Mixed Global Progress Against AIDS

The disease known as AIDS continues to spread rapidly in much of the world. But it is declining significantly in places where AIDS awareness is high, causing people to change the behaviors that put them at risk.

As the United Nations observes the 10th annual World AIDS Day today, those countries where AIDS awareness programs are implemented and backed by government clout - including most rich and some poor countries - have made progress against the disease.

In the United States, the largest drop in AIDS (acquired immune deficiency syndrome) cases has been among homosexual men, "the very group which sought and benefited from the most open exchange of information about the risks of unprotected sex in the early years of the epidemic," said Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS (UNAIDS), at a press conference in Paris last week.

But the AIDS epidemic remains a massive and growing imposition on the lives of people in the developing world, where a UN report released last week estimates that 90 percent of the people with HIV or AIDS live.

The spread of AIDS in countries such Brazil, Zimbabwe, and Thailand is reversing progress in quality of life, says a new World Bank study, independent of the UN report.

The UN report estimates that globally:

* Of an estimated 30.6 million people living with HIV/AIDS today, two-thirds live in Sub-Saharan Africa.

* Sexually active adults are the most at risk, doctors say. An estimated 1 in 100 adults in the 15 to 49 age group have HIV. Even so, the UN estimates nearly 1.1 million children under the age of 15 are also living with AIDS.

* Some 16,000 people get the AIDS virus every day of the year, says the report. Only 1 in 10 are aware of their HIV status.

But experts also note vast differences in the way AIDS spreads in each region and nation.

In sub-Saharan Africa, the most common mode of transmission is heterosexual contact. The southern part of the continent continues to be the worst affected by HIV. In South Africa, for instance, 2.4 million citizens live with HIV, up by more than a third over 1996. In Zimbabwe, nearly 1 in 5 adults has the HIV virus.

But education programs that teach people to avoid intravenous drugs and sexual promiscuity appear to have a dramatic effect. Even in eastern Africa, site of one of the first AIDS outbreaks in the 1970s, Uganda has reported a decline in infection rates.

Uganda's example

The decline has been most marked among younger Ugandans, an indication that young people are adopting safer sexual behavior than was common a decade ago.

For its part, western Europe has become somewhat of a role model in the fight against AIDS. Doctors there expect to find 30 percent fewer new AIDS cases in 1997 than they did in 1995. (The United States also cited a 6 percent decline in new AIDS cases last year, and expects a similar decline this year.)

The forces behind this overall decline range from more aggressive medical treatments - fewer HIV cases are developing into AIDS - to simple changes in habits and hygiene, says Mr. Piot of UNAIDS. Promoting baby formula instead of breast-feeding, for example, has helped lower mother-to-child transmission of the disease, experts say. First-world wealth has helped as well.

"Things are looking better here because they're richer and they can afford the ... treatment," says Karin Blanc at the Geneva-based UNAIDS. Medical treatment can cost as much as $15,000 a year per patient.

But on the proactive side, education also plays a major role. The greatest decline in new AIDS cases has been among homosexual men, in whom HIV rates have been dropping for some years, and AIDS activists attribute that change in large part to greater awareness about prevention.

Concern in Russia

In contrast to the Western European model of control and swift action, Russia presents a case study of neglect. The number of HIV cases may be low now, around 3,000 this year, but experts say they will skyrocket unless public awareness programs are beefed up.

"The problem is with propaganda, with social aspects, with outreach work," says Dr. Alexander Goliusov, the Health Ministry's chief AIDS specialist.

In Russia's shaky transition to a market economy, drug abuse is soaring, and 76 percent of new HIV cases in Russia are being found among hard drug users. Within a couple of years, however, doctors expect sexual relations to be the leading source of AIDS.

But conservative attitudes both in government and in the powerful Russian Orthodox Church have kept sex education out of the school curriculum.

"The general philosophy on sex education is 'they'll learn on their own when it's necessary,' "says Brigg Reilley, an anti-AIDS activist with Doctors Without Borders. "Well, they're learning through sexually transmitted diseases."

In Asia, meanwhile, the kingdom of Thailand has become both a caution sign for its neighbors and a model of how to address the problem of AIDS. As many as 800,000 of Thailand's 60 million population are estimated to have HIV.

Driving this AIDS epidemic, experts say, is a cruel combination of increased mobility, ignorance, and traditionally casual attitudes toward sex.

"As people got richer in Asia they started moving more and there were more opportunities for casual sex," says a UN worker in Bangkok.

Some residents say that AIDS may force Thais to confront their sexual mores. "The social values of men are playing a part in promoting the spread of AIDS," notes Chanthana Kinkaew, a Bangkok resident. "It is still acceptable for Thai men to visit prostitutes after they are married."

Until these attitudes change, AIDS workers are turning to creative, if somewhat unorthodox, methods for promoting "safe sex." Thai AIDS activist Mechai Veravaidya, has tackled by enlisting the help of prostitutes in conducting surveys and promoting the use of condoms. He uses such slogans as: "Diamonds aren't a girl's best friend. Condoms are!"

Compared with its neighbors, Thailand's statistics may seem high. But the disparity may just be a sign that other countries are not yet addressing the problem.

Facing facts?

"Indonesia reported just 800 AIDS cases ... That's just not realistic," says a UN worker in Bangkok. The Burmese junta puts its AIDS tally at around 10; health organizations put the number at closer to half a million people.

Not everyone is turning to education or medicine. In Cambodia, for instance, a group of former Khmer Rouge women guerrillas, armed with AK-47s and machetes, recently forced the closure of a string of brothels in northwest Cambodia. Their purpose, they said, was to stop the spread of AIDS.

* Contributing to this report were staff writer Nicole Gaouette in Paris, and contributors Yvan Cohen in Bangkok , Kurt Shillinger in Johannesburg, and Ryan Hawkins in Moscow.

Estimates of HIV/AIDS Cases

Sub-Saharan Africa 20.8 million

South and South-East Asia 6.0 million

Latin America 1.3 million

North America 860,000

Western Europe 530,000

East Asia, Pacific 440,000

Caribbean 310,000

North Africa, Middle East 210,000

Eastern Europe, Central Asia 150,000

Australia, New Zealand 12,000

Source: Joint United Nations Program on HIV/AIDS