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AIDS: A GLOBAL ASSESSMENT : Conquering Older Health Threats While Battling on a New Frontier

August 09, 1987|ROBERT STEINBROOK | Times Medical Writer

GENEVA — Instead of despairing that the AIDS epidemic will overwhelm the global efforts to contain it, the World Health Organization sees the mobilization against the disease as a window of opportunity to significantly improve the health of the world's people.

Preventing the spread of a sexually transmitted and blood-borne disease such as AIDS may lead to better control of other widespread infectious diseases, including bacterial infections, hepatitis B, and venereal diseases such as gonorrhea and syphilis.

And because the control of AIDS is inextricably linked to strengthening basic health services throughout the world, more children may receive immunizations against childhood illnesses such as measles and polio and more patients may receive effective treatments for scourges such as tuberculosis, leprosy and malaria.

"There is absolutely no question that AIDS has the potential to be the reason why certain changes in health practice occur which have always been suggested but which have never taken hold," said Dr. Jonathan Mann, director of WHO's special program on AIDS.

"These changes may or may not happen with AIDS either. But if they are going to happen, they will happen through something like AIDS," he said.

In a row of modest sixth-floor offices with a peaceful view of Lake Geneva, about 15 officials of WHO, a United Nations agency with primary responsibility for international health, are devising a global blueprint for the battle against AIDS.

The blueprint, established through long hours of work in the last six months, includes plans to help every nation in the world develop comprehensive AIDS strategies and to raise billions of dollars in new international aid to support AIDS control and basic health services in the developing world.

Already, the special program on AIDS is working with 78 countries, including almost all the African nations, to help them develop such strategies, Mann said. The program also has raised $37 million from member nations to fund its activities this year. Its efforts have been unanimously endorsed by the World Health Assembly, WHO's 166-member nation governing body.

The World Health Organization plans to help every country gather accurate data about AIDS virus carriers and to prepare an international Kinsey-style report on sexual practices.

In January, WHO and the British government are to jointly sponsor an unprecedented international summit on AIDS in London, to which health ministers from every country in the world will be invited.

By the end of next year, WHO expects that almost all countries will have national AIDS control programs and that the development of rapid and inexpensive diagnostic tests will make it possible to perform tests throughout the world to identify infected persons.

But the special program on AIDS also faces formidable obstacles in its efforts to tame what Dr. Daniel Tarantola, director of national program support for the special program on AIDS, called the "most intelligent disease we could possibly invent."

"Controlling AIDS is an immensely more complicated enterprise (than eradicating smallpox)," said Dr. Donald A. Henderson, dean of the Johns Hopkins University School of Public Health and director of WHO's smallpox eradication campaign from 1966 to 1977. "A lot of not totally probable events have to happen simultaneously. One has to be not optimistic that we are going to see dramatic changes in any short period of time."

For WHO's strategy to succeed:

- Hundreds of millions of people of all religious faiths and educational levels will need to change their sexual behavior--not just for weeks or months, but indefinitely. Prior attempts to change sexual behavior by, for example, promoting the use of contraceptives for family planning, have met with widespread resistance in many African and Asian nations.

"It is mind-boggling the number of condoms you need," said Dr. James Chin, a World Health Organization consultant from the United States. Moreover, it is expected to cost about $20 to provide a year's supply of condoms to a Third World couple, along with related educational programs, according to Dr. Jeff Harris of the U.S. Agency for International Development. This cost is much greater than the per capita health budget of many developing countries.

- Doctors and patients will need to avoid unnecessary injections and blood transfusions and to convert to the exclusive use of sterile needles, syringes and screened blood for medical procedures--a goal many health authorities believe will be very difficult to accomplish. In India, for example, "disposable needles" costing 15 cents each are often reused hundred of times at rural clinics to cut expenses.

- Billions of dollars for international AIDS control programs will need to be raised. By 1991, the budget for WHO special program on AIDS may be twice as large as the entire budget for the rest of the organization.

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