AIDS at 20: The Plague That's Killed 22 Million Isn't Done with Us Yet. While We Hunt for a Vaccine, People Continue to Die-From AIDS or the Drugs Intended to Treat It

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405,584

The number of all blacks and Hispanics in the United States infected with HIV in 1999, according to the Centers for Disease Control in Atlanta. In 1985 that number was 3,078.

On June 5, 1981, the federal Centers for Disease Control issued its weekly newsletter on outbreaks of illness and unusual deaths in the United States. Two tourists returning from the French West Indies had come down with dengue fever, reported one story. An additional 6,707 children were diagnosed with lead poisoning. And in a 553-word article, doctors reported that a rare parasitic lung infection, Pneumocystis carinii pneumonia, had shown up in Los Angeles. It had struck "5 young men, all active homosexuals." Three out of three tested had an inexplicable depression of their immune function.

And so it began.

How do you mark 20 years of AIDS? With mourning, surely, for the 22 million lives from San Francisco to Nairobi that acquired immune deficiency syndrome has stolen: Ryan White, Rock Hudson, Arthur Ashe, Alvin Ailey, Rudolf Nureyev, Randy Shilts, Elizabeth Glaser, Keith Haring, Liberace and all the emaciated, sunken-eyed nameless victims. And you mark it, too, with horror that last year 5.3 million people worldwide--14,500 a day--were newly infected. In the developed world, you probably also mark 20 years of AIDS with a sense of hope that the carnage of the early plague years may be behind us, thanks to drugs that have turned AIDS into a chronic disease that you live with rather than die of, at least for a while: after all, advertisements for the medications show young, buff HIV-positive men climbing mountains. And maybe you also commemorate June 5 with a trace of smugness. We closed bathhouses, sent every U.S. household a pamphlet called "Understanding AIDS" and preached safe sex, with the result that, in the United States, new HIV infections peaked at 150,000 a year in the mid-1980s and then plunged to 40,000 in every year of the 1990s. When 1997 brought the first report of a decline in AIDS deaths in America... well, we thought the worst was over.

We had no idea. Throughout the world 36 million people--more than the population of Australia--are HIV-positive, including 800,000 to 900,000 in the United States (of whom an estimated 300,000 don't know it). AIDS is now the fourth leading cause of death globally, and the leading cause of death in Africa. There it has stolen a generation and imperiled the future: it robs economies of their workers, families of their support and children of their parents. In seven African countries, more than 20 percent of the 15- to 49-year-old population is infected with HIV: 20 percent in South Africa, and a mind-numbing 36 percent in Botswana. Zambia cannot train teachers fast enough to replace those killed by AIDS. Within 10 years, there will be 40 million AIDS orphans in Africa.

Asia remains comparatively untouched. Only Cambodia, Thailand and Burma have infection rates above 1 percent. But the pandemic may be like a typhoon gathering strength off an unsuspecting coast. India's HIV rate of "only" 0.7 percent translates to 3.7 million infectious people. China predicts 5 million to 6 million HIV-positives by 2005. "With the current resources," says Dr. Peter Piot of UNAIDS, "it is not going to be possible to contain this epidemic."

Drugs won't do it. At upwards of $15,000 a year, the regimen that has helped thousands of HIV-positive people in the United States and Europe is out of reach for most Africans and Asians. Even international pressure to make the meds available at cost is only a first step: without a public-health infrastructure, poor countries can't distribute the drugs and track the patients. But even in the United States, "drugs cannot be seen as the ultimate solution," says Dr. Michael Merson, director of the Center for Interdisciplinary Research on AIDS at Yale University. Already the meds are being foiled by HIV's quick-change artistry. …