HIV Prevention is getting more emphasis:
AIDS Study Emphasizes Prevention
Worldwide
Researchers Estimate Effects of Past Programs,
Benefits of Future Ones in Developing Nations
By David Brown
Washington Post Staff Writer
Tuesday, November 4, 1997; Page A13
The Washington Post
About 2.3 billion people, roughly half the population of the
developing world, live in places where the AIDS epidemic has
barely begun and even mildly successful prevention programs
could have enormous benefits, according to a new study.
The 353-page World Bank study, released yesterday in
Washington after 18 months of preparation, attempts to
describe the effects AIDS already has had on the developing
world, and to predict what might happen under various future
scenarios. It also evaluates numerous countries' responses to
the epidemic and makes general policy recommendations.
One of the clearest lessons the authors of the report draw is
that AIDS prevention campaigns can have large benefits at any
stage of a country's epidemic -- provided the campaigns are
targeted at the right people. Early interventions also are far
more potent than late ones.
For example, statisticians and epidemiologists on the World
Bank's research team looked at what might happen to a
country where, three years after the arrival of the virus, 5
percent of the adult population is infected. If condoms are used
5 percent of the time by men, with commercial and casual sex
partners, prevalence of human immunodeficiency virus (HIV)
infection would top out at 30 percent 30 years into the
epidemic. However, if an AIDS prevention campaign
commenced after 15 years and successfully increased condom
use among the high-risk men to 20 percent of their sexual
encounters, the peak prevalence would be lowered to 22
percent of the population. Such a program started three years
into an epidemic would lower HIV prevalence further, to 20
percent, and by 30 years would have prevented more than
twice as many infections -- and three times as many deaths --
as the latest intervention.
In places where heterosexual transmission of HIV is common,
high-risk individuals such as truckers or military personnel often
are the bridges that carry infection into low-risk groups, where
prevention strategies are harder to implement and less
cost-effective. Furthermore, HIV is more easily passed when a
person's infection is relatively recent. That makes the early
years of a country's epidemic -- when most infections are new
-- the biologically "hottest" phase.
Such strategies are most needed now in China, India,
Bangladesh, Indonesia, Russia and the former Soviet republics,
according to the report.
The AIDS epidemic is nascent in all of China except Yunnan
Province, on the border with Burma, where male drug users
account for nearly 80 percent of all of China's cases of
infection. Central and eastern India also are relatively
untouched, but the disease is spreading rapidly from the
southern and western parts of that country. In the city of
Nikolayev, Ukraine, one-half of intravenous drug users recently
became infected over the course of 13 months. A tenfold
increase in the number of syphilis cases in that country between
1991 and 1995 is laying the groundwork for possible
heterosexual transmission of HIV, which is much more likely
when a person has concurrent venereal infections.
When it comes to the epidemic's demographic and economic
effect, the World Bank researchers found that things often are
not straightforward and intuitive.
For example, the predictions that AIDS would decimate
families in sub-Saharan Africa generally have not been borne
out. A survey done in Kagera, Tanzania, specifically for this
report found there was no change in household size in the two
years after a member died of AIDS. That is because, in nearly
all cases, new adults arrive to help the bereaved family cope.
Similarly, the loss of a parent did not have a profound effect on
either a child's nutrition or likelihood of going to school, in part
because the level of each was low even in intact families.
AIDS' effect on the economies of many African nations has
been even less noticeable, in large part because there is a
surplus of labor in most of Africa, and forces more powerful
than the epidemic are driving economic development.
At the same time, the epidemic's human toll cannot readily be
seen in measures of gross domestic product, the report says. In
just one dramatic measure of how the disease has touched
people, life expectancy in Ivory Coast, Zimbabwe and Burkina
Faso is now 10 years shorter than what it would have been if
the disease had never appeared.
"AIDS is reversing decades of progress in improving the quality
of life in developing countries," said Martha Ainsworth, an
economist and one of the two principal authors of the report.
A summary of the report can be obtained through the World
Bank's Internet site at
www.worldbank.org/html/extpb/confaids/htm. |
