Treatment Review No. 14; November 1994
Marlene Diaz

I was one of the fortunate people who received a scholarship from the NIH to go to the International AIDS Conference in Yokohama, Japan. Although I didn't see much of the country I met many people who shared one common goal - to better understand and perhaps find a cure for AIDS.

Japan is not an HIV friendly country, but the people in Yokohama were there because they wanted to be there; besides medical people who had a vested interest in being there, there were many people who volunteered their time. The opening ceremony lacked substance other than when a representative of GNP (Global Network of People with AIDS) spoke frankly about the negative climate in Japan towards people with HIV. When he asked everyone in the audience who was seropositive to stand up, and 25% of the crowd did, it was a very moving experience. I think that this public display of our presence was possibly one of the most important messages conveyed to the conference attendees.

I focused on sessions dealing with issues relating to women and children. In contrast to last year's conference, which offered "no good news," this year's conference seemed to dwell on the apparent efficacy of AZT in reducing perinatal transmission. There was no word, however, on using AZT in newborns.

As a mother of an HIV positive toddler, I was glad to hear about a possible non- invasive HIV antibody test using saliva instead of blood.

Some pediatric news

A nine-year compilation of data from a pediatric clinic in Brazil stated the importance of a holistic approach: diet, psychosocial, immunization, propolis, IV gamma globulin, and use of AZT only in symptomatic children.

The ACTG 128 study concluded that low dose AZT (90 mg) works just as well as high dose AZT (180 mg). The advantage of this is a 50% reduction in cost as well as less toxicity.

Physically, HIV is more aggressive in children than in adults. Emotionally, children are traumatized by watching their family unit collapse. Many of them drop out of school. A major problem is the very limited childcare and support for orphans. To date, there are approximately 18,500 orphaned children as a result of AIDS and by the year 2000 there are expected to be 80,000 orphans

The women's round table discussion I attended increased my awareness of the global impact of HIV/AIDS on women. Worldwide, 3,000 women are infected with the HIV virus daily, and 500 women will die of AIDS every day. Children who have been infected through incest or other sexual assault almost never get any treatment at all.

Another silent and underrepresented group of infected individuals are our children that are getting infected through incest or other sexual assault. 32% of adolescents between the ages of 11 and 17 years old have been sexually assaulted. 29% of children under the age of 11 have been raped. Another disturbing statistic is that 1 in 3 girls and 1 in 6 boys are sexually assaulted by age 18.

Many men make the mistake of thinking that young women are safe. In underdeveloped countries young girls have no alternative but to sell their bodies to support their family. Fear of pregnancy leads them to engage in anal intercourse, which puts them at higher risk of HIV infection. Certain countries still practice sexual mutilation on small girls - usually between the ages of 4 and 8. HIV is often transmitted secondary to lack of equipment sterilization.

Female controlled prevention was another interesting topic. It emphasized how sexual transmission could be prevented through abstinence, monogamy, reducing the amount of partners and treating STDs. Unfortunately, economic as well as social factors make this difficult. Twenty five percent of the world's households are led by women. Due to lack of funds, some women barter sex for money, rent, food or clothes for themselves and their family. Socially, some cultures condone multiple partners for men. There are very varied social and religious beliefs in other countries. In Brazil, anal intercourse is practiced to preserve virginity. In India, vaginal burning, itching and discharge are considered a "women's lot" and are not considered an STD. Catholicism forbids the use of condoms making it more difficult for women to practice the use of condoms.

The message was clear - what we need most to halt the spread of AIDS is education. We need to educate entire communities and we need to tailor it to each group's special needs. Boys and men must share in the family responsibility rather than leaving the burden on women who are considered "core transmitters" in some countries. We shouldn't just preach empowerment - we should go the extra mile and offer resources, ie: legal advocacy, condoms, education. We must also incorporate this outreach to include gay and lesbian teens and children. We must listen to them and hear what they're saying We must provide non-judgemental quality support groups.

The battle to fight HIV/AIDS must be multi-directional. The scientific community must continue to explore all aspects of treatment modalities. They should leave no stone unturned; however, just as important is controlling and limiting the amounts of new cases. This is in our hands. We must provide very graphic education, very early on, to make a difference

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