At the conclusion of the VII International Conference on
AIDS in Florence, Italy in June 1991, Dr. Hiroshi Nakajima,
Director General of the World Health Organization, highlighted
the urgency of the research and practical application of the work
being done by the conference participants by characterizing
AIDSand the spread of HIV as a global public health threat of
unprecedented magnitude.
Across the world church-related public health specialists,
health workers and missionaries are working in cities and regions
where HIV infection and AIDS are endemic. The following
information has been prepared for these individuals and the
members of the HIV/AIDS Ministries Network. This Focus Paper
updates the global AIDS pandemic's facts and figures which were
presented in 1989 as Focus Paper #1 and provides additional
information on the worldwide social and economic impact of
HIV/AIDS including a special emphasis on pregnancy and HIV
infection and on maternal-to-fetus/infant transmission.
1. AIDS CASES WORLDWIDE
A cumulative global total of 366,455 cases of AIDS has been
reported from 180 countries as of June 1, 1991. These figures
represent known cases.
Delays in reporting, under-reporting, and under-recognition
of existing cases, affects the accuracy of case totals in every
region. As many as 50% of the countries in some regions have
notupdated their case reports since 12/90.
2. NUMBER WORLDWIDE INFECTED WITH HIV
The World Health Organization estimates that 9 million
adults have been infected worldwide with the Human
Immunodeficiency Virus and that by the year 2000, the number of
people infected worldwide will reach 40 million. (See Exhibit 1
for a graphic depiction of the Estimated Global Distribution of
Adult HIV Infection as of mid-1991; and Exhibit 2 for Cumulative
Estimates/Projections of Adult HIV Infections through 1994,
Source: WHO 9/91.)
BREAKDOWN: A partial breakdown of the worldwide figures
indicates that in the U.S. up to 1 million are thought to be
infected; in Europe, well over 1/2 million; in sub-Saharan Africa
6 million adults and 900,000 children; and in South/South-East
Asia at least 1/2 million.
3. HIV INFECTION AND AIDS
The human immunodeficiency virus (HIV) is the causative
agent of acquired immunodeficiency syndrome (AIDS). HIV
preferentially infects lymphocytes and monocytes. By destroying
these cells, HIV infection can lead to progressive impairment of
the immune system, making an individual susceptible to
infections, such as tuberculosis and candidiasis, and cancers. In
addition, HIV infects cells of the central nervous system
ultimately causing neurological disturbances. An HIV infected
person with one or a combination of specific infections, cancers,
dementia or wasting syndrome is diagnosed as having AIDS.
AIDS represents the late stage of HIV infection. Most
people infected with HIV are asymptomatic for long periods of
time and may not know they are infected. Infected persons can
transmit the virus to others by sexual intercourse or donating
semen; by donating blood, organs or tissues; by sharing
contaminated needles or syringes, as well as during pregnancy or
delivery by mother-to-fetus/infant transmission.
Clinical signs and symptoms of HIV infection are caused by
diseases that occur because of impairment of the immune system
and by the virus itself. A few weeks after infection, some
people may experience symptoms such as fever, enlarged lymph
glands, skin rash and cough. These symptoms, when they are
present, develop at about the time antibodies produced by the
body against HIV can first be detected. An asymptomatic period
that lasts a few months to many years follows the initial
response to infection. Why some people remain without symptoms
is not well understood. However, during this asymptomatic period
HIV usually causes progressive deterioration of the immune system
until the person eventually develops signs and symptoms of
wasting syndrome, opportunistic infections and cancers and the
diagnosis of AIDS is made. HIV infection can be confirmed only
with a blood test. The fatality rate for AIDS remains very high
-- close to 100%.
3. INFECTION AND DISEASE MANIFESTATION
The incubation period before any symptoms of HIV related
illness appear varies significantly from person to person. Some
develop symptoms within six months to two years of exposure. Many
others, however, may be infected for as many as seven to ten
years or more and show no signs of illness.
4. TIME PERIODS
LENGTH OF INFECTIVITY: Worldwide it is assumed that once a
person is infected with the virus he/she will remain infected for
the duration of his/her life and will be capable of transmitting
the virus to others.
INFECTION TO ANTIBODY PRODUCTION: Antibodies produced by
the body against HIV usually appear within six (6) months after
infection and perhaps as early as two (2) weeks.
