September 5, 2003

HIV/AIDS HORROR IS A SPREADING PLAGUE
By Dr. Saul B. Wilen

AIDS (acquired immunodeficiency syndrome) cases were first reported in the United States in 1981, and the human devastation in the 1980s was rampant. Revolutionary new medications have allowed Americans to become complacent about safe sex and a new generation of gay men have reached their 20s without the experience and direct memory of the graphic early AIDS consequences and death rate. This new generation has not benefited from early prevention strategies. Socioeconomic factors -- homophobia, high rate of poverty and unemployment, and lack of access to health care by racial/ethnic minorities -- create barriers to HIV testing, diagnosis and treatment. Increased risk taking has resumed. Many myths about safe sex have emerged among young heterosexual individuals that are used to justify unprotected sex practices.

The HIV (human immunodeficiency virus)/AIDS global pandemic is entering its third decade. The director general of the World Health Organization (WHO) in July 2003 stated, "We must scale up an integrated global HIV/AIDS strategy linking prevention, care and treatment, and prioritizing poor and underserved areas."

And the problem is right on our doorstep, as a study released late last month by the San Antonio Metropolitan Health District demonstrates. The report shows that the number of cases of HIV infections locally increased 31 percent in 2002. At the same time, cases of AIDS have dropped. This is attributed to new medications used to treat those infected with HIV. Local health officials emphasize that many adolescents and young adults do not practice safe sex, and that these young people believe that they are able to protect themselves from infection.

HIV is a retrovirus spread by human-to-human unprotected sexual contact (homosexual and heterosexual) and by unsafe medical practices -- including use of contaminated needles and blood products. The virus causes the destruction and/or functional impairment of the cells of the human immune system, progressively destroying the ability to fight infections and certain cancers. A combination of prevention measures are required to control all modes of HIV transmission, and safe-sex promotion must be the primary feature. The AIDS Epidemic Update through the end of 2002 showed 42 million peoples living world-wide with HIV/AIDS. Five million new infections with HIV occurred in 2002, with 3.1 million people dying of related causes.

In sub-Saharan Africa where the AIDS pandemic is concentrated, the country of South Africa has the largest number of HIV infected people in the world. Greater than 11 percent of the population is infected (about five million people). Of greater concern is that up to 25 percent of those ages 15 to 49 years are presently infected, creating a major threat to South Africa's national economy. The international and regional communities have pushed South Africa to institute programs to provide HIV medications that help extend life. The South African government has only recently agreed to institute such programs.

In North America, there are 980,000 people living with HIV/AIDS. New medication development in the mid-1990s, which is solely for treatment, helped to control AIDS, allowing HIV-infected people to live longer and reduced U.S. deaths from 51,000 in 1995 to about 15,000 in 2001. The development of a viable HIV/AIDS vaccine for prevention has been elusive for the past 10 to 12 years. New data released in late July 2003 indicate that AIDS diagnoses in the United States have increased for the first time in 10 years.

In late 2002, the United Nation's Joint Programme on HIV/AIDS (UNAIDS) and the National Intelligence Council of the CIA (Central Intelligence Agency) both projected marked increases in new cases of AIDS by 2010, expanding beyond sub-Saharan Africa. Nigeria, Ethiopia, Russia, India and China -- which account for 40 percent of the world's population -- are predicted to have a surge of 40 million to 65 million new HIV/AIDS cases. To date, the governments of these countries have not made AIDS a priority. The CIA's directorate has suggested that each of these countries could limit the impact of the epidemic with aggressive prevention strategies.

A study released in July 2003 by the World Bank states, "If AIDS were to continue unchecked, it could wreck a society in three generations." This report emphasized that the AIDS economic impact has been underestimated and that it could lead to an annual decline of 1 percent of gross domestic product in nations. AIDS, by killing young, potentially productive adults, sets in motion a three-generation cycle that can result in economic collapse.

"It weakens the mechanisms by which knowledge and abilities are transmitted from one generation to another," a study by the United Nations Economic and Social Commission concluded. "Globally, HIV/AIDS is estimated to reverse annual economic growth by as many as 2 percentage points in the worst-affected countries. As its prevalence increases in any given society, its effect on economic growth worsens."

The HIV/AIDS pandemic has already had a substantial impact on the economies of many nations. AIDS differs from most other diseases by occurring primarily in those in the most productive age groups and is generally 100 percent fatal. Major gaps exist in the tools needed to address and create HIV prevention and limit its transmission. New psychological motivations and behavioral interventions are required. Political, financial and social barriers have kept effective prevention and treatment strategies from reaching those at highest risk. Urgent priorities remain.

Expanding prevention programs that link to treatment and care, and reaching at-risk populations for early diagnosis and treatment are important steps in the process. Learning from HIV/AIDS experiences of the past two decades and establishing globally linked programs can still keep the pandemic from worsening.

Dr. Saul B. Wilen, M.D., is president and CEO of International Horizons Unlimited (www.intlhorizons.com; 210-692-1268) a national consultation and resources consortium based in San Antonio. Dr. Wilen has a background in medicine and education, and is a recognized authority in prevention strategies, problem solving, systems dynamics and informatics.