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AIDS Increases Among Addicts in Europe The number of European countries reporting the dreaded Acquired Immunodeficiency Syndrome (AIDS) increased from 16 to 27 in a year, figures at the end of September show. And cases rose from 1 ,573 to 3,127 "with a particularly strong increase in the proportion of intravenous drug addicts among cases reported" . Photo: WHO/E. Mandelmann Spread through blood: more drug addicts are AIDS victims. According to a wHo report, the number of drug addicts in- fected by contaminated blood through sharing the use of un- steri li sed needles intravenously has trebled. In Italy and Spain alone over 70 per cent of al l cases were reported from this risk group. The report also shows: • That over 90 per cent of vic- tims were males, 63 per cent between ages 20 and 39 years, • That of all victims 73 per cent were homosexuals or bisexuals, and that over 1 0 per cent were drug addicts, I Dawdling with AIDS I This is the headline of an editorial carried recently in the New York Times, charging that "very little is being done " to curb the AIDS epidemic in the United States. The paper underscores this point in a question-and-answer fashion : Question: "Why not teach prostitutes and their customers that. the use of condoms helps block the virus's transm iss ion?" Answer: "Because that would condone prostitution." Question: "Why not educate intravenous drug abusers about the risk, provide more drug treatment centres and supply clean needles in an effort to retard the vi ru s's transmission on dirty syringes?" Answer: "Because that would sanction drug-abuse." Question: "Why not tell (young children) how, if they must experiment (with drugs or sex), to avoid AIDS?" Answer: "Because many parents don't want their children educated in either subject." Even though the "possible socia l remedies to prevent AIDS offend, law, custom or morality," the Times urges an increase of fund s for information and education targeted at high-risk groups. "That is a lot more practical than waiting for a miracle from the research laboratories," it concludes . •••••• ••••••• ••• ••• ••• •••••• •••••• ••••• • ••••••••••• ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••••••• ••••••• ••• ••• ••• ••••••• • ••••••••••••••••••••••••••• ••• ••• ••• ••• ••• ••• ••• • •••••••••••••••••••• ••• ••• ••••••• ••• ••• ••• •••••• ••••••• ••• ••• ••• • •••••• ••• ••• ••••••• ••• ••• ••• ••••••• • •••••••••••••••••••••••••• ••• ••• ••••••• ••• ••• ••• •••••• • •••••••••••••••••••••••••• ••• ••• ••• ••• ••• ••• ••• ••• • ••••••••• 0 •••••• ••• ••• ••••••• ••••••••••• ••••••• ••• • •••••••••••••••••••• ••• ••• ••••••• ••••••••••• ••••••• ••• • ••••••••••••••••••• ••• ••• ••••••• •••••••••• •••••• ••• • ••••••••••••••••• • That the Federal Republic of Germany, France and Italy, "with an average of six to ele- ven new cases per week," were countries with the great- est increases, • That 1 , 1 03 AIDS patients have died so far. AIDS is spread by sexual con- tact. blood, and birth-in the last instance, the virus is passed from infected mothers to chil- dren before, during or after birth. As there is no treatment, nor a vaccine in sight against the disease, AIDS can only be prevented through dissemina- tion of information that is aimed particularly at high risk groups and at health officials. Here are guidelines published by WHO for preventing AIDS and infection with the virus (LAVI HTLV-111, now known as HIV): To prevent spread by sex: Do not have intercourse with mul- tiple partners, nor with those in high risk groups, notably homosexuals or the promiscu- ous. Do not engage in ana l inter- course. Use a condom. To prevent spread through blood, or blood products: Steril- ise needles and syringes each time before use ; this applies as well to all instruments that pierce the skin. Check blood donations for the AIDS virus. Treat blood products, such as those used by haemophiliacs, so as to destroy the virus . Take blood transfusions only when essential. To prevent spread from mother to child: Advise in- fected women of the risk of pregnancy. • No Lectures At Maastricht Medical School AIDS Transmission There are no courses nor lec- tures facing medical students at Limburg University in Maas- tricht, Hol land. Instead the phy- sicians-to-be face "problem solving" virtua lly from the first year of their studies - and a great number of tests. • Transmission through: - intimate sexual contact with an infected individual - infected blood and blood products - infected mother to chi ld - contaminated, unsterilised syringes and needles - donation of infected body organs, other tissues or sperm. • No documented transmission through : - casual/social contact - food or water - ai rborne or faecal/oral routes - blood-sucking insects. Part of WHO's information and education material. 