From the DEC/JAN 2006 issue of Seed:
Courtesy of Ingo Gunther
In 1988, with few effective options to treat a disease that had appeared suddenly several years prior and was being transmitted with unanimously fatal results—a pandemic was clearly at hand—a group of health ministers met in London to discuss a coordinated response to AIDS. Among the determinations that January was that, in the words of the National AIDS Trust, “a united global effort was required to halt the spread of HIV and AIDS.”
Over the past two decades, Westerners’ perception of AIDS has shifted dramatically: What was once a terrifying plague transgressing all borders via difficult-to-regulate means of transmission has become a treatable (albeit still chronic) disease for the planet’s wealthy nations. But the goal set out in January 1988 is no closer to being met. AIDS ravages entire populations in Africa and is increasingly prevalent in other poor corners of the earth as well. So while fears in the West have calmed, AIDS continues to ravage much of the developing world.
Globally, AIDS is a fact of life so pervasive that the extent of its devastation is difficult to conceive. Last year, despite $6.1 billion spent combating the disease, three million people died and nearly five million people were newly infected. An estimated 40 million people worldwide now carry HIV. An entire generation of orphans is being brought up in central Africa; visitors to the region report being unable to meet anyone there who doesn’t have a friend or family member either infected or already dead. And in West Africa, where rates of infection are highest, abstinence-based programs have limited the availability of condoms to those most at risk. Prevalence rates are also increasing in Central Asia, where injected drug use has fed a rapid spread of the disease.
There has been some encouraging news: A recent study in South Africa confirmed long-held theories that circumcision dramatically reduces HIV infection rates in men, and efforts are underway to destigmatize the practice and provide the procedure to the poor. While death rates are still climbing in AIDS-ravaged sub-Saharan Africa, antiretroviral drugs are gradually becoming more widely available; in Uganda, a massive public awareness campaign has cut that country’s prevalence rate by two thirds; and recent research suggests that HIV may be gradually weakening as it travels from host to host.
But the holy grail of the fight against AIDS, the much anticipated HIV vaccine, remains far out of reach. Though lacking the optimism which signs of progress on that front might bring, the West is relatively flush in increasingly effective drugs, instilling a sense of complacency that seems to be spreading as quickly as the virus did back in the Eighties. Recent surveys have shown that among gay men in the U.S.—the first group decimated by the disease—unprotected sex (especially concurrent with methamphetamine use, which increases vulnerability to the virus as it diminishes inhibitions) is on the rise.
Along with a reduction in fear, however, more progressive approaches to dealing with the disease have emerged. In 1987, concern that positives would prompt panic and suicide prevented an at-home HIV test from gaining FDA approval, but in October the agency announced it would consider approval of a similar test.
As frustrating as complacency about AIDS may be, less fear and better monitoring and treatment are luxuries we did not have on the occasion of the first World AIDS Day in 1988. To have shed the panic is progress, but the urgency remains.
