Important note: Information in this article was accurate in 1997. The state of the art may have changed since the publication date.
Newsday - November 4, 1997
Laurie Garrett - Staff Correspondent
While noting that the human immunodeficiency virus is already widespread in 21 nations, the report pinpoints Russia, Ukraine, Belarus, China and "most of Latin America" as areas where "concentrated epidemics" are erupting at an unusually rapid pace.
But it suggests that because these "concentrated epidemics" initially involve very specific at-risk groups - such as drug abusers - the governments in these areas haven't felt the need to budget adequate funds for outreach programs such as needle exchange efforts, or to seek help from other governments and outside agencies if they don't have the money.
"It is a fundamental responsibility of government to ensure that HIV is prevented among people with the riskiest behavior," said Mead Over, a spokesman for the World Bank. "This will prevent the largest number of infections among all people - even among people who do not take risks."
"In every country that now has a serious epidemic, people said, `It can't happen here.' They were wrong," Martha Ainsworth, the report's co-author, said. "By the time that many AIDS cases are observed, it is too late to avert a serious epidemic; HIV will already have spread widely."
World Bank President James Wolfensohn, speaking at the University of California at Berkeley, said the epidemic is "perhaps the single most visible example" of how wealthier countries can guarantee themselves "a payoff in terms of health investment" in the future by helping poorer countries pay for anti-HIV programs.
As such, he said, the U.S. Congress and the leadership of other wealthy nations ought to be acutely interested in the new HIV hot spots pinpointed in the report. "In the case of Odessa [Ukraine], I think we are actually making some progress" in this direction, he said.
While he wouldn't detail what the progress was, he suggested it would probably be made public soon. "Stay tuned," he said. "I think there's going to be some announcements [about new efforts in Ukraine] in coming months.'"
In Odessa and other parts of Eastern Europe, the primary vehicle of HIV spread is needles shared among drug users. Prostitution, and therefore heterosexual transmission, is the second most common source of spread.
One solution to spread of HIV through these communities, according to the report, is a strong system to distribute sterile syringes. Many government officials in Eastern Europe say such a step supports a habit they feel would best be quickly eliminated.
But Joseph Stiglitz, a senior vice president of the World Bank, argued in an introduction to the report that "governments must make clear that the best way to protect everyone from HIV is to help people who engage in the riskiest behavior to avoid infection."
The 327-page report differs from many other studies analyzing the epidemic by focusing on how government decision-makers should allocate resources to combat AIDS. It said 23 million people are infected with HIV, with 8,500 new cases each day.
Among countries in the early stages of the epidemic are Bangladesh, the Philippines, most countries of the former Soviet Union, much of Eastern Europe and parts of China and India, the report said.
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