30 The classical manner of teaching anatomy, biochemis- try, pharmacology, physiology and the like is described by Dean Jacobus Greep as a "spoon-fed system" that pro- duces the "inflexible super-pro- fessors, and their groups and their research ." As Limburg 's medical school is oriented towards primary health care needs of the com- munity, the focus in the class- rooms is on day-to-day medical complaints . Students are exposed to medical knowledge through a " matrix method ", through which professors from specific disciplines-at Limburg, the preferred term is "capacity group" - address specific clini- cal problems. A participating anatomist, for instance, doesn't lecture just for the sake of anatomy but to solve a problem. Professors of sociology, psy- chiatry and economics are nor- mally a part of the group, which also looks at problems in the broader context of the health system and of health policy. "Despite the chilly reaction of the medical establishment, the matrix concept is apparent ly spreading," says David Ehrlich, a science writer based in Gene- va, in reporting on the Limburg experiment. "Many students from other universities sit with the new breed for examinations - and are often out-scored." Schools like Limburg, in both developed and developing countries have set up a network to exchange knowledge and ex- periences in their search for a type of health worker respon- sive to community needs. • $128 Billion Programme for Africa Proposed The Special UN General As- sembly that recently supported the African-proposed, develop- ment programme for Africa was the first-ever session devoted to just one region, thus attest- ing to international recognition of the gravity of economic prob- lems affecting its people. During a week-long session, delegates endorsed a massive five-year US $128 bil lion pro- gramme to revitalise Africa's economy based on what has been referred to as "Western- inspired " economic reforms. "For the first time since the mid-1970s, the phrase 'New Economic Order' does not ap- pear in an important UN docu- ment," Eugene Forson, a Ghanaian journalist, wrote in the UN's Development Forum. The proposed UN Programme of Action for African Economic Recovery and Development is based on an earlier two-volume report, "African Priority Pro- gramme for Economic Recov- WoRLD HEALTH, November 1986 ery, 1986-1990," drawn up at a preparatory meeting, which ac- cording to its chairman, Edgard Pisani of France, was "not a pledging conference but rather a meeting to plan Africa's future economic direction, with Afri- cans and not donors playing the key roles." As a result African states committed themselves to meeting about 70 per cent of the total costs, and the Assem- bly, in its final report. "to mak- ing every effort to provide suffi- cient resources to support and supplement the African devel- opment effort" Firm financial pledges were neither expected nor made at that time by the traditional donor countries. The proposed programme is based essentially on measures to improve agriculture. for which African states earmarked Photo: W HO/FAO Women: 60 per cent of agricul- tural workforce. $57 billion, and to combat drought and desertification, $3.4 billion. But it also calls for an outlay of $7 billion for the training of personnel, and for the promo- tion of literacy and adult educa- tion. particularly for women who comprise about 60 per cent of the agricultural work force. And it stresses incentives. Addressing the delegates. President Abdou Diouf of Senegal, who is also chairman of the Organization of African Unity, said that the programme should reverse trends "that have led a large number of Afri- can countries to . . desperate emergency situations." In summary, one delegate called it :·a breath of pure oxygen for our exhausted economies." • WoRLD HEALTH , November 1986 Newsbriefs e Airport Control. A 400-metre zone free of disease-transmitting mosquitos should be established around airports, according to experts from 7 5 island nations and areas of the Pacific. Such a "vector control zone" would prevent .the spread of diseases by aircraft. In 7982, for instance, a dengue fever epidemic struck Honiara, in the Solomons, following the introduction of the Aedes albopictus vector by air. "There is concern that this species may continue to spread, " warns Or Hiroshi Nakajima, Director of WHO 's Regional Office for the Western Pacific. As more and more people travel for pleasure and business, so the risk increases of the malaria-carrying anopheline mosquito being introduced in non-malarious areas of the Pacific. • In Cote d'lvoire. Of all cases hospitalised on psychiatric grounds, a study in the Cote d '/voire shows, nine per cent stemmed from chronic alcoholism and seven per cent from the use of narcotics, thus demonstrating that behavioural problems commonly associated with industrialised countries are now a Third World problem too. The study is cited in an article released by WHO's Regional Office for Africa in Brazzavil/e, on the subject of this year's World Health Day theme: " Healthy