San Francisco Chronicle - Monday June 12, 1989
Randy Shilts, National Correspondent

This problem was just one of the many tortuous issues that confronted the researchers, health officials and AIDS organizers who were leaving Montreal yesterday after the conclusion of the fifth International Conference on AIDS. Studies have made it clear what needs to be done to thwart the spread of the disease. What is less clear is whether any of it will be accomplished and whether all the knowledge released in the past seven days will be put to use.

THIRD WORLD WOES

In few areas were the epidemic-related problems more striking than in the Third World, particularly in Latin America and central Africa, where the human immunodeficiency virus is spreading rapidly. An avalanche of new epidemiological data traced in frightening detail the incursion HIV has made into the slums of Rio de Janeiro, the prostitutes of west Africa and the children of Kenya.

The reasons why these nations are having a difficult time holding back the viral invader were also made clear. For example, murmurs arose in the huge Montreal conference auditorium when Dr. N'Galy Bosenge, director of Zaire's AIDS Control Program, explained that his country is not screening blood donations, even though his own studies show that more than one in 20 blood donors in Kinshasa are infected with HIV. As if to answer the murmurs, Bosenge showed a slide with a bar chart comparing the level of government health spending in various nations. At the left side of the chart, marked by a barely discernable bar, was Zaire, which annually spends $1 per person on health care. At the far right was the huge bar representing the $500 that the U.S. government spends per person each year on health care.

"WE DON'T HAVE THE MONEY'

"It costs $5 to screen a pint of blood," Bosenge later said. "We don't have the money." Without more money, he added, his government will be able to do little about AIDS except try to reach people through the nation's primitive media networks.

In the Third World, where the bulk of the planet's estimated 5 million to 10 million HIV-infected people live, such problems are not unusual. Hundreds of studies also laid bare the growing threat that AIDS presents to the urban slums of North America and southern Europe, where intravenous drug abusers now account for the bulk of new AIDS cases.

NEW YORK CITY STUDY

A New York City study found that a staggering 9.8 percent of all black men checking in for non-AIDS related treatment in one hospital were now testing positive for HIV. In cities such as New York, Baltimore and Newark, levels of HIV infection among poor blacks and Hispanics is now equal to that of the worst AIDS-stricken regions of equatorial Africa. A dozen other studies also showed what can be done.

Needle-exchange programs can reduce transmission among addicts, research has shown. Other data demonstrated that educational programs can get drug users to stop the needle-sharing behavior that spreads the disease.

HUGE GAP

Yet, the huge gap between knowledge and policy was dramatized on the second day of the conference when New York City Health Commissioner Dr. Stephen Joseph boasted of his city's needle-exchange program from the conference's speaker platform. "Shame, shame, shame," shouted members of the New York City AIDS Coalition to Unleash Power (ACT-UP) when Joseph mentioned the program. What Joseph did not say was that his needle-exchange program dispensed syringes to only 200 addicts - out of an estimated 500,000 intravenous drug users in New York City. As in other cities, plans for a wider needle-exchange program in New York have been derailed by political leaders who are largely heeding objections from black community leaders.

NEW TREATMENTS

The gap between scientific knowledge and practical application was also evident in the crucial area of developing treatments that can tame HIV and save the lives of the estimated 1 million Americans who are HIV-infected. For the second consecutive conference, scientists presented data supporting the belief that science will, at some point, learn to disable HIV so that an infected person will not go on to develop AIDS. And, for the second consecutive conference, researchers from the National Institutes of Health did not produce any results from significant, large-scale trials on all the potential treatments that have long been foundering somewhere in the NIH drug development pipeline.

NO EASY SOLUTIONS

The complicated problems surrounding the epidemic's spread in the Third World undoubtedly will defy easy solutions, but it is germane to ask how many more studies have to be conducted on the problem of AIDS in Zaire and Brazil before the West offers the assistance necessary. In the United States, the continued inability to implement the knowledge that science has garnered deserves far less absolution because America has the resources and the expertise to get the job done. The data from last week beg a question: Will the federal government aggressively launch needle-exchange projects and expanded addiction recovery centers - or will the government stand idly by and watch a virtual depopulation of the inner cities?

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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