The AIDS epidemic

The following editorial appeared in Friday's Washington Post:

WASHINGTON -- The AIDS epidemic is so horrible, so long-running and so apparently intractable that the temptation is to turn the head and shut the eyes. But writing off AIDS as part of the world's long list of tragic problems is at once too optimistic and too pessimistic. Too optimistic in the sense that, although the epidemic is 21 years old now, it is by no means static; unless the world takes action, it will get massively worse. Too pessimistic in the sense that, despite the disease's general advance, it is retreating in some areas; if the world counterattacks, it can save millions of lives.

Consider, first, how AIDS is spreading. Last year, according to the latest annual survey of the disease released this week by the United Nations, there were 3 million AIDS deaths and 5 million new HIV infections, so that the total number living with HIV rose to 40 million, and the ranks of AIDS orphans grew to 14 million. About one in three new infections reflects the advance of AIDS into regions like Asia and Eastern Europe, where prevalence rates are way below African levels and the potential for new infections correspondingly large. India, for example, has an HIV prevalence rate of around 0.4 percent. If that rate were to rise to 4.5 percent, the level in sub-Saharan Africa, an extra 42 million people would have been infected, doubling the epidemic's global toll.

But even this may underestimate the threat that AIDS poses, because Africa's rate of infection does not represent the upper limit of how bad things can get. Even the hardest hit parts of Africa -- countries such as Botswana, with a prevalence rate of 21 percent -- have not reached a plateau, contrary to some recent hopes. In 1997, the HIV rate among pregnant women in urban Botswana stood at 39 percent; by 2001 it had hit 45 percent; in the 25-29 age bracket, it reached an astonishing 56 percent. Transfer those infection rates to densely populated Asia and the mind boggles. There is almost no natural limit to the epidemic's capacity for destruction.

But there are human limits, imposed by determined people in some parts of the world. Senegal, Thailand and Uganda have long been the star counterattackers, but the U.N. report adds other countries to this honor roll. Cambodia reduced the infection rate among pregnant women by almost a third between 1997 and 2000. The Philippines has stopped the epidemic from really taking off. Brazil has established a legal right to free treatment, cutting the number of AIDS deaths by two-thirds between 1996 and 2000. Even badly run countries that can't seem to get other policies right have registered modest advances. In Zambia a concerted education campaign has halved the HIV rate among pregnant teen-agers in the space of five years.

AIDS, in sum, is an optional catastrophe: It may get several times worse over the next decade, or it may be brought under control. There is no necessary reason why, in the 15-24 year age group, condom use should be 87 percent in Namibia but only 15 percent in Nigeria; or why HIV rates among prostitutes have jumped in China's Guangxi province but not in Yunnan or Guangzhou. Fighting AIDS is essential, and possible. Fatalism is assuredly fatal.