Living: Everyone a Winner. " • Mothers, Children. Extracts from a WHO fact sheet on the health of mothers and children: - Each year an estimated 200,000 women die from illegal abor- tions. Yet family planning methods, generally not available to them, would have markedly reduced mortality. - In developed countries, 68 per cent of married women of reproductive age used contraceptives, according to estimates for 7 980-87; in developing countries only 38 per cent did so. The figure for Africa was even lower: 7 7 per cent. - A daily cigarette smoked by a pregnant mother can reduce by 17.7 grams the birthwe1ght of the child Weight under 2,500 grams (5 lb 8 oz) is a threat to the baby's life. - Most infants need nothing but breast milk for the first four to six months of life to ensure good health. • ORS: Just a Half of Needs. With production doubling between 1983 and 7985, Third World countries are producing about a half of all the oral rehydration salts now used in the fight against diarrhoea! diseases. But even though world-wide production reached 270 million packets in 7985, according to a recent issue of WHO's Essential Drugs Monitor, that is still less than half of total needs of developing countries. UNICEF is the major external supplier of ORS, providing 30 per cent of salts imported to developing countries. it supplied about 7 50 million packets to some 70 countries over the two years. Commercially produced salts accounted for 7 5 per cent of imports. - In a related development, Or Halfdan Mahler, WHO's Director- General, told participants at the 2nd International Conference on Oral Rehydration Therapy, held in Washington, D. C. that " the use of these salts has saved at least 200,000 lives this year". • People. Appointed as Director, WHO 's Division of Public Information and Education for Health, which now reports to the Director-General : Or Hakan Hellberg (Finland), formerly in charge of coordination of strategy to achieve the goal of " Health for All by the Year 2000. " He is now responsible for these units: health education, media, and programme support. - Retired.after 30 years of international work; Mr Jack CS. Ling (China) twice director of UN in formation services; since August 7 982, D1rector of WHO 's Division of Public Information and Education for Health, and before that, Director of UNICEF's Information Division, New York. He is now visiting professor of communication, University of Southwestern Louisiana, Lafayette. - Appointed as Director, Strategy Coordination of WHO's "Health For All" programme, Or Sumedha Khanna (India), formerly Associate Director. In the next issue Safe water is crucial for development The December issue of World Health exami nes the International Drinking Water Supply and Sanitation Decade, now at its half-way point, and the efforts being made to bring safe water to the whole world. Authors of the Month Dr George ANTAL as just retired as Chief of WHO's Programme of Sexu- ally Transmitted Diseases. Dr A. 0. OsoBA is Professor and Head of the Department of Medical Microbiology at the University Col- lege Hospital , Ibadan, Nigeria, and Dr B. 0. 0GUNBANJO is Senior Lec- turer and Consultant at the Depart- ment of Microbiology and Parasitol- ogy, University of Ilorin Teaching Hospital , Jlorin, Nigeria. Mrs Maggie JoNES was formerly a staff writer for People, the magazine of the International Planned Parent- hood Federation, and is still a regular contributor to that journal. Dr Jonathan MANN is Responsible Officer for WHO's Control Pro- gramme on AIDS. Dr Gavin HART is Director of Sexu- ally Transmitted Disease Services, the South Australian Health Com- mission, Public Health Service, in Adelaide. Dr Fernando ZACARIAS is Adviser on STD Control at WHO's Regional Office for the Americas, and is based at the Centers for Disease Control in Atlanta, USA. Dr Andre MEHEUS is Professor of Epidemiology and Medicine at the University of Antwerp in Belgium. Dr Herbert NSANZE is a WHO Consul- tant based in Fiji, where he is teach- ing microbiology at the University of Fiji. · Dr Georges CAUSSE has now retired from WHO where he was formerly in charge of the Programme of Bacte- rial and Venereal Infections. Dr Pal VERES is a Hungarian physi- cian and journalist. His regular col- umn on health and sex education is widely read by young people throughout Hungary. WORLD HEALTH For readers everywhere 1986 Subscription Rates One year · Two years Three years US$ Sw. fr. 12.50 25.- 22.50 45.- 30.- 60.- ORDER F=ORM Please enter my subscription to "World Health" as follows: One year 0 Two years 0 Three years 0 I enclose cheque/international postal order in the amount of: _ ___ _ Name: _ _____ ____ _ Street: __________ _ City: ________ __ _ Country: _________ _ World Health, WHO, Avenue Appia, 1211 Geneva 27, Switzerland World Health is also distributed through the network of international bookstores and sub- scription agencies. 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