AIDS Treatment News No. 009 - August 1, 1986
John S. James

No breakthrough came out of the Paris conference, or at least none recognized as such. We shouldn't expect breakthroughs, because it would be very wrong to conceal important news in order to make a splash at the next meeting. Instead, this conference reported the routine advances which offer major leads for new research. And it portrayed a developing world-wide catastrophe which cries out for appropriate institutional and social response.

There is no way to summarize the abstracts of the conference in this column; the material is so vast that just reading all the titles takes over an hour. Instead, we will mention a few of the highlights selected by several AIDS experts who attended the Paris conference, and who reported on it at a 90-minute session at the "AIDS/ARC: Update '86" conference at the University of California in San Francisco last week. We cannot do justice to this session, and suggest that you get a tape of it if you want to find out more about the results presented in Paris; a phone number for ordering the tape is given below. Meanwhile, here are a few of the important points discussed; comments by this writer are in parentheses.

(1) One panelist reported that there is less emphasis on immune boosters and more on viral inhibition instead. (However, other experts are moving toward drug combinations of antivirals plus immune boosters. Others are emphasizing the importance of infection through direct contact of cells in the blood, which suggests that killing virus particles in the bloodstream may do only part of the joib, while drugs like AZT which work inside the cell might be more effective.)

(2) The question of whether intestinal parasites wuch as amebas are cofactors which help the AIDS virus establish itself and cause the disease is still up in the air. The tests to find out for sure would be very complicated, and no one seems to be doing that work now.

(Here we see another major failure of public policy in handling the AIDS epidemic. Since much evidence suggests that parasites and other cofactors play an important role, this question should clearly be followed up. Since we aren't going to get a conclusive answer, we should probably assume that the answer is yes, because this way the cost of being wrong will be so much less. Unfortunately, individuals as well as public agencies find it hard to commit themselves unless they have definite answers.)

(3) In San Francisco, safe-sex education has been notably successful and has dramatically reduced new infections. (Unfortunately, the rate of new cases and deaths here will continue to rise for a time, because these cases represent infections acquired months or years ago, before the widespread change to safe sex.) But in most parts of the world, basic AIDS information has not penetrated. Education could stop the spread of AIDS everywhere, but in most places it is not being used.

(The Federal government has refused to fund the kind of education which has proved effective in San Francisco. Gay organizations alone don't have nearly enough money to cover the whole country in time. State and local governments seldom fund work outside their borders, and foundations and mainstream churches have largely stood aside.)

(4) Central Africa is particularly critical. Millions of people may be infected already, by heterosexual contact and by sharing of needles used for medicines. These countries don't have enough resources for effective prevention programs.

An undercurrent at the Paris conference was that the Africans there were not being cooperative. The reality is much more complicated. The African scientists had to speak in terms acceptable to their governments, which are afraid that an AIDS panic will damage their shaky economies. Damage has already happened; ships have stopped coming to ports after widespread publicity to unconfirmed reports of AIDS among prostitutes there.

African countries also resent the treatment they often receive from foreign scientists. Research teams come in, take the data out, and then don't share their findings with the country's government or scientists. The excuse is that they cannot release the information before its publication in a technical journal. (This problem is also delaying AIDS researcyh and treatment development in the U.S. Many journals demand that authors keep their results secret until the publication date, usually many months after the scientists submitted the paper. During this time, other researchers who could benefit from the information don't know about it.)

(5) In the U.S., AIDS is spreading much faster now among IV drug users than among gay men. New studies reported at Paris show that almost all the IV users now know that they can get AIDS from sharing needles. Many have stopped sharing, but most continue to do so because clean needles are not available.

(The obvious solution of making clean needles available, for example by allowing sale without a prescription in drug stores, as needles used to be sold, usually gets blocked by political forces. The best available alternative may be teaching effective sterilization of "works", or use of veterinary needles, which are not controlled. Ultimately, we must inform the public that dirty needles are bringing AIDS into the heterosexual population, where it may become epidemic through sexual contact once a critical mass is reached. Opinions will differ on particular public-health measures, but each should be considered on its merits; political posturing at the expense of AIDS control now threatens not just gays, but everybody.)

The panel of speakers covered many more areas, such as AIDS in women, neurological complications, and the difficulties of vaccine development. A second panel of persons with AIDS or ARC then commented on the reports. You can order a tape of this meeting for $8.00 (plus $1.00 shipping) from InfoMedix. Ask for tape number S226-III, "Report from the Paris Meeting", at the AIDS/ARC: Update '86 conference at the University of California in San Francisco.

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