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Battling AIDS: Words Are the Main Weapons

February 07, 1988|Robert Steinbrook | Robert Steinbrook, a physician, is a Times medical writer

LONDON — Can an "information vaccine" slow the spread of the AIDS virus, until better medical measures are found to combat acquired immune deficiency syndrome?

The success of last month's summit on AIDS hinges on the ability of health ministers from the nearly 150 nations in attendance to dispense information on AIDS effectively. The summit and its "London Declaration on AIDS Prevention"--the most far-reaching international statement of its kind to date--are positive developments in the AIDS-control fight. But it may be impossible to know for several years whether the strategy will succeed.

The World Health Organization's global AIDS-control strategy, as unanimously endorsed at the summit, affirms that "AIDS is a global problem that poses a serious threat to humanity" and calls upon all nations to take "urgent action" to combat it. Each country is asked to develop educational programs that will motivate its citizens to minimize potential exposure to the sexually transmitted and blood-born AIDS virus.

In addition, the control strategy emphasizes social and health services to support the educational programs and the avoidance of discrimination. The caveat "to protect human rights and dignity" applies not only to people with AIDS and those infected with the AIDS virus, but also to uninfected members of population groups who are targeted for intensive educational campaigns, such as homosexual men, prostitutes and drug addicts.

"Unless you have all three elements, (AIDS control) is not going to make it," Dr. Jonathan Mann, director of WHO's Global Program on AIDS, said in an interview. But with those elements, he said, "then during 1988 we can begin to see a slowing of the spread of the virus. If that occurs, it is a new era."

Mann estimated that several hundred million people around the world are potentially vulnerable to AIDS virus infection; that number dwarfs the estimated 150,000 AIDS cases that have occured worldwide and the estimated 5 million to 10 million AIDS-virus-infected individuals.

Throughout the world, intravenous drug use is increasing, despite education and treatment programs. Sexually transmitted diseases are also notoriously difficult to control, even when good medications are combined with intensive education. Each year millions of people contract syphilis and gonorrhea, two easily curable and preventable sexual infections.

Finally, in most nations statistics on the number of AIDS-virus-infected individuals are imprecise. This makes it impossible to measure changes directly in the rate of spread of the virus, except as part of carefully conducted research studies.

Despite these gloomy facts, there were some positive reports on programs to reduce AIDS risk. From Amsterdam came word of a needle exchange program to supply free sterile needles to intravenous drug users. (New York City officials were recently given permission by the state health department to launch an experimental program to give clean needles to drug addicts.) The Amsterdam program has apparently helped to decrease the percentage of the city's 5,000 drug addicts who share needles from 75% in 1985 to 25% in 1987.

From Kenya there was news of an educational program for female prostitutes that has dramatically increased condom use by their clients. The result, a Kenyan report said, was a threefold reduction in the rate of AIDS virus infection among women insisting on condom use by their clients--a finding considered particularly impressive because condoms are rarely used as a method of contraception in Africa.

WHO's "information vaccine" strategy--as one official termed it--also reflects the pessimism expressed at the summit about progress toward a traditional medical vaccine against AIDS.

"We have no candidate vaccine that at this point is showing any promise as a vaccine for man," said Sir James Gowan of WHO's Global Program on AIDS. Gowan, the program's coordinator for vaccine development, cited the failure of all six experimental AIDS vaccines that have been tested in chimpanzees to offer any protection at all against the virus.

WHO officials are also pessimistic about the short-term prospects for AIDS drug development. The expensive drug AZT, or azidothymidine, prolongs the lives of some AIDS patients, but it has potent side-effects and so far much of the benefit appears to be limited to about a year.

For these reasons, WHO officials now feel that AIDS control is more a social and behavioral issue than a medical one.

Physicians and health ministers are not accustomed to taking a leadership role on information and communication issues. Nevertheless, a consensus emerged in London that health ministers, perhaps emboldened by a sense of common purpose, have little choice but to try. Their ability to keep AIDS in the eye of their public and political leaders and to mobilize resources may well play a large part in determining whether global AIDS control succeeds.

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