In Geneva, Dr. Jonathan Mann, an American physician, heads the World Health Organization's program on AIDS. Here he discusses some issues confronting political leaders and health professionals in the global battle against the pandemic with Washington Post staff writers Abigail Trafford and Susan Okie.

Q. Has AIDS caused political unrest in some developing countries?

A. I don't think AIDS has triggered political unrest per se. What we can say, however, is that as AIDS becomes the topic of discussion, whether we are talking about the United States or a developing country in Africa, it becomes one more issue around which people can express strong feelings that can crystallize political attitudes.

In some cases, this may take the form of opposition to the established government. It can take the form of "Why are we letting all these foreigners in?" It can take the form of "Why are we not doing more?" or "Why are we being singled out?" There are many ways AIDS can become a touchstone for political beliefs. Q. Can you think of another disease that has had the same political and moral overtones?

A. What we see happening all the time are expressions of blaming and finger pointing and stigmatization. One sees, for example, proposals for laws and regulations, which would require the screening of certain students coming from certain parts of the world. One sees in the United States the proposal to screen all immigrants. The message that sends -- regardless of the disease or what the realities may be -- is that it is the outsider who is dangerous. It is from outside that the threat comes. Q. But scientists are even defensive about studying the origins of the virus --

A. When you see so much of this stigmatization going on, I must say I do understand the attitude of many African countries about the origin of the virus question. When many people have linked origin with such unpalatable concepts as the idea of sex with animals, or a kind of uninhibited sex, which has a distinctly moralistic overtone -- suggesting it's unbridled sexual relations in Africa that makes Africa have a significant AIDS problem, the use of words like promiscuous, the evocation of images of tribal rites and orgies -- frankly, if I were African I'd feel exactly the same way. I would be fed up with all this facile moralizing and ignorance.

Think about how you might feel if in prominent European publications it was announced that AIDS started in the United States because the United States, as everyone knows, as a long history of bizarre and perverted sexual practices. If everywhere you went, people said, "Oh, you're an American, well, that's where AIDS comes from. Tell me about your perverted sexual practices." You might actually begin to be a bit sensitive.

On the other hand, we must face the facts. And these attitudes -- whether stigmatizing or in response to stigmatizing -- interfere with control efforts. Our interest is that we speak a common language of reason and prudence and science and try to focus on where the disease is going and how to prevent it from spreading rather than focusing on issues such as where did it come from.

We are at a historical moment. We are still pretty much at the beginning of a worldwide epidemic. Therefore we have the responsibility for prevention. If we are successful, we will not have AIDS as the major plague of the last part of the 20th century. If we are not successful, then we may.

Q. Is the AIDS epidemic spreading as fast as early predictions? A. What has become very clear over the past year or two is that we have not yet developed the tools to answer that question adequately. National estimates of the numbers of infected persons have been criticized severely, and I think justifiably, on the ground that they have been made on the basis of relatively little information. If we don't have accurate information in this regard, not only will we not be able to know how fast it is going but we won't be able assess the impact of the preventive measures that we implement. And we won't be able to predict in a reasonable way how many AIDS cases are likely to occur from people who are already infected. Q. What about the difficulties in getting good information, especially in Africa where the disease seems more prevalent? A. Frankly, I see a tremendous problem getting the information in the industrialized world. In the U.S., estimates suggest that there are between 400,000 and 4 million infected Americans. With those kinds of broad estimates, it's difficult to get good data on HIV-infection rates.

Now what's better in the developed world is the capacity to make the diagnosis of AIDS and the infrastructure for reporting the disease. In the U.S., about 90 percent of the cases that are diagnosed are reported to national health authorities. In Europe, that percentage may be much lower.

Q. Are some countries resistant to studying AIDS within their borders? A. We're not aware of any country that is unwilling to think about the problem of AIDS within its own borders. Certainly there are countries that are at this point not interested in having foreign researchers study AIDS -- but their own researchers are often interested.

Q. But there's not an equal amount of cooperation among all countries. A. Of course that's true. There are countries still in Africa that have AIDS cases and are not yet officially reporting them at all. We also have examples where, because of various political questions, international researchers are perhaps discouraged from conducting further research in certain countries. It's a very complicated issue because political and social and cultural kinds of problems become immediately involved when one studies AIDS. Put yourself in the position of a developing country that agrees to allow foreign researchers to come in. They come in, draw blood samples and the next thing the country knows is that it reads in a major foreign newspaper a story about how many people are infected in that population. That works against good collaboration.

