AIDS: A CHALLENGE FOR THE PUBLIC HEALTH

Abstract

While the number of cases of acquired immunodeficiency syndrome (AIDS) has been increasing worldwide, the incidence in the United Kingdom (UK) is substantially lower than in the United States (US) and several other European countries. In the UK and US, the infection is confined largely to homosexual and bisexual men, persons who abuse drugs by injection, hemophiliacs, and sexual partners of members of these groups, including heterosexual men and women. Public education must focus on methods of transmission and control of the disease. The efficacy of testing for antibodies to the HTLV-III infection is questionable because there is no cure at present. Issues of confidentiality and denial of insurance or other support to persons who test positive must be considered.This discussion of acquired immune deficiency syndrome (AIDS) covers the incidence of AIDS in Europe and the US, the means of spread, the pattern of incidence of aids within the population, prevalence of specific antibodies, heterosexual transmission, AIDS and HTLV-III infection in Central Africa, control of spread of the infection (public education, counseling, treating for antibodies to HTLV-III, control of nonsexual transmismission, and surveillanc); and confidentiality and other social issues. To judge by reported cases, the incidence of AIDS in the UK is at present substantially lower than in the US and in several other European countries. Up until September 30, 1985, the UK ranked 9th among 21 reporting European countries. Cumulative incidence rates almost 3 times the UK rate of 4.0 cases/million population have been reported Belgium (11.9), Denmark (11.2), and Switzerland (11.8). At a comparable date the cumulative incidence in the US was about 55/million. In the K as in the US, the infection is at present largely confined to homosexual and bisexual men, persons who abuse drugs by injection, Hemophiliacs, and sexual partners of these groups. Yet, since transmission can occur as a result of vaginal intercourse, public health policy must take into account the fact that heterosexual men and women in general also may possibly be risk. In view of the long latent period, the pattern of occurrence of positive antibody tests is a better guide to the future course of the epidemic than the number of cases of AIDS. The British serological data show that HTLV-III infection has increased in prevalence among homosexuals both in London and elsewhere. The average figure for 1984-85 in male homosexual attenders at genitourinary medicine was 21%. In drug abusers the comparable figure is lower (10%), but the recent report of prevalence rates in excess of 50% in Edinburgh drug addicts is an ominous development. The prevalence of antibody in hemophiliacs (31%) has not increased since 1984. In the absence of a vaccine or effective antiviral agents, public education to help people avoid risky sexual behavior and drug abuse is the mainstay of a policy for controlling the spread of infection. Such programs must meet the different needs of the general population, of the risk groups, and of adolescents. They also must include facts about how HTLV-III is and is not transmitted, practical advice on its avoidance, and advice to infected persons to help them avoid infecting others. If the use of serotesting is to be promoted for the control of infection, there willneed to be prior agreement about its efficacy.