THE AIDS EPIDEMIC

October 30, 1998
		A report released by the United Nations suggests that AIDS is significantly lowering life expectancy rates in Africa. A separate recent study dashed hopes making treating AIDS less costly. Susan Dentzer provides details of the disheartening news.

July 3, 1998: AIDS in developing countries June 29, 1998: The results of the World AIDS Conference in Geneva. Dec. 1, 1997: Researchers find more people with AIDS than expected. Sept. 24, 1997: The search for a vaccine. Browse the NewsHour's Health coverage     The United Nation population report The World Bank's sites on HIV and AIDS and AIDS Economics New England Journal of Medicine's article about the AIDS cocktail trial and their editorial	ELIZABETH FARNSWORTH: Now, developments this week in the fight against AIDS. Joining me is Susan Dentzer of our health policy unit, a partnership with the Henry J. Kaiser Family Foundation. Susan, the UN released a new report this week. Tell us about it. SUSAN DENTZER: Well, Elizabeth, the United Nation's population division released a report where they took into account new numbers available on the rate of infection of AIDS around the world. And they produced a very startling and very tragic analysis which essentially shows that in Africa, where now currently 26 million people are infected with AIDS, there is going to be an absolutely cataclysmic impact on the make-up on the structure of the African population for the foreseeable future as a consequence of this, with life expectancies falling to the levels that have not been seen in Africa since the 1950's, with the population growth rate diminishing, and with overall 47 million people expected to have died of AIDS in Africa from 1986 until the year 2015.
	Drastically higher numbers.
	ELIZABETH FARNSWORTH: Why this new information? Has something changed, some kind of access to figures? SUSAN DENTZER: In fact, what happened earlier this year is that the six agencies that participate in the umbrella group -- called the UN AIDS -- came into possession as a consequence of analysis and other things of some drastically higher numbers about the prevalence of AIDS worldwide and specifically in Africa, where 86 percent of the AIDS - HIV-infection rates worldwide exist. As a consequence, they were able to - UN population people were able to take these higher AIDS numbers, which had become available in part because certain countries in Africa had finally faced up to the reality of the infection rates within their borders and finally we're producing realistic estimates, estimates that came much closer to those that private researchers had been saying for some time must have been true. The population projection - people at the UN, as I say, were able to take those new numbers and essentially run them through their models - their computer models - and forecast this enormous shift in the population. ELIZABETH FARNSWORTH: Okay. Tell us some specifics. SUSAN DENTZER: In fact, let's take some examples of a country like Botswana in sub-Saharan Africa - one of the thirty-four countries of sub-Saharan Africa. It's a nation of about 1 ½ million people. It's about the size of Texas, and it happens to be a place where one out of four adults is now infected with HIV. As a consequence of that, life expectancy is shifting dramatically there. Life expectancy at birth was about 41 years in 1950 that peaked out at about a little over the age of 60 in 1993 and it is now forecast a plummet back to the levels of the 1950's, presumably as early as the year 2005. So, dramatic, dramatic change.
	Some improvement.
