While education can help change behaviors to prevent the spread of HIV, the virus that causes AIDS, fundamental social change is needed for global AIDS control efforts to succeed, says a scientist from the National Institute of Allergy and Infectious Diseases (NIAID).
To manage the AIDS epidemic, countries need to not only promote change of people's behaviors, but also must address the related problems of increasing landlessness, mounting unemployment, accelerated urbanization, prostitution, rapid decline in health services and drug abuse," says Thomas C. Quinn, M.D., senior investigator in the NIAID Laboratory of Immunoregulation.
Dr. Quinn, also on the faculty of Johns Hopkins University, plans to discuss the global spread of HIV and AIDS on Feb. 21 at the annual meeting of the American Association for the Advancement of Science in Atlanta, Ga.
The early phases of the HIV pandemic can be traced, in part, to people moving to and from rural and urban centers, Dr. Quinn explains. People also migrated internationally because of civil wars, tourism, business and illegal drug trade.
For example, in sub-Saharan Africa between 1960 and 1980, the number of cities larger than 500,000 people increased more than 90 percent from 3 to 38, and more than 75 military coups occurred in 30 countries. Such changes in populations, economies and social structure disrupted rural families and cultural values ignited an epidemic of sexually transmitted diseases including HIV, Dr. Quinn says.
The migration of poor, rural and sexually active individuals to urban centers coupled with large international movements of HIV- infected people plays a prominent role in the global spread of HIV," says Dr. Quinn.
In the 1980s, the AIDS epidemic centered in Africa, but the epidemic of the 1990s will focus on Southeast Asia, says Dr. Quinn. The majority of AIDS cases still occur in Africa, stemming from HIV infections during the last decade, but the most rapid spread of HIV is in Southeast Asia.
While reported AIDS cases in Africa total 348,000, WHO projects more than 4 million Africans have AIDS and more than 11 million are HIV-infected. In Southeast Asia, the estimated annual number of new AIDS cases for 1994--more than 200,000--was more than eight times the number in 1993. HIV infections for the area now total more than 2.5 million, WHO estimates.
HIV arrived relatively late in Asian countries. Though the first cases were recognized in 1985, the epidemic did not occur until 1988 to 1990. In Thailand, for example, WHO lists just 13,246 AIDS cases in late 1994, but the organization predicts the country's HIV infections could total more than 4 million by 2000. In Thailand, the virus has spread among injection drugs users (IDUs) and commercial sex workers, and subsequently to their male clients and then to wives and girlfriends in the general population. Of note, molecular studies of HIV in Thailand revealed that more than 70 percent of the infected IDUs have HIV subtype B, which is identical to the predominant subtype in the United States, illustrating the linkage between the two countries' epidemics.
India, the most densely populated country in Asia, has seen similar increases. Less than 1,000 new AIDS cases were reported to WHO in 1994, but the organization estimates that more than 1.6 million Indians have HIV. As in Thailand, prostitution, drug abuse, commercialized blood donation centers and the low social status of women have contributed to rapid spread of HIV in India. Another part of the HIV problem in India is the reluctance of health care workers to discuss sexual activities and HIV, but many physicians treat the illnesses of their HIV-infected patients without ever mentioning AIDS, Dr. Quinn says.
Worldwide, some 18 million adults and 1.5 million children are HIV-infected, WHO estimates. As of Dec. 31, 1994, WHO had received reports from 192 countries of 1.03 million AIDS cases, a 20 percent increase from 1993.
Dr. Quinn is professor of medicine at the Johns Hopkins School of Medicine and of international health at the Johns Hopkins School of Public Health. NIAID, a component of the National Institutes of Health (NIH), supports investigators and scientific studies at universities, medical schools, hospitals and research institutions in the United States and abroad aimed at preventing, diagnosing and treating such illnesses as AIDS, tuberculosis and asthma as well as allergies. NIH is an agency of the U.S. Public Health Service, part of the U.S. Department of Health and Human Services.