Coming to Terms with the AIDS Pandemic
Tarantola, Daniel, Mann, Jonathan, Issues in Science and Technology
Faltering national and international programs must be reinforced to meet the growing crisis.
More than a decade after acquired immune deficiency syndrome (AIDS) was recognized, the world has become ever more vulnerable to the pandemic. Effective programs have been developed to prevent human immunodeficiency virus (HIV) infection and to mitigate the effects of HIV/AIDS on people and communities. Indeed, the world has the knowledge needed to bring AIDS under control. Yet, while the pandemic pursues its inexorable course, the global response to it has weakened and become fragmented.
There is a growing gap between the quickening pace of the pandemic and our faltering efforts to contain it. As increasing numbers of people are directly or indirectly affected, demands for prevention and care increase. Meanwhile, there is a growing lack of coordination among national and international AIDS programs. International resource mobilization has stagnated or even declined, and health programs are under strong pressure to treat AIDS as if it were just another disease.
AIDS is not just another disease. The scope of the pandemic, its extraordinary mortality rate, its interaction with other infectious diseases, and most of all the fact that it primarily strikes adults in their most productive years make it a uniquely devastating medical and social phenomenon. As some effective, community-based AIDS programs have demonstrated, our ability to come to terms with the disease demands a broad vision of the social factors that make people vulnerable to HIV infection and a systematic implementation of techniques to reduce that vulnerability. At the global level, however, the inadequacy and fragmentation of national and international programs means that we are not keeping pace with the progress of the disease.
In its second decade, the HIV/AIDS pandemic continues to expand relentlessly. In 1981, when AIDS was discovered, an estimated 100,000 people worldwide were infected with HIV. By early 1992, an estimated 12.9 million people around the world--7.1 million men, 4.7 million women, and 1.1 million children--had been infected with HIV. Of these, about one-fifth (2.6 million) developed AIDS, and nearly all of them (2.5 million) have died.
Today, the pandemic continues to reach new communities throughout the world. An explosion of HIV has occurred in Thailand, Burma, and India, where more than 2 million people have been infected in just the past few years. Cases of HIV/AIDS are now reported from areas that had previously been relatively untouched, such as Paraguay, Greenland, and the Pacific island nations of Fiji, Papua New Guinea, and Samoa. The global implications are clear: Geographic boundaries cannot protect against HIV.
The pandemic is also becoming more complex as it matures. It is composed of thousands of separate, yet linked, community epidemics. Every large metropolitan area affected by AIDS--Miami, New York, Bangkok, London, Amsterdam, Sydney, Rio de Janeiro--now contains several subepidemics of HIV going on at the same time. This reflects emerging trends in patterns of transmission. In Brazil, the proportion of HIV infections linked with intravenous (IV) drug use has increased more than 10-fold since the early 1980s; in the Caribbean, heterosexual transmission has replaced homosexual transmission as the major mode of HIV spread. Thus the populations most affected by the epidemic also change over time.
Although some communities have succeeded in slowing the transmission of HIV, its spread has not been stopped in any community or country in the world. On the contrary, the pandemic has not yet reached its peak in any country. From 1992 to 1995, the total number of HIV-infected adults will increase by 50 percent. During the same period, the number of children infected with HIV will more than double, from 1.1 million to an estimated 2.3 million. The number of children orphaned by AIDS will more than double in the next three years. …