Shame upon the earth
"AIDS is far more than a medical problem. AIDS is far more than a national problem. AIDS is far from over."
It might sound like something from the 1980s, accompanying the TV ads with the falling gravestones, inscribed with the ominous words "Don't die of ignorance", and pamphlets pushed through all our front doors. But as we approach the year 2000 it seems that AIDS has fallen away from the public consciousness and the glare of the media spotlight. The common attitude: we have drugs to control it, the epidemic never happened, and the only people who actually ever needed to worry about it were the "high risk" groups. AIDS is certainly a million miles away from the dreaming spires and us lot here in Oxford, right? But the above statement was actually made by Kofi Annan, UN Secretary General, this year. 33 million people now have HIV. More than 14 million have already died, 2.3 million last year alone. AIDS is now the world's fourth biggest killer. In Annan's words, "the AIDS emergency continues - and it continues to grow."
Earlier this year the United Nations stated that AIDS now causes more deaths than any other infectious disease. Its impact is beginning to rival that of the Black Death, and AIDS cases are far from reaching their peak. It is a simple virus in descriptive terms: HIV (Human Immunodeficiency Virus) weakens the human immune system, leaving it open to attack by a whole range of diseases which a HIV negative individual would fight off more easily - pneumonia, TB, bronchitis, to name a few. Once one of these diseases is diagnosed, the person has developed AIDS. This disease has, in the words of the UNAIDS director Peter Piot, been with us for just twenty years and "is already killing more people than any other infectious disease. It is the most formidable pathogen to confront modern medicine."
The effect of AIDS is most pronounced in the developing world. Africa stands shaken by AIDS: four or more young Africans are infected every four minutes, and every day five and a half thousand people are buried there as a result of AIDS. The life expectancy of a child born in Botswana is some thirty years shorter due to AIDS; a teacher dies of AIDS every other day in the Ivory Coast; and in Zimbabwe 2000 people die every week from AIDS - far more than might die in four jumbo jet crashes.
The epidemic is also expanding: five years ago, HIV was virtually unknown in Eastern Europe; now it is prevalent. It was thought that rural areas of India had been spared until recently, when it was revealed last year that half a million people in the southern state of Tamil Nadu (which has a population of 25 million) are already infected. HIV infection in East Asia and the Pacific, meanwhile, rose by 70% between 1996 and 1998.
The economic problems we are already accustomed to associating with the Third World are actually exacerbated by AIDS. Illness wreaks its effects in absenteeism, the decline of an already limited skilled labour force and in limiting the potential of countries in a trading market. It is predicted that the Kenyan gross domestic product, for instance, will be some 15% smaller by 2005 because of AIDS than would have otherwise have been the case. The effect of AIDS on Asia, an increasingly important world market, could be equally devastating, and the effects will be felt worldwide.
So what about the Western world? The total of number of reported HIV infections at the end of June this year was over 35,000 in the UK alone, and AIDS cases, over 16,000. The true numbers are likely to be much higher. There is still no cure, no vaccine and even no truly effective treatment for HIV infection of AIDS. Various drug treatments, typically in "cocktail" format, have made a difference to people's life expectancy and standard of living. The onset of AIDS can be delayed, and the risk of mother-child HIV transmission can be reduced, though the long term effects of the drugs on mothers and children is not yet clear. Neither do we know for how long, or how well, the drugs will work. We must also remember the side effects of the vast majority of these new drugs, from nausea to the simple constant reminder of HIV status that they provide. HIV is also constantly mutating, providing new challenges to science to stay ahead. Even now we do not fully understand how AIDS acts to compromise the immune system: reports from November this year show that when standard tests cannot detect HIV infection it is actually still at work, replicating, within the body. This suggests that current therapy is not actually effective enough to stop new cells from becoming infected. Certainly at this stage our "drug cocktails" are far from a magic answer to the AIDS problem. Even if they were, they would be an unfeasible answer to the problem in the developing world: as Annan put it, "the $10,000 - $60,000 annual price tag of an anti-retroviral regime belongs, quite simply, to a different galaxy." Even if the price obstacle could be overcome, most countries where AIDS is an acute problem simply do not have a sufficient health infrastructure to ensure that the drugs are distributed and taken properly. If taken improperly then the risk of developing drug resistance is increased.
The impact of AIDS is, of course, compounded by the attitudes with which it is still associated. There have been spurts of concern and action in the Western World: the Freddie Mercury tribute concert in 1992 saw the first appearance of the Red Ribbon, the international symbol of AIDS Awareness, in the UK, and donations to AIDS charities rose dramatically in the wake of the death of Diana, Princess of Wales, an advocate of the AIDS cause. But AIDS charities generally struggle to raise money. The Mercury Phoenix Trust, founded in memory of Freddie Mercury and attempting to instigate the first UK national street collection for AIDS, suffer a combination of blank looks and downright abuse when they shake their tins at the general public every year. It is an accurate reflection of the fact that in some parts of Africa, the name for AIDS translates as "shame has fallen on the Earth". In Zimbabwe, for example, the shame of AIDS is clear. Here Oxford University's Simon Gregson is working with the Mutasa Project, which attempts to investigate the efficacy of HIV prevention strategies. The Project is not only faced with locals' fears that researchers are actually taking blood samples for satanic purposes, but also with denial that HIV is even a problem. This trend is being forcefully changed, though, as a consequence of the painful observation that the number of people dying, and the number of funerals taking place, is increasing. AIDS, over all sexually transmitted disease, carries a huge stigma.
That shame and stigma of prejudice and ignorance is undeniably present in our society too, and has stayed with us as deaths have risen and lives have been destroyed. AIDS presents us with a double target: the disease itself, and the shame which surrounds it. It is hard enough to fight the first, and it is a challenge for us to fight the second. Of course, this difficulty can be at least partly attributed to the still widespread perception of AIDS as a gay disease - when the disease first emerged, it was actually labelled GRID: Gay Related Immune Deficiency. But we now know this is not the case: the numbers of heterosexual cases are rising significantly, and are likely to further increase as the behaviour of a decade ago becomes manifest in new rates of HIV infection. Furthermore, it is not accurate to consider homosexuals a "high risk group": it is behaviour, and not people, which are high risk. Non-protected intercourse, no matter what gender the participants are, is going to be much more risky than protected intercourse. Blame or responsibility is not the issue: the most effective weapons which we have against HIV infection are information and education about safer sex. Condoms are far cheaper and easier to use than any potential AIDS treatment.
The future for living in a world with AIDS, though, is not a totally gloomy prospect: in Africa governments are beginning to increase budgets, change policies and declare war on AIDS "not in words only, but in deeds". Businesses such as Glaxo Wellcome, working in conjunction with UNAIDS, the World Health Organisation, the Global Business Council, governments and individuals such as Bill Gates (who has donated $25 million) have supported programmes which spread AIDS awareness material across the world. Last year all Virgin airline services distributed Red Ribbons and information to staff and customers. December 1st of this year sees the twelfth World AIDS Day, an international day of action designed to raise public awareness of all issues surrounding HIV and AIDS on a national and global scale. And yes, that includes Oxford.
The new millennium is full of opportunities for the world, but it must also face up to serious challenge in terms of the growing AIDS epidemic. Even if the falling tombstones of the 1980s have not stayed with us, then perhaps Kofi Annan's message will: "Shame will indeed fall on the Earth if we turn our backs on those affected by AIDS and cast them into the shadows. Shame will fall on all of us if we do not wipe out every trace of prejudice and discrimination surrounding this disease... Is the choice really so hard?"
18th Nov 1999