude of the AIDS epidemic, particularly in Africa and the Caribbean where many cases are neither diagnosed nor counted, according to the World Health Organization, a specialized United Nations agency headquartered in Geneva with primary responsibility for international health.

Other countries may attempt to suppress information. That seems to be the case in Zaire, which has not officially acknowledged a single case of the disease even though it is widely recognized as one of the nations where the epidemic is worst.

In fact, Mann of the World Health Organization estimates that two to three times as many AIDS cases--or from 100,000 to 150,000--have actually occurred throughout the world and about half of these patients have already died from the disease.

In addition, between 5 million and 10 million people worldwide are estimated to be healthy or minimally symptomatic AIDS virus carriers. By 1991, Mann estimates that between 500,000 and 3 million of these infected individuals will develop AIDS.

In the interim, millions of additional people may contract the AIDS virus, the vast majority through sexual contact with infected individuals. Hundreds of thousands may be exposed through contaminated blood. Thousands of infected mothers may also transmit the virus to their newborns.

"AIDS is out of the box," said Dr. James Chin, a World Health Organization consultant with primary responsibility for global surveillance of the disease. "Even if we had an effective vaccine to prevent new cases today, it is something the world would have to live with over the next century."

AIDS is spreading throughout the world through three distinct patterns, according to Chin.

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