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Responding to AIDS as a global emergency

THE United States has by far the largest national caseload of acquired immune deficiency syndrome (AIDS). Of about 60,000 AIDS cases reported to the World Health Organization (WHO), only 31 percent are from outside the US, and only 17 percent from the third world. But these figures are dangerously misleading. AIDS in parts of the Caribbean and Africa is in per capita terms 10 times as serious as in the US. It is time for its own tragic experience with AIDS to be translated into effective American leadership internationally. Global action is self-defense. Even if AIDS is brought under control at home, the US will be directly affected if cases are still developing abroad. The AIDS virus will respect neither the Rio Grande nor the immigration line at Dulles Airport.

In October, the US had reported 172 cases of AIDS per million people. Bermuda has reported 1,107 cases per million; French Guiana, 1,025 and the Bahamas, 536: three to six times the US level.

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Europe has caseloads one-quarter to one-tenth of the US level; Latin America's worst epidemics are slightly lower, and so far there are few cases in Asia and East Europe. But in central Africa, four countries report about 100 cases per million, and two more report about 50.

We know many third-world figures are substantially underreported because of political unwillingness, inadequate public-health systems, or doctors recording AIDS deaths as something else.

In the capitals of half a dozen central African countries, about 15 percent of sexually active age groups, men and women equally, are now carriers. That compares with 0.15 percent of all military volunteers in the US, and 2.9 percent of military volunteers in the New York region.

In one of these capitals, 10 AIDS patients a day are dying in hospitals: about 3,500 a year. Since half those diagnosed go home to die, and many more never enter a hospital, the real AIDS death rate is probably over 10,000 a year.

The US, with a population more than 10 times that of that African country, had 6,700 AIDS deaths last year. The African country has a death rate that in population terms is well over 10 times the US figure.

In the same African country, some major hospitals still lack household bleach to sterilize needles against the HIV (AIDS) virus.

The quilt laid on the Washington Mall during the recent march by homosexuals commemorated the tragedy of thousands of Americans killed by AIDS. Yet most of the people who are dying of this terrible disease are neither homosexual nor American. They are heterosexual men and women, and their children: Africans, Caribbeans, and Latin Americans. No one is making commemorative quilts for them.

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How is the US responding to AIDS as a global emergency? The US was one of the first to send special AIDS funds to WHO, and the Centers for Disease Control lent Dr. Jonathan Mann to head the WHO program on AIDS: In the past year he may have earned more goodwill than any other US citizen. Meanwhile, the US surgeon general's report is widely quoted abroad, and after a slow start, initiatives in the Congress and by the Agency for International Development should soon be translated into action.

But the administration is still six months or more behind some European governments in factoring AIDS into foreign assistance, and private relief, children's, and development agencies have barely begun to do this.

Some third-world governments are moving energetically to control AIDS. President Kaunda of Zambia, whose son died of AIDS, has given notable leadership; Rwanda has singled out truck drivers, since they are effective disseminators both of AIDS and of information; and Uganda uses the slogan ``Love Carefully.''

I believe the US has a special responsibility for global leadership on AIDS:

The US controls much of the world's research capacity on it. Is this being adequately harnessed to develop cheap and rugged test kits, vaccines, and therapies suitable for third-world use?

While it would be as wrong to blame the US for the AIDS pandemic as it would be to blame Haiti or Central Africa, there is no doubt that some Americans have unwittingly helped spread the HIV virus around the globe.

The US holds by far the largest share of humanity's experience in fighting AIDS, from the San Francisco Health Department to the New York-based Gay Men's Health Crisis.

Existing public-health machinery cannot handle AIDS. To cope at all, officials have had to support voluntary groups, most notably those formed by homosexual men, to provide hospices and home care, compassion and counseling, as well as sex education.

Such techniques cannot be blindly transferred to the third world, but they could be adapted. City authorities and gay organizations, preoccupied by their own tragedies, may not themselves be able to do this, but both the Agency for International Development and private agencies should be drawing on their know-how.

Until a vaccine is produced, the only effective weapons the medical community has against AIDS are screening blood and education.

The international family planning movement has built up substantial experience in culturally sensitive sex education. US-based groups play a leading role in this movement, but there are few signs yet that they are using their knowledge against AIDS.

The HIV virus respects no frontiers. Nor should the fight against it. The US needs to find more ways to share its experience and expertise.

Jon Tinker is president of the Panos Institute, an international institution based in Washington, London, and Paris. Panos is one of the main nonprofit organizations working on AIDS in the third world. This article is based on a speech he gave recently at the Overseas Development Council.

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