The New World of AIDS: Part One

As Epidemic Matures, the Battle Shifts

By David Brown
Washington Post Staff Writer
Sunday, August 31, 1997

For most of the 15 years since AIDS entered our vocabulary, this odd acronym built around a word for help has been the quintessential symbol for helplessness.

Now, things are changing. They're changing because -- in the most literal sense -- the global epidemic is becoming mature.

The days when the death count from AIDS rose every year everywhere are gone. So are the days when the disease's inner workings seemed to defy understanding or scientific decoding. Gone also, in some places at least, is the sense of impotence many AIDS sufferers, and the doctors who cared for them, felt as they faced the disease.

Today, in many parts of the world, the AIDS epidemic burns less fiercely than in the past. A decade and a half of research has brought insight, and finally treatment of unexpected potency, to bear against the disease. The monotonous pessimism AIDS called forth in the early years of the epidemic has been replaced by a diverse mix of hope, accommodation and resignation.

A series of articles in The Washington Post over the next five days will sketch a picture of this new world of AIDS.

Last year, approximately 22.6 million people around the world were living with human immunodeficiency virus (HIV) infection, or its late stage, AIDS. There were 3 million new infections, the vast majority in people younger than 25, and almost half of them in women.

Despite those huge numbers, however, the epidemic has actually leveled off in many places.

The incidence of new infection peaked in the United States in the 1980s. Last year for the first time, deaths from AIDS fell in this country, and experts believe that event marks the start of a trend.

The rate of new infection has also peaked in Europe, Australia and Latin America. Even in Africa, where the disease emerged and has caused the greatest devastation, the rate of new HIV incidence has reached a plateau, or is about to. In each of those regions, however, there continue to be places or populations where the disease is still spreading rapidly.

Today, the greatest growth of HIV infection is in Asia. In India in particular, incidence is climbing steeply. It is also rising in China, the great wild card of the epidemic that has avoided the onslaught so far but may not forever. Even in Asia, however, there are places (such as Thailand) where HIV's explosive growth has stopped.

The slowing of HIV's spread is a product of both the natural course of epidemics and the hard-won efforts of people to stanch the spread of this particular one. But change is occurring in more than populations. It is also changing in individuals.

After a long period of frustration, medicine in the last few years has finally started to catch up to the disease and can now offer, for the first time, treatments that may substantially lengthen life and in some cases even restore health. In the United States, and other affluent societies with a tradition of aggressive medical care, the trajectory of HIV illness is substantially different from what it used to be.

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