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The International Council of AIDS Service Organizations provides periodic updates on the international AIDS situation.

The United Nations published a survey of the international AIDS situation in December 1996.

The Centers for Disease Control provides HIV prevention information for international travellers.

The U.S. Census Bureau has maps of high-risk areas of Africa and Asia.

The U.S. Agency for International Development has AIDS programs in Africa.

Australia's University of Queensland has information on AIDS in Asian nations.

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Despair in the Third World

Franci Koffi at Illumination Action Franic Koffi, staffer at Illumination Action, takes a call on their AIDS information phone line.
By Jim Ruppert/The Washington Post

The new treatments could provide a powerful new brake on the spread of HIV in the world's wealthy regions "simply because they will make people less infectious," according to Thomas Quinn, a Baltimore-based researcher with the National Institute for Allergy and Infectious Diseases. "But that won't happen in the Third World."

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."

Another member, Arsene Tao, took an AIDS test after the death of an army buddy with whom he had shared prostitutes. His parents were stricken with fear. "They would not come close to me. They thought they might catch AIDS by eating from the same dishes as I did," he said. They forced him out of their home and he now lives alone, working for a few hours a day as a street vendor.

Traditionally, African family ties are strong and far reaching, "and always provided a support mechanism for the sick," said Aguirre at his AIDS clinic. "But this [epidemic] has overwhelmed that capacity." From his patients, "I've heard countless stories of people locked away, abused or ostracized from their families," he said.

There are few other sources of help. Like most African countries, Ivory Coast lacks even basic health services for its people, and can do little for those infected with AIDS.

Ivory Coast's prevention campaign -- including radio programs and traveling theater troupes -- "is well organized and financed," said Kouame, who is president of Illumination-Action. But if you are already HIV positive, Kouame said, "you have crossed the line. . . . There is no help."

The country's government-run hospitals and clinics are desperately short of money and materials. "People come in with full-blown AIDS, and can get nothing more than aspirin and a simple antibiotic," or pills to prevent malaria, said Nina Okagbue, a health specialist here with the African Development Bank.

Ivory Coast has only a handful of places, most in the capital, offering care for AIDS. The capital's main hospital offers outpatient care for the equivalent of $8.50 a month.

But vast numbers of people are too poor to pay. Research projects run by the CDC or a French foundation offer treatment to a handful. For others, Aguirre's clinic, funded by a U.S.-based charity, Hope Worldwide, is virtually the only place available. But even running at capacity, Aguirre said, it has treated only 2,000 patients in seven years, an invisible percentage of those needing help.

Article Continues

© 1997 The Washington Post Company

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