SPECIAL REPORT -- NewsWeek 06.11.01
The plague that's killed 22 million isn't done with us yet. While we hunt for a vaccine, people continue to die -- from AIDS or the drugs intended to treat it. BY SHARON BEGLEY

AIDS:
A Twenty Year View

We had no idea. Throughout the world 36 million people—more than the population of Australia—are HIV-positive, including 800,000 to 900,000 in the United States (of whom an estimated 300,000 don’t know it).

AIDS is now the fourth leading cause of death globally, and the leading cause of death in Africa. There it has stolen a generation and imperiled the future: it robs economies of their workers, families of their support and children of their parents. In seven African countries, more than 20 percent of the 15- to 49-year-old population is infected with HIV: 20 percent in South Africa, and a mind-numbing 36 percent in Botswana. Zambia cannot train teachers fast enough to replace those killed by AIDS. Within 10 years, there will be 40 million AIDS orphans in Africa.

Asia remains comparatively untouched. Only Cambodia, Thailand and Burma have infection rates above 1 percent. But the pandemic may be like a typhoon gathering strength off an unsuspecting coast. India’s HIV rate of “only” 0.7 percent translates to 3.7 million infectious people. China predicts 5 million to 6 million HIV-positives by 2005. “With the current resources,” says Dr. Peter Piot of UNAIDS, “it is not going to be possible to contain this epidemic.”

Drugs won’t do it. At upwards of $15,000 a year, the regimen that has helped thousands of HIV-positive people in the United States and Europe is out of reach for most Africans and Asians. Even international pressure to make the meds available at cost is only a first step: without a public-health infrastructure, poor countries can’t distribute the drugs and track the patients. But even in the United States, “drugs cannot be seen as the ultimate solution,” says Dr. Michael Merson, director of the Center for Interdisciplinary Research on AIDS at Yale University. Already the meds are being foiled by HIV’s quick-change artistry. Susceptible strains mutate into drug-resistant strains. And there is another problem. “People who take the drugs feel better,” says Merson. “They see a decrease in their viral load, become confident the drugs work and then become more sexually active. When that happens, they may not practice safe sex.”

Safe sex. Although in 1986 William F. Buckley Jr. called for people with AIDS to be tattooed on their forearms and buttocks, public-health authorities had a less hysterical response: avoid infection by not sharing needles and by wearing a condom during sex. To an astonishing extent, people did. Being bombarded with the message that AIDS equals death “was a very strong motivator for people to change their behavior,” says James Nguyen of the San Francisco-based STOP AIDS Project.

Many of today’s teens and twentysomethings lack that motivation. “Young people are not nearly as terrified of [HIV/AIDS],” says Sean O’Brien Strub, founder of the magazine Poz. In a new survey of six American cities, researchers find that among young (age 23 to 29) men who have sex with men, 4.4 percent become newly infected with HIV every year. Among African-American men who have sex with men, the rate is 14.7 percent. The new face of HIV is young and female, like Promise, now 20. She had nonconsensual sex with her 22-year-old boyfriend when she was 16. “What makes you think it couldn’t happen to you?” she asks the high-school classes she visits for Health and Education for Youth. Among 13- to 19-year-olds, 64 percent of HIV-positives are female.

click to read: AIDS at 20

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