How many people are affected? rich countries. In other words, the number of new infections each year is about the same as the number of deaths. The disease is not spreading faster and faster. But people are still catching it, and still dying. Europe has about 600,000 HIV+ residents.
In Africa, Asia and Latin America, the diseases is still spreading exponentially, thought the rate of growth varies enormously. Africa is the most severely affected region, and the AIDS debate is at the centre of public attention. In other regions of the third world, the catastrophe is still looming. Chinese authorities recently admitted having given contaminated blood products to the country's haemophiliacs. The People's Republic officially records only 150,000 HIV+ residents. The real figure is certainly higher.
No-one knows how fast HIV is spreading in the former Soviet Union. But the socioeconomic catastrophe there is creating all the preconditions for a massive growth in this kind of viruses. The number of recorded cases of syphilis in Russia has doubled every year since 1990. What now?
The big story in 1996 was the development of new treatments, and evidence of the beneficial effects of the combination of two or three anti-viral treatments. The results are spectacular. But much remains to be done: developing drugs which patients will be able to tolerate with less side-effects.
The development of a treatment which can stop the virus multiplying, (but not eradicate it) is certainly good news for the sufferer. And even better news for the pharmaceutical industry. An expensive drug that doesn't cure people, but stops them getting sicker, if they take it for the rest of their lives. Perfect!
With over 1.5 million deaths officially estimated in the last 12 months, AIDS is overtaking and interacting with other mass killers. In mid 1996 the United Nations (UNAIDS) estimated that 28 million people had contracted HIV infection world-wide, of whom 6 million had already died. 94% of people with HIV are in Third World countries. Of the 22 million adults with HIV, 42% are women, a percentage that is steadily rising.
Although these global estimates are far more realistic than the official figures the World Health Organisation used to record, they are still probably underestimates. As access to health services in Sub-Saharan Africa and South East Asia deteriorates, more and more people become ill and die without treatment or diagnosis. Few countries can maintain comprehensive databases of HIV infection or AIDS mortality, and few can afford effective surveillance testing.
For political and economic reasons, many countries minimise the dimensions of their problem. Indonesia's official cumulative AIDS mortality is only 66. But researchers at the University of Indonesia recently published their estimate that the country suffers 30,000 unrecorded AIDS deaths every year.
Life expectancy in several countries with well established epidemics has already begun to fall. Life expectancy in Sub-Saharan Africa will decrease from 62 to 47 years by the end of the century.
women is expected to fall from 58 years to 30-35 years by the year 2000.
The interaction of HIV infection with tuberculosis (TB) has emerged as a dangerous and key trend in the second decade of the epidemic. TB itself is easily transmissible, particularly to nonHIV positive children and grandparents in the domestic environment. TB can reactivate quite soon after HIV has started to impact on the immune system. The underlying HIV infections often remains undiagnosed in overworked TB wards and clinics. For example, while Cambodia reports only 235 AIDS cases so far, foreign and local TB specialists maintain that the overwhelming majority of the 13,000 adult TB deaths in the last year have been in people with HIV.
Resources for HIV testing in the Third World have been deployed with little regard as to how testing will benefit affected communities and individuals Much testing takes place through delinked surveys, where pregnant women, blood donors or soldiers are tested often without explanation, and without individuals being told results or offered support. The effect of knowing, as did the pre-massacre Rwandan army, that over 60% of the group will develop a fatal illness, can be disastrous. In some countries, such as Cambodia, those found positive even in individual diagnostic tests are not told, since it is considered socially wrong for a doctor to
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