WHO predicts dramatic rise in global AIDS toll.

WHO predicts dramatic rise in global AIDS toll

An estimated 8 to 10 million people globally will contract the human immuno-deficiency virus (HIV) that causes the acquired immuno-deficiency syndrome (AIDS) in the next 10 years, a new study by the World Health Organization (WHO) predicts. That figure marks a significant and alarming rise of 2 million more people than WHO's projections last year.

Equally dramatic are statistics showing that HIV is spreading fast among women and children in sub-Saharan Africa and Asia. An estimated 3 million women will develop AIDS in the 1990s and at least 80 per cent are in sub-Saharan Africa, WHO suggested. By the end of 1992, there will be 1 million HIV-infected children born to these women. AIDS will become the leading cause of death of women aged 20 to 40 in some cities of central Africa.

"It's obvious that HIV infection is continuing to spread very rapidly in parts of the world like central Africa, where AIDS is having a devastating impact on individual countries", said Dr. Michael H. Merson, Director of WHO's Global Programme on AIDS (GPA), in a recent interview.

"It's also frightening to see the jump in HIV infection elsewhere, such as among certain groups in Thailand and India", added Dr. Merson. "There, even though the actual AIDS cases are low, HIV is clearly beginning to make its mark, and that means it is already a serious problem."

The WHO study, published in the 28 July edition of The Lancet, a leading medical journal issued in London, highlights the shifting pattern of HIV transmission in the world. During the first years of the HIV/AIDS pandemic, infection occurred primarily among homosexual men, intravenous drug users and hemophiliacs in North America, Western Europe and Oceania.

Since the mid-1980s, however, the virus began to spread rapidly among heterosexually active groups in sub-Saharan Africa, parts of the Caribbean and Latin America. The latest WHO data show that Asia can be added to the list, with an HIV seroprevalence rate of 50 per cent among female prostitutes in Thailand and India.

WHO's earlier estimates put the number of women and children with AIDS at 500,00 cumulative cases during the 1980s, with some 2 million women and children with HIV. Those figures are now viewed as too low. Using more precise evaluation methods, current WHO estimates suggest that 3 million women of childbearing age will develop AIDS in the 1990s.

Recent surveys by the agency also suggest that 10 to 20 per cent of pregnant women in several central African cities are infected sith HIV, which means that HIV infection may jump sharply among children born in these areas in the next few years. The report predicted that "life expectancy at birth in many sub-Saharan cities may fall be about six years. Infant and child mortality could be as much as 30 per cent greater than would otherwise have been expected."

More disturbing yet is that these figures are considered conservative by AIDS-surveillance experts. "These are crude estimates at best", said Dr. James Chin, head of the GPA forecasting unit. "If anything, we're probably underestimating the numbers Most experts in the AIDS area feel they are all conservatively low."

In a telephone interview, Dr. Chin, in explaining the unexpected sharp rise in WHO's analysis of the global AIDS toll, said that a new database on HIV and additional serologic surveys had provided material on which to base the new projections.

"The new study is based on data we've been collecting since 1987", Dr. Chin said. "In 1987, if you look at the estimates of seroprevalence, the data was very limited. So we started pulling the data together from 1987, 1988 and 1989, and it forced us to revise." Dr. Chin acknowledged that the new WHO data could be interpreted "either as a marked increase or an underestimation of the problem earlier, during that 1987-1988 period".

Echoing Dr. Merson, he added: "It is quite clear that all the trends are markedly upward." Despite an apparent "levelling off" of HIV infection among some groups, such as white homosexual men in the United States, the virus was raging almost wildly among others.

"It's true that we have seen some levelling off in certain places, for example in Kinshasa, Zaire, where 6 to 8 per cent of pregnant women women are infected with HIV", Dr. Chin said. "That situation seems to be stabilizing" but, he cautioned, "in other areas, we're seeing 20 to 30 per cent of adults who are HIV infected. Nor do we know if the changes in Kinshasa are due to behavioural changes or education, or, to be frank, if the virus has somehow run its course in that population."

The WHO analyst added that, barring any unforeseen changes or cure, his projection of the grim picture for AIDS was accurate. Regarding hardest-hit Africa, he added: "I don't see levelling off in sub-Saharan Africa for one or two decades." He noted that HIV was only now spreading to the rural areas of Africa.

Experts working in the field of AIDS have noted that one of the greatest obstacles to prevention is the general lack of basic health care in the developing world, as well as among the poor in urban cities of Western Europe and the United States. For example, Dr. Patricia Klozer, a leading AIDS researcher studying the impact of the disease on women, recently stated that based on current epidemiological data on AIDS cases among women in New Jersey in the United States, a poor, black woman living there has the same chance of contracting HIV as a woman living in Cote d'Ivoire.

In Zaire and Tanzania, a lack of resources and medicine compounds the gravity of AIDS. As Dr. Merson noted: "In many of these countries, the health budget calls for one dollar to be spent per person per year--total. There isn't any money to buy medicine, even if the supply of medicine existed."

He said the agency's AIDS programme was therefore focused more on prevention than treatment, although WHO was working closely with government health ministries to promote studies on promising agents and therapies to fight AIDS.

"We provide material to national AIDS programmes, and make available what we can", Dr. Merson explained. "But, from the standpoint of a public health issue, the AIDS problem in Africa is so complex you have to keep your top priority on prevention, while still trying to give quality care."

Dr. Merson also noted that the AIDS profile was different in Africa than in Asia. "In Asia, we have the chance to try to prevent infection and link our effort to other sexually-transmitted diseases." He said that in Africa, where HIV was ravaging entire populations, "the emphasis is necessarily going to have to be on basic care and social issues. With all the orphaned children that are going to be left on their own, we have to face who is going to provide for their care, their school fees, etc. We have to help the families and the communities."

The most common national AIDS education programmes developed for Africa and Asia stress condom use among sexually active heterosexuals. But again, lack of resources has also limited the success of the battle against the spread of HIV.

So has, what Dr. Merson termed, "a kind of denial" of the threat AIDS poses on government leaders. As he explained, lack of resources is often set in opposition to a relatively low incidence of AIDS cases on the national agenda.

"In some countries, there is still a need for them to appreciate what might be coming. One of the problems we face is the long period of infection. In India, for example, they may not see AIDS as a priority, because they don't have cases yet. But we know from experience what to expect. It's a matter of saying to them, 'well, if you don't deal with this now, you're going to pay the price later'. These are very difficult issues."

Without a cure for AIDS in sight, the only approved treatments are the drugs Azidothymodine (AZT) for HIV and standard sulfa drugs for Pneumocystis Carinii pneumonia. Unfortunately, access to these medications is severely limited for people with AIDS in Africa and Asia. Even in the United States and Western Europe, AZT is a very expensive option.

Given the clear and chilling global picture for AIDS, Dr. Merson said his agency is working closely to promote better use and distribution of sulfa drugs in the developing world. WHO is also financing drug development studies for promising agents in these countries.

"It's important not to lose sight. There are certain things we can do", said Dr. Merson. "If we just focused on tuberculosis, which is what is killing most Africans with AIDS, we would already be making an important step. We have to be realistic and work with the resources we have."

A top priority for WHO will be to advocate global unity to fight AIDS. Dr. Merson said he hoped to persuade international leaders of the pharmaceutical industry to lower the cost of drugs like AZT and work together with national governments to supply and distribute medicines in the developing world.