Aids: fighting the new black death

People are calling Aids a "pandemic" - prevalent over a whole country or the world. How you view it depends where you live, reports ARNOLD PICKMERE.

If you live in South Africa, you may by now be inured to the fact that graveyards in Johannesburg are running out of space because of the Aids epidemic.

Recently, population estimates for the country turned out to be about 300,000 people too high: the reason was sombrely obvious.

South Africa mining firms this year started testing workers anonymously for Aids. They suspect that as many as a quarter of the 500,000 in the industry could be living with the disease - a potential timebomb threatening their workforce.

New Zealand, on the other hand, had only 27 more people diagnosed with Aids last year, with 88 new cases testing positive for HIV.

And Americans with Aids are now often living four years rather than one, thanks to drug treatments.

But whatever impression you get from judging different regions, the overall picture is frightening.

What is the scale of the problem?

Speaking in the United States in late April (building up to a special session at United Nations headquarters on HIV-Aids on June 25) the UN Secretary-General, Kofi Annan, characterised it this way:

* Twenty years ago few of us had heard of Aids.

* Ten years ago few of us had any notion of the scale of the disaster.

* And even two years ago, most people in Western nations thought of Aids as a mainly domestic problem and believed they were getting it under control.

"The magnitude of the disaster is beginning to sink in. More than 36 million people around the world are now living with HIV-Aids," the Secretary-General said.

How fast is Aids spreading?

The United Nations expects about 5.3 million new cases of HIV infection this year, including 600,000 children under 15.

At present most cases of HIV-Aids (more than 25 million) are in Africa south of the Sahara. South Africa, according to recent reports, has about 4.7 million infected.

But Mr Annan says the pandemic is also spreading at an alarming rate in Asia and Eastern Europe.

There were about 250,000 new HIV infections in these areas last year, bringing the total to 700,000. The World Health Organisation says the epidemic hit after the fall of communism. In the industrialised countries of North America, Western Europe and the Pacific, the UN estimates 1.5 million will be living with HIV by the end of this year.

Worldwide last year, three million people died from the virus (the highest annual total yet) and five million more became infected - an average of 13,000 a day.

Who gets Aids?

Anyone, if they are not careful. In countries like New Zealand, with a low incidence of Aids, experts say heterosexuals often think of HIV-Aids as a homosexual problem, or something far away in Africa, unlikely to affect them.

But what is happening where the disease is prevalent?

In countries where the disease is far more evident, the extent of the problem is compelling more focus on basic causes.

Mr Annan says prevention can save millions of lives, and in several African countries has been shown to work. But people not yet infected must know what they need to do to prevent infection.

"That campaign must reach girls as well as boys. At present in sub-Saharan Africa, adolescent girls are six times more likely to be infected than boys.

"That is something that should make all us African men deeply ashamed and angry."

The cruellest infections are those passed from the mother to child.

Mr Annan says all mothers must be able to find out if they are HIV positive, and have access to short-term anti-retroviral therapy, shown to halve the risk of transmission.

Why would people be unwilling to take basic precautions?

As delegates from more than 100 countries prepared for the June 25 UN Aids summit last week, they could not agree on a draft declaration, including the key role of sex education.

As at a women's conference last June, a group of Islamic countries including Egypt, Libya, Sudan and Pakistan opposed language on sexual education for women, as well as widespread access to condoms for women as well as men.

Most objectionable to these countries were calls for participation by at-risk groups, such as homosexuals, prostitutes and prisoners.

For many other states, the important thing is to focus on protecting and promoting the health of the groups most vulnerable to HIV infection. That includes "children in especially difficult circumstances, men who have sex with men, sex workers and their clients, drug users and their sexual partners, persons confined in institutions and prisons, refugees, internally displaced persons and people separated from their families due to work or conflict."

How about a cure?

So far there is no vaccine. The search is heating up, but the solution may still be far away. And present drugs do not constitute a cure.

Among the challenges are that the HIV virus continually mutates and recombines, which suggests that a successful vaccine would have to protect a person against many strains. And there are other problems, including the way it can be transmitted as both a free virus and in infected cells.

Julian Meldrum, formerly special adviser on vaccines to Britain's National Aids Trust, wrote in the Observer last week that there was cautious optimism among researchers that a vaccine was achievable.

That is a striking turnaround from 1994, when the United States National Institutes of Health decided against launching a first full-scale HIV vaccine trial.

In 1996 an independent non-profit organisation, the International Aids Vaccine Initiative, was launched to promote research for globally accessible Aids vaccines.

It now has backing from big United States foundations and the federal Government, and the Governments of Britain, Canada, Ireland and the Netherlands.

Scientific cooperation agreements have been reached with the European Commission, and the Governments of India and China are about to follow.

In April, Mr Annan also met the leaders of six of the world's biggest pharmaceutical companies.

They accepted the need to combine incentives for research with access to medication for the poor and are ready to sell drugs to poor countries at greatly reduced prices.

How might an Aids vaccine work?

Britain's Mr Meldrum says an important development since 1994 has been a shift in emphasis from seeking a vaccine to prevent HIV infection.

The emphasis is now on developing one which will allow people to live longer, healthier lives with HIV and stop them from transmitting it to others.

Broadly, this means a shift from vaccines making antibody responses that stop viruses entering cells in favour of vaccines that make cellular immune responses that destroy virus-affected cells.

The Aids initiative body's first project supports researchers at Britain's Medical Research Council at Oxford University and the University of Nairobi. Some Kenyan prostitutes have exhibited a resistance to the HIV virus, which normally leads inevitably to Aids.

Mr Meldrum says the researchers' vaccine delivers a small and harmless part of the Kenyan HIV virus in two ways, hoping that a vaccinated person's immune system will recognise and destroy cells infected with the real thing.

Both vaccine components are being tested independently on a group of volunteers to confirm their safety. The crucial step will be to give both vaccines one after the other and measure the immune responses that follow.

What of the future?

There is far to go. Money is needed for education and awareness campaigns, for HIV tests, condoms, drugs, scientific research and better healthcare in countless countries. And to provide care for the millions of orphans who have lost parents because of Aids.

Mr Annan suggests a total cost of $US7 billion to $10 billion a year.

The UN Secretary-General also believes a "deep social revolution" is needed, giving more power to women and transforming relations at all levels of society between women and men.

"It is only when women can speak up, and have a full say in decisions affecting their lives, that they will be able to truly protect themselves - and their children - against HIV."