AIDS, Acquired Immunodeficiency Syndrome, estimated to have killed more than 16 million people worldwide since doctors discovered it in humans more than 20 years ago, is still rampaging around the world. On the occasion of the 12th annual World AIDS Day, RFE/RL correspondent Brent McCann reports the latest developments, including the spread of the disease in the post-communist region.
Prague, 1 December 1999 (RFE/RL) -- Leaders in the world's fight against AIDS say today, on this World AIDS Day, that the disease continues to grow as a health threat, despite billions of dollars spent on research and treatment.
The World Health Organization (WHO) -- and the United Nations Program on HIV/AIDS -- known as UNAIDS -- say that the countries most at risk from AIDS are in sub-Saharan Africa, which has been devastated by the disease and has already seen mortality rates rise. But the steepest growth in new exposures to HIV, the Human Immunodeficiency Virus which causes AIDS, is in a different region -- the countries of the former Soviet Union.
Dr. Lev Khodakevich oversees UNAIDS efforts in Eastern Europe and Russia. He told RFE/RL that in less than a year, the number of registered HIV cases in Russia has more than doubled to 23,000.
"We are very, extremely concerned about the developments in Russia because still from 1987 till 1998, [health officials] registered about 10,000 cases of HIV infections and in this year alone, in eleven months, they registered 13,000 cases."
Khodakevich says that intravenous drug use is the main cause of the dramatic increase. He says between 1.5 million and 2.5 million people in the post-communist region use drugs, and the problem is growing among unemployed young people in the industrial cities. That pattern is reflected in HIV infection -- the Moscow area alone reports 5,000 recent HIV infections.
Particularly worrying is the rise in the number of schoolchildren who use intravenous drugs. In St. Petersburg, for example, the number of children under age 14 who inject drugs has skyrocketed to as much as 20 times what it was just a few years ago.
Khodakevich says that aside from receiving a blood transfusion from an infected donor, the most certain way to catch HIV is to use contaminated needles. And, he says, drug users are most at risk in places like Russia, Ukraine, Belarus, Moldova, and Kazakhstan, where both HIV infection and intravenous drug use are epidemic. Dr. Khodakevich:
"The drug users are being infected very quickly. Once the infection enters the community of drug users, it takes only one or two years [before] half of them or more are getting infected with HIV."
In addition to drug use, the WHO and UNAIDS link the spread of AIDS in the region to several other factors. One is the new, post-communist freedom to travel -- isolated populations are less likely to catch diseases. And the growth in the numbers of poor and unemployed people in the region have contributed to prostitution -- another potential source of infection.
Khodakevich says UNAIDS is implementing, in his words, a "harm-reduction strategy" in the region. This includes educating people of the danger of AIDS, distributing clean needles and syringes, and handing out condoms. He says that outreach workers are finding the at-risk populations responsive and cooperative, but that the workers are reaching only 10 percent of those who need their help.
The relatively recent spread of the disease through the region offers some hope, in that efforts to combat AIDS can draw on techniques developed by 20 years of research and experience in Africa, Western Europe and the United States. Khodakevich says the epidemic in Russia and Eastern Europe is still young.
"We are at the very early stages of the epidemic in Eastern Europe and that gives us an excellent window of opportunity to affect the epidemic."
Health ministers from countries around the world initiated World AIDS Day in 1988. Since then, the World Health Assembly, agencies of the United Nations, and government, communities and individuals have endorsed the occasion to coordinate action against the disease.
Health workers use World AIDS day as another opportunity to tell people how to avoid AIDS, by using condoms and not sharing needles. AIDS is a breakdown of the body's immune system, which makes those infected unable to fight off disease. It is caused by HIV -- although not all cases of HIV develop into cases of AIDS. HIV is spread through contact with blood or semen, most often through unprotected sexual intercourse, blood transfusions, or injection with contaminated needles. Infants also can acquire the infection from their mothers.
World awareness of AIDS began in 1981, when a technician at the Centers for Disease Control in the United States noticed a high incidence of an unusual kind of pneumonia among homosexual men in Los Angeles and of Karposi's sarcoma, a rare cancer, among a similar community in New York.
Before long, 14 nations were reporting AIDS cases. It now appears that the disease originated in Africa in chimpanzees of some other genus of ape. Researchers have developed several theories about how humans contracted HIV. Last February, researchers in Alabama who affirmed apes as the HIV source suggested that HIV could have crossed over as a result of a human killing and eating a chimpanzee. Another well-publicized theory is that polio researchers transferred HIV to humans when they used monkey organs in early vaccine research.
WHO and UNAIDS report some positive developments worldwide in the fight against AIDS. They say they have reduced their projections of the number of HIV-infected people in Asia and parts of India. India has successfully promoted the use of condoms. And in many countries of Latin America, health officials are providing free drug treatments to people infected with HIV.
However, the AIDS experts say, the world must guard against complacency. They say the threat of HIV has not diminished.