Help Least Likely Where Most Needed; Africa Ravaged by Virus

AIDS continues to spread, primarily through heterosexual contact, in Africa and densely populated South and Southeast Asia. The latest annual U.N. summary of global AIDS noted an explosion of the disease in cities of India that "may be spreading rapidly to . . . rural areas through migrant workers and truck drivers, as has happened in many other countries." The epidemic in Asia is likely eventually to be even bigger than that in Africa, Quinn said.

Regional generalizations "lump together vastly different local conditions," and "it's difficult to see more than three years or so into the future," Quinn warned. Still, "if all continues as it is right now, I wouldn't expect to see a leveling off [of new HIV infections] in Africa until the next decade." New infections in Asia would not level off until about the year 2010, he said.

And, researchers have noted, other poor countries are at particular risk for local epidemics, notably those of the former Soviet Union, which for years were physically isolated from AIDS by Soviet travel restrictions.

Amid Africa's agony, Uganda now offers the first signs that prevention campaigns might succeed. Uganda's government has spent years on health education, especially on promoting the use of condoms and discouraging sexual promiscuity, and in the past few years has measured local declines in the rate of new infections. "The message has penetrated the public consciousness," said Agathe Lawson, head of the U.N. AIDS program in Abidjan.

"There are glimmers of hope from East Africa," said Stefan Wiktor, director of an AIDS research project in Abidjan run by the Atlanta-based federal Centers for Disease Control and Prevention. "People have really latched onto them as signs that this eminently preventable disease is finally being prevented."

AIDS in Africa is a powerful illustration of what a recent U.N. study called "the two-way relationship between poverty and illness." Poverty "offers a fertile breeding ground for the epidemic's spread, and infection sets off a cascade of economic and social disintegration and impoverishment," the 1997 Human Development Report said.

AIDS' damage to Africa has been barely visible in the usual macroeconomic statistics, researchers say. Years ago, some economists predicted the virus would shatter the continent's fragile economies by killing off masses of younger people during their most productive years. But Africa also has masses of unemployed who have been available to fill the places of AIDS victims.

Rather, AIDS' damage is visible at the level of families and individuals. Even before AIDS, Africans lived shorter lives with more illness, and had fewer choices about how they worked or lived, than those of any other region. Now AIDS has deepened those measures of poverty.

Many African countries greatly improved health conditions for their people since the 1960s, but AIDS is rolling back the gains. In Zimbabwe, life expectancy was on course to reach 72 years by 2010. Instead, due in great measure to AIDS, it currently is 35 years. Infant mortality, projected to drop to about 35 per thousand births, will be about 115 Zimbabwean children, according to U.S. Census Bureau projections cited by the U.N. report.

And even where African governments aggressively have pushed education about AIDS, fear and ignorance often rule. In Ivory Coast, researchers estimate that 2 million people -- 14 percent of the population -- are HIV positive. But the great majority either are unaware of their infection or keep it a secret, researchers and AIDS activists said.

In Abidjan, the country's two largest organizations of HIV-positive people total no more than 250 members. At a meeting of Illumination-Action, Kouame, Koffi and others said few people will admit openly having the virus. "You are immediately stigmatized, especially in the villages," Koffi said.

Koffi learned he was HIV positive from the personnel director at the luxury hotel where he worked. He had taken a medical test in applying to be a supervisor in the laundry service. "The director called me to his office and told me that I had AIDS and I was fired," Koffi said. His wife left him and he fled briefly to alcohol, he said. Since then, he has searched for work, but "I'm always told there's nothing available."