	ELIZABETH FARNSWORTH: And how about population growth decline, specifics on that? SUSAN DENTZER: Similarly, take another country, South Africa, next door to Botswana, much larger, 42 ½ million people. Again, the population growth rate in South Africa had been declining, as one would expect, as the population, in effect, as the country became wealthier. We know over time birth rates fall as countries become healthier. And we would expect the population growth rate to decline in the case of South Africa. In fact, as a consequence of AIDS, it has declined dramatically. And we see this big gap now as a consequence of AIDS in how much the population of South Africa will grow in the future. ELIZABETH FARNSWORTH: Are any African countries having any success in fighting AIDS? SUSAN DENTZER: Yes, some, but very few. There are countries where the authorities have become enlightened. For example, Uganda, where the president, Urere Musavany, has taken a personal interest in fighting AIDS. I'm told that if you land in - get off an airplane in Uganda now, you will see all over the place posters basically designed to raise AIDS awareness. Infection rates, for example, among pregnant women, in urban areas of Uganda, have dropped as much as 40 and 45 percent as a consequence of education, prevention, and, in particular, delaying the onset of the first sexual activity among women, which has been an important aspect of the prevention strategy. There's hope now for going a step further. The World Bank is among many organizations looking at, for example, administering to pregnant women certain of the anti-viral drugs like AZT, a popularly known one, to basically reduce the rate of transmission of the HIV virus from pregnant mother to fetus and also to unborn infants. So there's some potential that some of that may take place in the future. But, overall, the situation is very grim, as I say, with as many as 47 million deaths expected over the next several decades. ELIZABETH FARNSWORTH: And I know this would be a long conversation, but just briefly, why is the situation so desperate in sub-Saharan Africa? SUSAN DENTZER: Largely because AIDS and the HIV virus is believed to have emerged in Africa. It is believed that the virus came - made the jump from monkeys to human beings somewhere perhaps in the 1050s or 1960s. We know that the virus has a long period of incubation, sometimes as much as ten and fifteen years. So Africa, having been the place of - the tragic birthplace of HIV, in fact, has been living with this for a long time. And it's known now that as early as the early 1980s there was a band of HIV infection across West Africa. Now, we're finally seeing the full flourishing of this. Africans have basically been living their lives amid this problem, and 90 percent of the cases in the developing world of HIV transmission are heterosexual cases of transmission, so Africans have basically just been living their lives in the context of this dread disease.
	AIDS cocktail here to stay?
	ELIZABETH FARNSWORTH: Okay. Some other developments this week, some new information about the cocktail, as they call it, of drugs that people who can afford to get drugs take. SUSAN DENTZER: Yes, indeed. This is an example of the kind of parallel universes in which the global AIDS epidemic plays out. In Africa, we're talking about trying to stave off millions and millions of deaths. In the US, by contrast, as in other rich industrialized countries, we've been very successful in actually causing the death rate of AIDS to decline. It declined, for example, last year by half, as a consequence, and part of some of these new therapies. The one you mentioned is known as an AIDS cocktail. That makes it sound much more pleasant than, in fact, it is. What is really at stake here is treatment with several - perhaps as many as four - relatively new antiviral drugs taken in pill form on the order of twenty-five to thirty pills a day over a period of many years. Notwithstanding unpleasant side effects that result from these, these have been successful in basically eradicating to a large extent the presence of HIV among many people who take these medications. The recent studies, the studies that were unveiled this week in the New England Journal of Medicine, basically shed light on something that people had been wondering a great deal about, which is, can you take a very intensive course of these therapies and then stop and actually see the virus not come back - that was the burning question, because we know in many other diseases - tuberculosis, cancers - sometimes a similar therapy works. In fact, as a consequence of these studies, we now know that in at least a certain percentage of patients, that doesn't work. If you stop the treatment, in fact, the virus comes back, so the studies basically indicate that we have less hope for reducing these therapies to what is known as a maintenance level. In fact, people on them will have to stay on them at heavy doses for a long time.
	President's initiative.
	ELIZABETH FARNSWORTH: And finally, the President announced an initiative on AIDS this week. What was that? SUSAN DENTZER: The President, as have others in Congress, have become increasingly concerned about another aspect of the parallel universe of AIDS here in the United States, which is the prevalence in the minority population, basically African-Americans and Latinos. African-Americans constitute 45 percent of all newly-diagnosed AIDS cases, and, in fact, there's a great deal of concern that in very poor African-American and Latino communities with substance abuse and other things the rates could go even higher in the years to come. As a consequence, the President announced that as part of this year's federal budget an additional $156 million will be made available to strategies specially targeted on prevention, in particular, among these minority populations. So a range of activities are going to be undertaken at this point - more substance abuse - treatment made available, in particular, to Latino and African-American women. In one instance divinity school students at the historically black colleges will be trained to go out and talk in their communities about AIDS prevention and so forth, an entire range of things designed to make this tragedy a lesser one than it looks like it might be. ELIZABETH FARNSWORTH: Susan Dentzer, thank you very much. SUSAN DENTZER: Thanks, Elizabeth.