INFECTION TO DISEASE: The proportion of HIV infected
persons who will eventually develop AIDS is not known. Some
researchers postulate that over a longer time span some 75
percent or more of those infected might move from infection to
disease if effective antiretroviral treatment is not started
relatively soon after infection.
The average period from infection to the development of AIDS
is estimated to be between eight (8) and ten (10) years or more
in industrialized countries, but much shorter in other regions.
DISEASE MANIFESTATION TO DEATH: The interval between
diagnosis of AIDS to death varies greatly: in industrialized
countries 50 percent of persons with AIDS die within 18 months of
diagnosis, and 80 percent within 36 months. (See below regarding
therapeutic agents and viral/disease progression.)
Survival times appear to be shorter in all countries where
diagnosis takes place later into the disease; where care is
limited, unaffordable, or inaccessible; or where one's health
status is already compromised by other health problems.
THERAPEUTIC AGENTS AND VIRAL/DISEASE PROGRESSION: In
regions where effective therapeutic agents such as AZT,
aerosolized pentamidine, ganciclovir, DDI, Kemron and other
agents are being administered soon after HIV infection, viral and
disease progression are slowed and acute illness might be
avoided.
5. ORIGIN OF CAUSATIVE VIRUS
The origin of HIV is not known. In 1987 the World Health
Assembly stated that HIV is a "naturally occurring retrovirus of
undetermined geographical origin".
Two Human Immunodeficiency Viruses have been implicated
inthe spread of AIDS. The original virus is referred to as
HIV-1. A related virus, referred to as HIV-2, was discovered in
West Africa in 1985.
Almost all known cases of AIDS worldwide have been caused by
HIV-1. Relatively little is known about HIV-2. It seems,
however, that HIV-2 causes the same clinical signs and symptoms
as HIV-1, including AIDS. HIV-2 is transmitted by the same
routes as HIV-1. The genetic structure of HIVs-1 and -2 are
similar. HIV-2 and its effects may not be exactly the same as
HIV-1. HIV-2 may not be transmitted as often as HIV-1 from
mother to child, and persons with HIV-2 may not progress to AIDS
as rapidly as those infected with HIV-1.
VIRULENCE AND INFECTIVITY: Research indicates that the
virulence and infectivity of HIV increase the longer an
individual is infected making early intervention with
antiretroviral agents increasingly important.
6. MODES OF VIRUS TRANSMISSION ARE SIMILAR WORLDWIDE
Studies continue to show three main modes of transmission:
þ By sexual intercourse (vaginal, oral or anal: male to
female, female to male, male to male, female to
female) with an infected person.
þ By the injection or administration of infected blood or
other means of blood to blood contact; and through
donated semen, organs and tissue.
þ From an infected woman to her baby during pregnancy and
/ or childbirth. Incidences of virus transmission via
breast-feeding have been documented.
7. NATURAL IMMUNITY OR HEIGHTENED SUSCEPTIBILITY
No genetic predisposition has been identified among any
group either for: an increased susceptibility to infection; a
greater capacity to disseminate the virus or; a natural immunity
from the virus. There are some aggravating co-factors which are
thought to explain possible differences in susceptibility to HIV
infection.
þ Individuals whose immune systems have been frequently
activated by other chronic infections might be at
higher risk upon exposure to HIV;
þ The presence of other sexually transmitted diseases
seems to increase the Risk of HIV infection and;
þ Repeated exposure to the virus increases the risk of
infection.
8. WORLDWIDE PATTERNS OF INFECTION
Three infection patterns of HIV have been documented
worldwide.
PATTERN I: Typical of industrialized countries with large numbers
of AIDS cases having been reported. Includes the following
industrialized regions and countries: North America, Western
Europe, Australia, and New Zealand
Initial Spread of HIV: Probably began in the late 1970s
MODES OF VIRUS TRANSMISSION:
Male homosexual/bisexual intercourse and injection drug use,
especially in urban areas. Heterosexual intercourse remains
responsible for a smaller percentage of cases, but is increasing
especially in regard to the sex partners of injection drug users.
Some transmission due to the transfusion of infected blood
and blood products between the late 1970's and 1985 before blood
collection centers began screening blood for the presence of
antibodies to HIV; and through the transplantation of infected
organs and tissues; and the receipt of infected donated semen.
Male to Female Ratio of Reported Cases: Ranges from 10 (m) to 1
(f) - to 15 (m) to 1 (f).
