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Message for the World

January 29, 1988

The first global conference of health ministers on acquired immune deficiency syndrome--AIDS--has produced a useful, if general, declaration underscoring the urgency of international cooperation and education at a time when it is increasingly apparent that there are no alternatives to prevention in curbing the deadly disease.

Dr. C. Everett Koop, the U.S. surgeon general, asserted at the conference that AIDS is the "No. 1 health problem of this planet." The presence of health ministers and senior public-health officials from almost 150 nations at the London meeting indicated that his view is widely shared.

There was not much encouraging news to report. Koop outlined doubts, which are widely shared by research scientists, that a cure will be found. There is, at minimum, little likelihood of developing a vaccine in this century. Even as the delegates met, the problems that they face were intensified by confirmation that a second AIDS virus, already identified in Africa and Europe, has spread to the United States. This alone will hasten the need for a second test to determine infection in individuals and to screen blood for transfusions and organs for transplant.

"We are convinced that, by promoting responsible behavior and through international cooperation, we can and will begin now to slow the spread of HIV (human immunodeficiency virus) infection," the delegates said in a final resolution. But "slowing" is very different from halting or reversing. Dr. Jonathan Mann, the American epidemiologist who is in charge of the World Health Organization's AIDS program, told delegates that the cumulative total of cases has now reached 150,000 worldwide--a number that will double in a year and that will reach 1 million by 1991, WHO reports.

"It is too early for any sense of relief--quite the contrary," Mann said. "We are still in the early phases of a global epidemic."

There was a reluctance to go beyond generalities because of differences among the delegates. That was a lost opportunity. A majority statement reaffirming the WHO guidelines would have been helpful at a time when anxiety leads to diversions of precious resources into such politically motivated programs as massive testing.

American delegates to the conference were in a sense on the defensive because the U.S. government response in terms of education has fallen short of what many other Western nations have done. But the U.S. government was able to confirm during the conference that a pamphlet on AIDS will be mailed by the end of June to every home in America, as mandated by Congress in the current budget. Within the Reagan Administration, however, there is still disagreement as to how candid the pamphlet should be on the means by which the virus is transmitted and on the role of condoms in reducing the risks of infection.

Koop defended the U.S. response on the ground that the diversity of the United States makes it harder to implement some programs. But he exhibited openness to new programs, including the possibility of providing sanitary needles to intravenous drug users. A Dutch official reported that a free needle program in Amsterdam had cut the use of shared needles, a common means of transmitting the disease, from 75% to 25% of the addicts. The greatest potential source for the expansion of the AIDS pandemic in the United States is thought to be intravenous drug users.

Communication problems, particularly in reaching drug users, has handicapped the educational programs, Koop told reporters at the London conference. The absence of candor and specificity--particularly in dealing with risks related to sexual intercourse, both anal and vaginal--have handicapped educational efforts in the United States more than in most nations. Koop acknowledged moral differences as a factor. But the bigger barrier has been created by those who resist any sex education on the ground that it promotes what they judge to be illicit practices. In fact, research has shown that the contrary is true: Those well informed are more likely to behave responsibly.

The World Health Organization and the British government deserve global gratitude for sponsoring this meeting. The task now is to see that the message is not lost on the governments of the world. Failure has an uncommonly high price.

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