Morality and education - these are the twin messages emerging from a rapid increase of campaigns in developing nations against the spread of AIDS. More than 40 developing nations, most within the past several months, have now turned to education to combat acquired immune deficiency syndrome. The campaigns use radio, television, leaflets, classroom discussions, and other methods to inform women, men, and children how to protect themselves from AIDS. There are indications in countries with the oldest educational campaigns that some sexual patterns are changing as a result of these efforts. But experts say the threat posed by AIDS requires even greater efforts to educate the public.
The educational programs in Africa and Latin America (Asia has few reported cases) come amid new reports of high levels of AIDS among some groups engaged in high-risk behavior in Africa. Unless the spread of AIDS is slowed or halted, some African nations could see a decline in skilled manpower, further impeding the continent's already languid development, according to some studies.
The rapid transition by many nations from ignorance of the issue, to denial of its existence, to realization of the extent of the threat, to action to combat it, is ``extremely encouraging,'' said Daniel Tarantola of the Geneva-based World Health Organization. He is helping developing nations map out educational efforts against AIDS.
But the message in such campaigns should not just be a list of ``don'ts,'' Dr. Tarantola said in a telephone interview. The message should be ``positive,'' such as: ``Have a wife, live with her.'' But so far, most campaigns have not included that emphasis, he noted.
``Church and ideas of social morality'' will play an increasingly important role in efforts to curb AIDS, said Renne Sabatier, a public-health specialist with Panos Institute, an international research organization in London. ``If the churches don't get behind the AIDS program, it won't work.''
In some places, churches are joining the fight. The Roman Catholic Church in the East African nation of Uganda is calling for marital fidelity as a way of preventing the spread of AIDS, according to a Ugandan health official.
At the same time, proponents of population control and forces working to prevent AIDS in the developing world are likely to begin working more closely together, promoting condoms as a way to fight AIDS, says Gwenn Crawley, a health specialist with the Presbyterian Church USA.
According to medical authorities, AIDS can be transmitted from an infected person to someone else by sexual intercourse between men and women; sexual activity between men; unsterilized needles used for medical injections or illicit drugs; transfusion of infected blood; and, in some instances, by a mother to her fetus. Medical tests to detect AIDS are available in Western nations and increasingly in parts of the developing world.
In Brazil, as well as other nations, prevention specialists are urging increased use of condoms to limit the spread of AIDS through homosexual activity, prostitution, and other sexual contact outside marriage.
Education programs are yielding results. Luis Ochero, head of AIDS-prevention efforts in Uganda, says that, since the campaign to educate people about prevention of AIDS began about a year ago, ``we are seeing some decline in sexual promiscuity,'' he says.
In Brazil, Lair Guerra de Macedo Rodr'iguez, the physician in charge of the campaign against AIDS, says there are informal indications of some reduction in male-female sexual relations outside marriage. Also, there appears to have been a reduction of sexual contacts between homosexual men and a much greater use of condoms during such contacts, he says.
Other developments in the growing battle against AIDS in developing nations include:
Disputed levels of AIDS in Africa. A report circulating within the United States Department of State, based on classified cables from some embassies in East and Central Africa, suggests that AIDS could have a major effect in those countries.
But WHO officials, althugh they say there has been a significant increase in AIDS in some African countries, dispute the sometimes devastating predictions made in the report. And one State Department official, when questioned about the report, described its statistics as ``extremely non-reliable'' and based on anecdotal sources.
Development affected. ``Instead of having skilled manpower going up, you're going to have an absolute decline of 2 to 10 percent,'' as a result of AIDS-related deaths in some developing countries, says Jon Tinker, president of Panos Institute, which issued one of the first reports on AIDS in the developing world.
Mr. Tinker estimates that in some African cities, among people in their most sexually active years, the AIDS infection rate has increased from 5 to 10 percent about a year ago to 10 to 20 percent today.
``Some researchers feel there is a positive correlation with higher incomes and [AIDS] infection,'' Tinker says. Wealthier people in the developing nations, these researchers believe, travel more and have more opportunities to engage in extramarital sex. But, he adds, these assumptions are, at least in part, based on ``gut feelings,'' and ``unscientific judgments.''
Poverty effects seen. Some researchers say poverty among African women drawn away from their families to cities for jobs leads some to prostitution, a high-risk activity with respect to AIDS. ``A lot of them [female prostitutes] are paying for schooling for their children. Their only other choice is to go back to the villages where life is pretty dire,'' says Ms. Sabatier.
Many married men in Africa have little choice but to pursue work as migrant laborers. They live in the cities and are often separated from their families.
Migration to the cities, famine, war, and economic turmoil in Africa have tended to ``break down traditional relationships,'' increasing the amount of sexual relations outside of marriage, Sabatier says.
Cultural attitudes noted. Use of condoms is not popular in Africa, according to AIDS-prevention specialists there. Nor was open discussion of sexual issues, but that appears to be changing as AIDS prevention becomes a more important issue.