Perinatal (Mother to Child) Transmission:
A definite mode of transmission, but because relatively
fewer women are infected to date in Pattern I countries,
perinatal transmission is not as prevalent as in Pattern II
countries.
OVERALL RATE OF INFECTION:
In North America it is estimated that 1 out of every 75
adult males in infected and that 1 out of every 700 women is
infected. Estimates for Western Europe are that 1 out of every
200 adult males is infected and 1 out of every 1400 women is
infected. In some groups, however, which practice high-risk
behaviors infection is estimated to be as high as 30 - 50
percent: e.g. among men with multiple male sex partners and
injection drug users who share infected needles, syringes and
works.
PATTERN II:
Countries Include: In sub-Saharan Africa, Pattern II prevails in
the large urban areas of central, eastern and southern Africa;
and in West Africa where HIV-2 infections are more common than
HIV-1.
Initial Spread of HIV: Extensive spread of HIV-1 began in the
late 1970's, with HIV-2 being identified in West Africa in 1985.
MODES OF VIRUS TRANSMISSION:
Heterosexual intercourse is the major mode of transmission.
Perinatal transmission is common. The transfusion of infected
blood or blood products, the use of infected needles or other
skin-piercing instruments for medical purposes or as a part of
traditional practices accounts for a portion of HIV infections.
It has been postulated that ritual female circumcision and
scarification could be important factors in the spread of HIV,
though the areas where such practices are carried out do not
generally coincide with the areas where HIV or AIDS is currently
most prevalent. Homosexual intercourse and injection drug use
are nearly absent.
Male to Female Ratio of Reported Cases: Because
heterosexual intercourse is the major transmission mode it is
estimated that the ratio is 1 (m) to 1 (f). (For every male
infected there is an infected female.)
Perinatal (Mother to Child) Transmission:
Common mode of transmission owing to high infection rates
among women. In some of the urban centers, 10 to 20 percent of
the females of childbearing age might already be infected. Child
mortality rates could increase by as much as 25 - 50 percent,
nullifying many of the child survival program gains achieved over
the past two decades.
OVERALL RATE OF INFECTION:
Overall number of adults infected is estimated at 6 million
with 1 out of every 40 adult males infected, and 1 out of every
40 women infected. Surveillance in some urban areas reveals that
infection rates among some persons involved in prostitution for
economic reasons is high, and that 30 - 50 percent of all
patients in the medical wards of hospitals in Kinshasa, Zaire;
Nairobi, Kenya and Butare, Rwanda are infected.
PATTERN I/II:
Countries in the Caribbean and Latin America are now
classified as Pattern I/II countries owing to changing
transmission patterns. Extensive spread of HIV probably began in
the early 1980's initially among homosexual males and injection
drug users. During the latter part of the 80's, heterosexual
transmission of HIV increased to become a major mode of
transmission.
OVERALL RATE OF INFECTION:
Overall number of adults thought to be infected is estimated
at 1 million with 1 out of every 125 adult males infected and 1
out of every 500 women infected. Mother-to-fetus/infant
transmission is increasing owing to the increase of heterosexual
transmission and the resulting increase in the number of women of
child-bearing age who are infected.
PATTERN III:
Includes: Areas of Eastern Europe, North Africa, the Middle East,
Asia and most of the Pacific (excluding Australia and New Zealand
which are Pattern I countries).
Initial Spread of HIV: Probably in the early to mid 1980's with
only a small number of AIDS cases having been reported to date.
MODES OF VIRUS TRANSMISSION:
Reported cases of AIDS in Pattern III countries can be
traced to high-risk behaviors such as injection drug use,
homosexual and heterosexual contact with infected persons;
transfusion with contaminated blood; and reuse of unsterilized
injection equipment.
Extensive spread of HIV is being documented in several
countries of South-East Asia, but the overall prevalence of HIV
in most Pattern III countries remains low in contrast to the
large population mass living in these countries.
OVERALL RATE OF INFECTION:
To date, less than 1% of all AIDS cases have been reported
to WHO from Pattern III countries.
9. PREGNANCY, HIV INFECTION, AND MATERNAL-TO-FETUS/INFANT
TRANSMISSION
Most children infected with HIV, including those with AIDS,
have been infected by mother-to-fetus/infant transmission. Such
transmission can occur during pregnancy, at delivery, or during
the postpartum period. Detection of HIV in fetal tissue supports
the hypothesis that infection can occur in utero. Also, HIV
transmission could possibly occur during birth through exposure
to infected maternal blood or vaginal secretions. A few
well-documented cases of HIV transmission through breast-feeding
have been reported.
