A Losing Battle With AIDS

By Dick Thompson

As more than 10,000 participants from at least 80 countries gathered last week for the Sixth International Conference on AIDS, the spotlight was focused squarely on the victims of the disease. The meeting was staged in San Francisco, the epicenter of the epidemic, and held during the city's Gay Pride Week, an annual festival that drew 100,000 homosexual men and women from around the U.S. AIDS sufferers helped write the conference agenda and delivered impassioned speeches about the extraordinary human cost of the disease. In fact, they stole the show from the hundreds of scientists, who exchanged information but had no breakthroughs to announce.

Much of the time, more was going on outside the Moscone Convention Center than inside. The streets were often filled with protesting gay activists, who demanded more Government money to help find a cure for AIDS and provide care for those afflicted. Said Paul Boneberg, head of a group called National Mobilization Against AIDS: "We have to take this opportunity to draw the world's attention to discrimination and underfunded research and medical care that characterize the AIDS problem. People are dying, and these protests move policy forward."

At times, though, the demonstrations generated more annoyance than sympathy. On Wednesday a large group of protesters outside the convention hall confronted a line of police officers in full riot gear. In the resulting scuffle, 80 demonstrators were handcuffed, loaded into buses and taken to headquarters to be booked on misdemeanor charges. (They were all later released.) After the arrests, some of the remaining protesters staged a march down Market Street, one of San Francisco's main thoroughfares. The marchers stalled trolley buses in the middle of the street by pulling the vehicles' rooftop poles away from the overhead wires that supply the vehicles with electric power. Another group briefly occupied a cable car, jostling passengers and posting in the window a placard bearing the slogan SILENCE=DEATH. By week's end police had arrested and released more than 400 demonstrators.

No one can deny that AIDS victims deserve all the compassion and help that society can muster. The latest statistics presented at the conference show that the toll is still mounting and the end of the epidemic is nowhere in sight. At least 600,000 Americans are infected with the virus, more than 136,000 have become sick, and some 83,000 of those have died.

But many public health experts fear the focus on present suffering may be diverting too much attention from the task of protecting those who could become victims. Billions of dollars have been poured into research aimed at finding a cure, but relatively little has gone into programs designed to stop the disease from spreading. The National Research Council, in a report released last week called AIDS: The Second Decade, declared that prevention efforts fall "far short of the magnitude of intervention needed."

That is a tragedy, since AIDS, which is caused by the human immunodeficiency virus (HIV), is a preventable disease. No one gets it from the air, food or water. The victims mostly fall into two categories: people who have had sex with infected individuals without using condoms, and drug addicts who picked up the virus from contaminated needles. Wide use of condoms and distribution of sterile needles to addicts could stall the epidemic. But efforts to encourage such measures have been hampered by conservative politicians, who are squeamish about sex education and clean-needle programs. As many conferees pointed out last week, the failure to mount an effective prevention campaign is allowing the disease to spread more readily from adult males to women and adolescents, who were once thought to be relatively safe. "Do we want to stop this damn epidemic?" asks Dr. June Osborn, chairwoman of the National AIDS Commission. "If we do, we have to teach people how to protect themselves from risk."

Prevention is vital because a cure is still distant, if it is attainable at all. Although several drugs are being tested on patients, only one, AZT, has been approved by the Food and Drug Administration for general use. AZT helps slow the progress of the disease in many sufferers and prolongs lives, but it does not eradicate the virus, and it has toxic side effects. Treating AIDS is like trying to hit many targets at once, since the virus destroys the body's immune system and leaves the victim open to a multitude of afflictions. Doctors have learned to combat some of these infections, but as patients live longer, new ailments are popping up.

The main obstacle to attacking AIDS is that HIV is a so-called retrovirus -- one that inserts its genes into the genetic material of the host cells, in this case the cells of the immune system. A drug cannot eliminate the virus without also wiping out those vital cells. "I don't think one can think of a cure for a retrovirus," says Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases.

It is possible, however, to hope for a vaccine, and the modest amount of progress toward that goal was reviewed at the conference. In recent experiments, scientists have successfully used vaccines to protect chimps against infection by a strain of HIV and monkeys against a similar virus. Seven potential vaccines are being tested on humans. The problem is that HIV mutates rapidly and comes in many varieties. It will be difficult to produce a shot that offers protection against every possible strain of the virus. At best, an effective vaccine is many years away.

In the meantime, the only antidote to AIDS is to stop the practices that spread the disease. And that is becoming increasingly difficult as the nature of the epidemic changes. In general, homosexual men are getting the prevention message, and new infections have slowed drastically in gay communities. Most gays who come down with the disease now were infected years ago, when less was known about AIDS. But the infection continues to spread unchecked among drug addicts. In 1989, 23% of the new AIDS cases occurred in people who inject drugs intravenously, up from 11% in 1981.

From the drug culture, AIDS is starting to seep into the heterosexual population. More and more women are getting AIDS, mostly because they either inject drugs themselves or have sex with infected men. But the problem is not limited to the households of heroin addicts. AIDS is increasingly common among abusers of drugs that are not injected, such as crack cocaine and alcohol. These people tend to be sexually uninhibited and promiscuous, which increases their risk of picking up the AIDS virus. Last year about 5% of the new AIDS cases resulted from heterosexual contact, compared with 0.5% in 1981.

Many experts believe providing sterile needles to addicts would be one of the most effective ways of slowing the AIDS epidemic. That kind of program has shown promise in other countries, but in the U.S. such efforts are limited to a few locally funded experiments. The Bush Administration refuses to support any clean-needle program or even research into whether that approach is effective. Only an educational campaign to encourage addicts to sterilize needles with bleach has federal funding. And that $50 million program, a minuscule part of the $2.6 billion annual federal AIDS budget, was nearly cut this year at the behest of conservative Senator Jesse Helms of North Carolina.

Helms and other like-minded politicians are also hostile to efforts to educate people, particularly young people, about safe-sex practices. Most teens are not likely to be exposed to the AIDS virus, but those who become sexually active at an early age, particularly in poor communities where drug use is rampant, are at risk. A Government study found that about 1% of the black teenage girls who bore children in New York City during 1988 were infected with the AIDS virus. There is a 40% to 60% chance that an infected woman will transmit the virus to her child.

It is clear that educational efforts should be generously funded and sustained indefinitely. Each new group of adolescents must be alerted afresh to the dangers of AIDS and the ways to block the disease. This is especially - critical for young gay men. While the large majority of older homosexuals have learned to practice safe sex, the younger generation does not appear to be so scrupulous. One study in San Francisco of 100 gay men, ages 18 to 25, found that within the previous month 46% had engaged at least once in anal intercourse without a condom.

Although this was a small study, and it may not be indicative of behavior in all gay communities, the findings were shocking. They show how far educational efforts still have to go. If society is unwilling to expend the energy and resources necessary to teach its young people to avoid AIDS, then the epidemic could grow ever larger and ever more tragic well into the next century.

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CREDIT: TIME Chart

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With reporting by Lee Griggs/San Francisco