Q. What developing countries are at the forefront of research with W.H.O.? A. Collaboration implies a kind of equality between foreign and local researchers. Fortunately, there is an increasing number of very good examples of real collaboration, one of which I worked on in earlier years. It is Project Sida in Kinshasa in Zaire. It is an example where the government of the United States, the government of Zaire and the government of Belgium are working together to study epidemiology of AIDS, the clinical aspects and immunological and laboratory research in Zaire. The project started in 1984 and has grown to more than 25 people. Of those, only four are not from Africa. The results have been very productive. Q. But isn't Zaire one of the countries that are still officially not reporting AIDS cases?

A. Officially at W.H.O., that is correct. Q. That seems so strange when Zaire is involved in such good science. A. Well, I agree. We have great hopes that there will be official reporting relatively soon. On the other hand, the lack of official reporting has not constrained the collaboration of W.H.O. in Zaire. We have had several missions to Zaire.

Q. Looking to the future, let's say a vaccine is developed. Given the history of vaccine development, how can W.H.O. make sure a vaccine would be distributed to all countries? A. That indeed is a big concern. The fruits of modern technical research must be made available to the whole world and not just to the rich. We must avoid a repetition of the hepatitis-B vaccine, where a vaccine that was needed very desperately throughout the developing world was initially made available only in the western world and cost $100 a person, which put it completely out of reach of major programs in the developing world. Now that whole problem has begun to be resolved through the transfer of technology so that countries can manufacture the vaccine themselves. But with AIDS, we won't have as much time. We plan at W.H.O. to work with the pharmaceutical manufacturers and with governments to determine how we can ensure that once a vaccine is shown to be safe and effective, that vaccine can be made available with advantageous conditions financially to the developing world. Or that the technology transfer can be accelerated in such a way that countries realistically can make vaccines for regions at an affordable price.

Q. The first drug available for AIDS -- AZT -- costs patients $10,000 to $15,000 a year. Is that a bad omen for a vaccine? A. Well, I'm not sure. It was a little discouraging. On the other hand, I've read many conflicting reports about whether it was a fair price or not. What it certainly is, is a price that will not permit its use in the developing world. In fact it would be a tragedy if moneys that would be available in national health budgets for AIDS prevention and control -- meaning education, screening of blood -- were diverted to pay for AZT for patients already suffering from AIDS. That would really be disastrous. Although {AZT} is a very important step forward in the development of drugs for AIDS, it is still not an ideal drug, still has many side effects, and its ultimate protective effect is as yet unknown. It gets back to the question: If you have scarce resources, do you mop up the waters that are spilling over the dam or do you repair the dam? We really feel the need to put prevention at the highest priority. Q. What about new drugs for AIDS? A. The issues are the same. If a drug comes out that is indeed safe with minimal side effects and appears to be effective for treating HIV-infected people and preventing them from developing AIDS, that's a drug that we would need right now -- at a level of 5 million to 10 million doses around the world. If that drug were at a price that could not be afforded, then we'd really be talking about a fundamental issue of justice.

Also, let's remember that these vaccine trials and drug trials may very well involve the developing world. If one permitted even conceptually the idea that it was possible to control AIDS in one part of the world without providing those control benefits to other parts of the world, that would be a prescription for long-term failure. AIDS is not a problem that can be stopped permanently in one country until it's really stopped everywhere.

Q. Is there a danger that countries are spending too much time and money on AIDS and ignoring other health issues? A. AIDS is not the only priority at W.H.O., but it is one of the major health priorities. If we do our AIDS prevention work well, we will actually strengthen the systems that are dealing with all those other important problems as well.

One example is the population explosion. One of the ways of dealing with this explosion is through education and the provision of various forms of family planning. A major place for AIDS education is through existing family planning and maternal health clinics. If we integrate AIDS education with activities under way, we strengthen the area of family planning.

Another example would be in laboratory services. We don't want to build AIDS laboratories around the world. We want to strengthen existing public health laboratories so they can deal with AIDS.

It's very narrow to take the view that health people should fight among themselves about which is a more important problem -- X or AIDS. It's actually pathetic to think that we health people might scrabble over the small crumbs of the budgets around the world that are available for health. We have to see AIDS as another example of just how very important our health is and how health shouldn't be relegated to the bottom of the funding picture. We might need to reconsider national priorities.