It is difficult to determine whether a newborn infant is
infected. The maternal HIV antibody is passively transmitted
across the placenta to the fetus during pregnancy. This antibody
persists in the infant postnatally for as long as 18 months.
Consequently, during this period, the detection of HIV antibody
in infants does not necessarily mean that the infants are
infected.
The transmission rate of HIV infection from
mother-to-fetus/infant during pregnancy and at the time of
delivery is probably between 20% and 45%. However, most of the
HIV-infected women in research studies have been asymptomatic.
The occurrence of symptomatic infection in mothers probably
presents a much greater risk of HIV transmission to the
fetus/infant.
Earlier studies indicated that caesarean sections may reduce
mother-to- fetus/infant transmission. Current studies indicate
that this is not so.
EFFECTS OF HIV INFECTION ON PREGNANCY AND VICE VERSA
Early in HIV infection, when women are asymptomatic,
pregnancy has little, if any, effect on the clinical course of
HIV infection and similarly HIV infection probably has little, if
any, effect on the complications and outcomes of pregnancy. This
may not be the case later in HIV infection, especially when women
have severe immuno-deficiency and/or AIDS.
Pregnancies in women with AIDS are often complicated
especially by premature labor, as might be expected in seriously
ill or debilitated women.
CARING FOR PREGNANT HIV INFECTED WOMEN
HIV infection and AIDS in women occur primarily during their
reproductive years. Approximately 85% of women will become
pregnant and many will receive prenatal care or care at the time
of delivery from MCH/FP service providers.
These service providers can introduce preventive strategies
that provide practical ways to substantially reduce risk, even if
they do not eliminate it entirely. MCH/FP care providers have
two principal tasks to accomplish with regard to prevention: to
teach women how to reduce the risks of becoming infected and to
motivate them to use the information effectively. Successful
prevention of HIV transmission, however, requires that men be
educated about the impact of HIV infection on their families and
communities, and take all precautions from either becoming
infected or transmitting the virus to others.
STRATEGIES TO REDUCE THE NEED FOR BLOOD TRANSFUSIONS AT THE TIME
OF DELIVERY
In areas where blood for transfusions may be infected with
HIV, strategies to reduce the need for blood transfusions at the
time of delivery are especially important to reduce the risk of
HIV infection in women.
The need for transfusions can be reduced by increasing the
iron stores of pregnant women, so that blood loss at delivery is
better tolerated. Iron stores can be increased during pregnancy
in the following ways:
þ by using oral iron supplements, folic acid and foods
with high iron content, such as, green, leafy
vegetables;
þ by prescribing injectable iron for women with severe
anemia;
þ by using antimalarials for chemoprophylaxis; and
þ by diagnosing and treating, as early as possible,
anemia and diseases which cause anemia, such as,
malaria, hookworm and other parasitic diseases.
The need for transfusions can also be reduced at the time of
delivery. Well-timed episiotomy when indicated, active
management of the third stage of labor and prompt repair of
lacerations and episiotomies can reduce blood loss. In addition,
to reduce the risk of HIV infection from blood transfusion,
acute blood loss may be managed through the use of normal saline
and plasma expanders rather than packed red blood cells or whole
blood. In most cases, replacement of blood volume rather than
replacement of red blood cells is needed, and plasma expanders
are safer, less expensive and can be transfused faster. Finally,
only women who have both a low hemoglobin level and symptoms of
acute blood loss or severe anemia should be transfused.
CONTINUATION OF BREAST-FEEDING
The number of reported cases of HIV transmission by
breast-feeding remains relatively small, but they are well
documented and provide clinical histories consistent with HIV
infection acquired shortly after birth. For instance, in some of
these cases, HIV-negative women were transfused postpartum with
HIV- infected blood. Subsequently, they infected their infants
through breast-feeding. Moreover, several studies have
demonstrated the presence of HIV in the breast milk of infected
women.
Although HIV transmission by breast-feeding occurs, the
relative contribution of this route to the total number of
HIV-infected cases in children is probably very small, compared
with in utero and intrapartum transmission. This risk must be
weighed against the well-recognized immunological, nutritional,
psychological and child-spacing benefits of breast milk and
breast-feeding. Breast milk is also important in preventing
intercurrent infections which could accelerate progression of
HIV-related disease in already infected infants. Unlike the
cases described above, the more common situation facing health
workers is the infant born to a mother who has been infected
throughout pregnancy and delivery; the additional risk of such an
infant acquiring HIV-infection via breast-feeding, if any, is
low.
