San Francisco Chronicle - Saturday June 3, 1989
David Perlman, Chronicle Science Editor

Although the life spans of many AIDS-infected men and women are being lengthened dramatically - at least in those high-income countries where advanced medical care is available - the epidemic's death toll continues to rise unchecked. When President Kenneth Kaunda of Zambia opens this fifth annual AIDS conference in Montreal's huge convention center tomorrow, however, his keynote address will symbolize a major change in the global picture. That change is marked by a single word: prevention.

In country after country, the fact that science has yet to cure the disease or check its spread has stimulated growing campaigns to educate entire populations, both literate and illiterate.

AFRICA A CASE IN POINT

Africa is typical of a continent heavily afflicted by the epidemic yet poverty-stricken in terms of advanced medical care and rife with ignorance about prevention. Kaunda has charged that in the past, Africans stricken by AIDS have too often been looked upon by Western scientists either as potential recipients of untested drugs and vaccines or as subjects of research that has failed to relieve suffering.

Now, however, the Zambian president has indicated that he intends to call for global educational that candidly addresses the epidemic's most complex social issues, including modes of transmission through sexual contact, contamination of blood, problems of drug use, and lethal hazards to exposed women and their babies. "These are issues that should be discussed openly," Kaunda said recently, "and my contribution will be in that direction: discussing this issue as openly as we discuss malaria."

More than 800 of the delegates to the five-day conference have been invited to present major lectures on their specialties. Three thousand participants are already putting up large illustrated wall posters and charts in the convention center, designed to provoke discussion and to share ideas on a broad spectrum of AIDS issues in public health, epidemiology, research, therapy, economics, ethics and even politics.

Outside the conference, protest groups from the United States and Canada are preparing large-scale demonstrations and picket lines to object to what they perceive as a lethally slow pace of new drug development and approval, the inadequacy of resources to care for patients, and the inability of AIDS workers to focus effectively on minority groups. On Monday, for example, the militant New York branch of the national organization called ACT UP will be in the stands for the baseball game pitting the Montreal Expos against the St. Louis Cardinals. Fifty ACT UP members will spend their time passing out free condoms and distributing AIDS literature to the crowd. ACT UP is an acronym for "AIDS Coalition to Unleash Power."

FEW BREAKTHROUGHS IN SIGHT

Although nearly half the conference will deal with updated reports on new drug developments, advances in diagnostics and progress in attempts to find vaccines, organizers say that few breakthroughs are in sight. Most of the recent significant progress has come from basic research exploring the molecular structure of the AIDS virus and the mechanics of its invasion of the human body.

"Over the past year, there has been a real acceleration of fundamental science building blocks in our understanding of the way the virus works," said Dr. Anthony Fauci, director of America's National Institute of Allergy and Infectious Diseases in Bethesda, Md., and coordinator of AIDS clinical research in the United States. At least 40 reports will examine laboratory tests of new drugs aimed against AIDS, and as many as six vaccine research reports will be discussed, even though none is nearing approval.

For an epidemic whose existence was first reported by epidemiologists only seven years ago, the absence of breakthroughs is hardly surprising.

DIFFICULTIES OF RESEARCH

It was only five years ago that HIV, the human immunodeficiency virus that causes AIDS, was discovered by American and French scientists, and the straight-forward test for evidence of HIV infection became available only a year later. Since then, only a single anti-viral drug - zidovudine, or AZT - has won full approval for AIDS patients by the U.S. Food & Drug Administration.

Promising early reports on one other anti-viral drug - dideoxyinosine, or DDI - are scheduled for presentation at the conference. Meanwhile, the toll from AIDS continues to climb.

Dr. Jonathan Mann, director of the World Health Organization's global AIDS program, reports that as of this month 150,000 AIDS cases have been officially reported from 149 nations. Underreporting is so widespread that the true total is more likely to exceed 450,000 cases. In San Francisco, the AIDS toll since June of 1981 to the beginning of this month stands at 6,661 cases and 4,297 deaths. In the United States, the most recent reported figures from the national Centers for Disease Control give the total of known U.S. cases since the epidemic began as 94,280, with 54,402 patients dead by the beginning of last month.

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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