Containing A.I.D.S. — four steps

Press, 16 August 1985, Page 16

Containing A.I.D.S. — four steps

From ‘The Economist,’ London

A.I.D.S. will not be as lethal as the Black Death, which killed one European in three (and countless Asians) in the fourteenth century. Its virus is much harder to catch than the bacterium that caused plague. But A.I.D.S. makes up for not being particularly contagious with a terrifying persistence — once infected, always infectious — and a life cycle that is all but impregnable to modern medicine. Much of the medical profession has tried to avoid alarmism about A.I.D.S. Now that perhaps a million Americans and several million Africans are infected, even though only 12,000 Americans have yet been reported as having the actual disease, the time for understatement is past. Much of the conventional wisdom about A.I.D.S. is nonsense. It. is nonsense to say a cure is in sight. Some drugs, such as sura-

min, may postpone death, but neither a vaccine nor a cure looks remotely feasible for at least five years and probably longer. It is nonsense to say that only 10 per cent of those infected will die. All the evidence points to an eventual mortality that is much higher. The time it takes for the disease to result in death might average five years or even more; and A.I.D.S. was identified in America only six years ago. That A.I.D.S. is a sexually transmitted disease is the newest and wrongest assumption. A.I.D.S. is easily transmitted by some sexual practices, notably homosexuals’ anal intercourse, but is probably very difficult to pass on by normal heterosexual intercourse. It is frequently asserted that A.I.D.S. must be spread in Africa by heterosexual intercourse, since

it strikes men and women there in almost equal proportions. A much stronger hypothesis is that A.I.D.S. is transmitted in Africa largely by the reuse of innoculation needles.

A.I.D.S. is a blood-borne disease, probably transmitted only by mixing blood, in the same way as hepatitis B. It is passed on in four ways: blood transfusion with infected blood; intercourse during which blood mingles (i.e., anal); use of shared needles; and long-term physical contact with a victim so that eventually, somehow, there is blood-to-blood contact. The last explains why the families of victims sometimes go down with it. A.I.D.S. probably came from African monkeys. In most people it shows no symptoms for two to three years. Yet all are infectious from infection till death. It hides inside the body’s genes. It changes its spots too fast for the immune system (or a conventional vaccine) to catch up.

It destroys the immune system itself. Most horrifying of all, it eventually seems to invade the sanctuary of the brain where medicine dares not follow.

The only thing in medicine’s favour is that A.I.D.S. is hard to catch. Governments will have to attack through that chink in its armour.

First, make blood-banks safe by testing for the virus: though not perfect, the tests available will do. Second, mount a noisy campaign to tell people to avoid anal intercourse unless they are certain that their partner is entirely faithful. Third, make free diagnosis confidentially available on request. Fourth, make syringe needles so cheap and abundant that no drug addict need use one more than once.

A massive programme is needed to help Africa. A.I.D.S. is probably killing many more people there than is realised: most of them die

of tuberculosis, dysentery or malaria after the virus has poleaxed their immune systems. Somebody must try to stop disposable needles being reused. That means an international agency with the resources to see that every clinic and household in central Africa is visited.

For those already infected, the kindest thing the world can do is to redouble the effort going into research. Governments should prepare for the worst and spend accordingly. Copyright — The Economist.