WHO advises MCH/FP service providers to remember the
following facts about breast-feeding and HIV infection. The rate
of transmission of HIV through breast-feeding is low. In many
situations, the risks of not breast-feeding far outweigh the risk
of HIV transmission. Thus particularly in situations where the
safe and effective use of alternatives is not possible,
breast-feeding by the biological mother should continue to be the
feeding method of choice, irrespective of her HIV infection.
10. WORLDWIDE SOCIAL AND ECONOMIC IMPACT OF HIV/AIDS
Ten years into the global HIV/AIDS pandemic every
significantly affected country and region is experiencing
economic, social, demographic, and political ramifications. The
following outlines some of the most critical areas of concern.
WOMEN AND CHILDREN:
Women and children are being increasingly affected by the
growing AIDS pandemic. In the 1980's, 500,000 AIDS cases in
women and children are believed to have occurred, while in the
1990's an additional 3 million women and children are expected to
die of AIDS. AIDS is presently considered the leading cause of
death in women aged 20-40 in certain cities in sub-Saharan
Africa, Western Europe and the Americas.
In some Caribbean and African countries, 10 percent of
persons with AIDS are children under age 5. By the end of the
century, WHO estimates that up to 10 million children will have
contracted HIV, with the vast majority of them dying by the year
2000. In addition, WHO predicts that worldwide 10 million
uninfected children under the age of 10 will, by the year 2000,
be orphaned due to AIDS as their parents develop and die from the
disease.
FEMALE INFECTION RATES AND INFANT MORTALITY:
"In a population with an under-five mortality rate of 100
per 1,000, if 5% of CBA (child-bearing age) women are infected
with HIV, child mortality rates rise by 9%; if 10% of CBA women
are infected, child mortality rises by 18%; and if 20% of CBA
women are infected, child mortality increases by 36%.
"In a heavily affected area such as Kampala, Uganda, where
surveys of pregnant women have documented an HIV seroprevalence
of 24%, HIV/AIDS causes the infant mortality rate to increase by
up to 38% and may nearly double the under- five-year child
mortality rate.
"High rates of infection among pregnant women are not
limited to Africa or the Caribbean. Surveys of pregnant women in
selected settings in parts of the United States has found high
rates of HIV infection Newark (4.3%), Miami (3.6%), New York
(3.1%), and Boston (1.7%)."
DEMOGRAPHIC IMPACT:
Most research on the demographic impact of HIV has focused
on sub-Saharan Africa, because in that continent, HIV has spread
heterosexually affecting whole families and communities.
"Researchers have designed mathematical models to simulate
the spread of HIV infection in a country with a pre-AIDS
population growth rate (i.e. 3-4%), where heterosexual
transmission is the predominant means of transmission.
"These models have shown that HIV infection is capable of
reducing population growth rates and altering the overall age
structure of a society. Eventually, 'if HIV infections continue
to increase in urban areas and spread extensively in rural areas,
then the potential for a negative population growth rate will be
present' according to the World Health Organization.
"Mathematical models suggest that AIDS will not cause a
population growth rate to turn negative until at least two or
three decades after HIV has begun to spread in the population:
the full impact of the disease thus has yet to be seen."
Premature death rates among CBA women owing to HIV/AIDS will
further increase the impact of HIV on population growth rates.
"This impact is greater the earlier a woman acquires
HIV-infection. The younger a woman dies, the fewer children she
is likely to have. Data from some countries shows that many
women are becoming infected while teenagers.
"The impact of HIV on population growth will be exacerbated
by unequal transmission rates for HIV. Some studies have already
suggested that transmission of HIV is easier from men to women
than from women to men, although data from a larger number of
people is required to draw firm conclusions.
"The spread of HIV will alter the age structure of society
by changing the proportions of young or elderly dependents and
working adults. In developing countries, for each working adult
who dies, proportionately more children are left dependent than
in an industrialized country.
Changes in the age structure of a society could, in turn,
have an impact on labor supply and agricultural productivity."
Implications for food production, agricultural extension and
small farm assistance need to be addressed and the problems that
could arise in certain areas because of the impact of HIV/AIDS.
