Mobilizing and unifying national and international efforts against AIDS to prevent infection and to reduce the personal and social impact of HIV infection.
HIV (Human Immuno-deficiency Virus) is the virus that caused AIDS (Acquired Immune Deficiency Syndrome). HIV can be passed in these ways: (1) through unprotected sex with an infected person; (2) by sharing needles and other equipment with an infected person; (3) through infected medical and dental instruments; (4) by blood transfusion with HIV infected blood; (5) from an infected mother to her baby during pregnancy, at birth or when breastfeeding.
Every day, 8,500 people in the world are infected by HIV. About 1,000 of them are children. Most of them live in the poor parts of the world, mainly in Africa and South-east Asia. In a number of countries in southern Africa, 50% of all women aged 25 to 29 may be infected. One third of all children born to infected mothers carry the virus. And many of the children who are not infected risk being orphaned and may contact AIDS as street children. The AIDS epidemic has already become a dominant public health concern in many countries. Although HIV, the virus that causes AIDS, has only recently begun to spread through human populations, it has so far caused 2 million deaths and infected about 13 million individuals.
Some parts of the developing world are already heavily infected: in Sub-Saharan Africa an average of one in forty adults has the virus, and in certain cities the rate is one in three. In Thailand one adult in fifty is infected. More than 90% of the infected individuals are in their economically most productive years, ages 15-40. They will be developing AIDS and dying over the nest decade. Projections of the future course of the epidemic are gloomy: conservative estimates from WHO are that by 2000, 26 million individuals will be HIV-infected and 1.8 million a year will die of AIDS. By destroying individuals' immune systems, HIV also vastly worsens the spread of other diseases, especially tuberculosis. Countries as diverse as Bangladesh, Ghana and Indonesia share the preconditions for rapid transmission of HIV—substantial numbers of prostitutes, high rates of promiscuity and/or polygamy, and prevalence of other sexually transmitted diseases (STDs, such as syphilis, gonorrhoea and chancroid, which facilitate the spread of the AIDS virus). In highly affected areas demand for AIDS treatment will overwhelm capacity for clinical treatment and cause a deterioration of care for other illnesses.
This strategy features in the framework of Agenda 21 as formulated at UNCED (Rio de Janeiro, 1992), now coordinated by the United Nations Commission on Sustainable Development and implemented through national and local authorities.
Public policy and attitudes play an important role in the fight against AIDS. In Thailand and Uganda, for example, where there is strong political leadership on AIDS issues, the spread of the disease has been greatly reduced, particularly among young people. The number of infected individuals among pregnant women has declined by half and young people are postponing their sexual debut. Strong public action is also required to reduce HIV transmission. Particularly important are efforts targeted to high-risk groups: information to promote change in sexual behaviour; distribution of free condoms; distribution of free bleach and clean needles to drug users, and treatment for other STDs. Early reduction in HIV transmission by high-risk individuals is very cost-effective, but later in an AIDS epidemic the cost-effectiveness of interventions declines substantially.
In 1993, the International Federation of Red Cross and Red Crescent Societies spent 596,155 Swiss francs on AIDS prevention, and care and support of HIV/AIDS infected people. During the year, youth and AIDS pilot projects were initiated in Jamaica, Ghana, and Benin.
In May 1997 President Clinton of the USA set a 10-year target for the discovery of an HIV vaccine, which he likened to the previous US project, to put a man on the moon. That target date of 2007 is looking increasingly unlikely. Scientists still disagree about how best to proceed, and about how to evaluate the existing state of knowledge about HIV vaccines. Total worldwide funds devoted to HIV vaccine research probably do not total more than $200-250 million a year, most of that in basic research rather than product development, and most aimed at the type of HIV predominant in the USA and Europe. The majority of the major international pharmaceutical companies remain wary about committing substantial funds to HIV vaccine research that takes account of the needs of developing countries.
Current expenditures on AIDS prevention in developing countries—totalling less than US$200 million a year—are woefully inadequate. Five to ten times this level of spending is needed to deal with the emerging epidemic.