As Epidemic Matures, the Battle Shifts

Some things, however, have not changed in the new world of AIDS.

Prevention is always the most important victory in the battle against an incurable disease. That remains as true in the battle against HIV disease as it has always been. Preventing infection is no less urgent in the current era of therapeutic optimism than it was in the long period of pessimism it replaced.

In recent years, the task of preventing the spread of HIV in this country has become less national and centrally conceived, and more local and home-grown, than in the past. Today, more than ever, the nation's prevention efforts reflect the needs -- and the prejudices -- of the myriad communities and cultures AIDS touches.

In just the most high-profile example, needle-exchange programs designed to slow the spread of infection among IV drug users are in place in several cities, but have never been widely implemented or endorsed by the federal government.

Also unchanged is the search for the ultimate tool of prevention -- a safe and effective vaccine. Many scientists believe only a vaccine has the power to stop, and ultimately reverse, the HIV epidemic worldwide. Current research, however, suggests a good AIDS vaccine is still years away. Even when promising "candidates" emerge from the laboratory, testing them in human populations will be an enormously tricky and expensive undertaking.

Finally, this series of articles will look briefly at a place more representative of the AIDS epidemic than the United States.

In the West African country of Ivory Coast, HIV infection continues to rise, and people with it continue to suffer severe ostracism. The new treatments so rapidly being adopted in affluent countries are out of reach of all but a handful of people.

There, the new world of AIDS looks painfully like the old.