AIDS is here to stay

AIDS is here to stay World Health asked four senior figures in different fi,elds of health to answer two questions. Firstly, wHat are the prospects for the next ten years? And secondly, is there any issue to which more attention should be given, or which has been neglected? Or James W. Curran, Director, AIDS Program, Center for Infectious Diseases, Atlanta, Georgia, USA: 1. HIV infection and AIDS will continue to be a m~jor worldwide health problem for the next decade. There will be no change in the modes of transmission, so most HIV infections throughout the world will continue to be transmitted,.through sexual contact. 2. One issue that will need more attention during the next decade will be how best to implement and evaluate activities aimed at preventing sexual transmission of HIV in various societies. In additio'n, many developed nations will need to re- evaluate, overhaul and greatly expand their efforts to control intravenous drug abuse in order to prevent transmission through contaminated needles. Professor Lars Olof Kallings, Director-General of Sweden's National Bacteriological Laboratory: 1. Dealing with a pandemic of a retrovirus infection, 10 years is a short period of time. We must realise that we are only at the beginning of the pandemic and that it may take many decades and perhaps centuries before a steady state has been reached, that is, when th.ere is a balanced relation between HIV and the human population after mutual adaptation. HIV will stay forever with mankind and continue to pose a threat, particularly in endemic pockets. So we have to aaapt our lives to the presence of HIV from both a personal and a societal viewpoint. The number of HIY-infected in the world today has been estimated at between five and ten million. On the current estimates, at least two million of these will probably develop AIDS within the next decade. Of the rest, most will show symptoms. There is hope that the problems of developing a vaccine will be solved during the next ten-year period, and that we will see new anti-viral drugs that will prolong the survival time and improve the quality of life for the HIV-infected. 2. Such large and difficult issues as changi rlg sexua l behaviour and controlling drug addiction are not being dealt with in a direct and purposeful way everywhere. Forcefulness should not be expressed in terms of legislation or mandatory testing, but in intense education with regard to preventing sexual transmission, anq crash programmes directed against drug addiction. Or C. Everett Koop, Surgeon-General of the United States : 1. I am certain that significant achievements will be accomplished in our efforts against AIDS, in finding an effective treatment and perhaps even a vaccine. Even if we find an effective vaccine, I am afraid that the impact of AIDS on the world's cultural, economic, and social fabric will last many years after the disease is no longer a public health threat. Before AIDS is fully checked, nations -especially developing nations-will lose large numbers of their most productive young adults in fields of important economic endeavour. We can only conjecture how many generations will pass before the void that their loss will create is filled . The expenses associated with caring for the sick, finding a cure, preventing the disease, will be astronomical. We estimate, in the United States, that the costs for treating AIDS by 1991 will have reached between 8 and 16 billion dollars a year. Even for a countrywith as many resources as the United States, this can have a serious effect on its economic fabric, and particularly the delivery of social services. In the developing countries the effect can be devastating. 2. I believe that creating a safe blood supply world-wide is a high priority area which we currently have the technology to accomplish . We in the United States would also like to see a more realistic approach by governments to AIDS as a public health problem, since there is still a strong tendency by many nations to deny the existence or the full extent of AIDS in their countries. The under-reporting of AIDS can only retard our progress in the fight against it. Professor Alain Pompidou, AIDS Counsellor for the French Ministry of Health: 1. In the next ten years, we shall have to devise ways of integrating sero-positive persons into social activities, while at the same time arranging long-term care for AIDS patients. Scientific advances may make it easier to arr.ive at a better prognosis for such patients, and there will also be better coordination of epidemiological data on a global scale. We shall certainly need to emphasise the use of condoms in people's sex life wherever there is risk of transmission. 2. More attention will have to be given to fertility problems, and to ensuring that sperm banks for artificial insemination are free from risk. As part of the search for a cure, scientists must look for ways of restoring immunity and promoting an immune response in sero-positive people and in AIDS patients. • WORLD HEALTH, March 1988 27