MORTALITY RATES:
Lives lost among the age-groups (ages 20 to 49) will rise
several-fold in severely affected Pattern I and Pattern II areas
as a result of HIV/AIDS. This selective impact on young and
middle age labor force adults has the potential for grave
economic consequences. High rates of HIV maternal mortality and
morbidity will leave larger and larger numbers of children
without their primary care provider. A Kinshasa, Zaire research
report presented in June 1990 predicts as many as 5.5 million
AIDS orphans in 10 African countries by the year 2000.
STRESS ON FAMILY AND EXTENDED FAMILY STRUCTURES:
Increased stress will be found within every cultural group
in which the immediate and extended family remain the traditional
structure of care when family members/loved ones are ill. The
situation will be particularly grave in regions/countries where
the family is the main or only system of social security and
care.
ECONOMIC IMPACT:
The Harvard Institute of International Development estimates
that by 1995 the annual loss to Zaire from AIDS' deaths will be
$350 million, or 8 percent of the country's 1984 G.N.P.; this is
more than Zaire received in that year from all sources of
development assistance combined. The same study estimates that
economic losses in central Africa by 1995 will be $980 million
which could result in the political destabilization of the
countries involved.
HEALTH SYSTEM IMPACT:
Taking Africa as an example, the estimated cumulative AIDS
case load in Africa yearly by the mid 1990's will be more than
100,000. Health care systems in developing African countries
have been hard pressed to cope with existing case loads. It is
not known how these health care systems will be able to manage
the additional 400,000 cases projected within the next five years
in urban and rural areas combined.
The estimated cost of caring for each person with AIDS in
Africa ranges from $US100 to $US1,500. Place this against the
reality that in Africa, government per capita spending on health
care varies from $US1 to $US10 per year. One ELISA test for HIV
antibodies in Africa costs $1US, while one machine for testing
blood samples can cost up to $1,500.
The cost of securing, distributing, administering, and
monitoring the effects of therapeutic antiretroviral and
antitumor agents such as AZT, Kemron and other alpha interferons
early after HIV infection falls beyond the means of the health
economies of developing countries.
11. WORLD HEALTH ORGANIZATION'S GLOBAL AIDS STRATEGY
The global program against AIDS, being coordinated by the
World Health Organization, has three major objectives:
þ To prevent new HIV infections.
þ To provide support and care to those already infected.
þ To link national and international efforts against
HIV/AIDS.
PREVENTING NEW INFECTIONS:
This objective is achievable in principle because the modes
of HIV are known and include readily identifiable and mostly
voluntary behaviors. Information and education programs are
needed in all countries and must be supplemented by health and
social services. (E.g. advocating the use of condoms is
pointless if condoms are not available, costly or of poor
quality. Advocating a change of behavior among injection drug
users is fruitless if treatment centers are not available.)
Prevention of new HIV infections through blood transfusions
is feasible. Simple and inexpensive screening assays for HIV
infection appropriate for use in the developing world are being
tested and distributed.
The prevention of perinatal transmission depends primarily
on protecting CBA women from HIV infection. Dealing with issues
of childbearing, contraception and family planning calls for
varied approaches adapted to the cultural background of the
population.
PROVIDING SUPPORT AND CARE FOR THOSE ALREADY INFECTED AND ILL:
To reduce the personal and public impact of HIV infection
means giving persons with HIV/AIDS humane care of a quality at
least equal to that provided in each society for other diseases.
Counseling, social support and services must be available to
all infected individuals. HIV infected persons must not be
discriminated against; the rights and dignity of these people
must be protected to ensure that HIV/AIDS programs can be
effective and that the HIV/AIDS problem is not simply driven
underground.
Supporting families in their careproviding role in all
societies and cultures is essential, especially in those regions
where the immediate and extended family is the primary form of
social and communal security.
LINKING NATIONAL AND INTERNATIONAL EFFORTS AGAINST AIDS:
More than 183 countries are receiving support from the WHO's
Global Program on AIDS. Scientific consensus has led to plans to
coordinate international drug trials of therapeutic agents and
HIV/AIDS vaccines as they become available for field testing.
-------------------------------------------------------------------------------------------------
REPORTED AIDS CASES AS OF JUNE 1, 1991
From WHO Global Programme on AIDS Report
REGION NUMBER OF CASES
Africa 92,922
Americas 217,729
Asia 1,088
Europe 51,914
Oceania 2,802
TOTAL 366,455
