THE GLOBAL EPIDEMIC

By ANDREW PURVIS

While researchers were celebrating the latest AIDS advances in Vancouver this summer, Rosemary Omuga had other things on her mind. Since testing positive for HIV in 1992, the Kenyan mother of four has lost both her job as a midwife and her home. Today she barely earns enough to keep her children alive and cover her $12 monthly rent on a tin-roof shack in one of Nairobi's most fetid slums. Treating her illness is low on her list of priorities. In a good week, when she gets paid to give talks about AIDS to employees of the local railway company, she manages to scrimp enough to buy a palliative for her recurrent diarrhea or a dose of the latest herbal AIDS "cure." But even those she considers luxuries. "We are dying because we don't have medicines," she says. "I heard that there are new treatments. But I cannot afford them."

For Omuga, this year's good news on AIDS underscores a bitter truth: the new combination therapies are of little use to 90% of the people suffering from the disease. In Africa, India, Thailand and to a growing extent Central and Eastern Europe, the treatment's price tag of up to $20,000 a year puts it way beyond the grasp of all but the superrich. "With this discovery, the AIDS gap only becomes wider," laments Dr. Peter Piot, executive director of the U.N.'s AIDS program. To most AIDS researchers, it has become painfully obvious that drugs of any kind, no matter how effective, are not the solution to the world's deadliest epidemic. But a vaccine, which would address the problem, is not a top priority in Western laboratories. Indeed, with the new optimism on AIDS, some are beginning to talk about reducing funding for basic research. That, according to Piot, would be a fatal error. "As long as HIV exists somewhere in the world," he says, "it threatens us all."

Meanwhile, AIDS is tightening its grip outside the U.S. and Western Europe. In India, researchers estimate that by the year 2000, anywhere from 15 million to 50 million people could be HIV positive. Half the prostitutes in Bombay are already infected, and doctors report that the disease is spreading along major truck routes and into rural areas, as migrant workers bring the virus home. In Central and Eastern Europe, countries that had largely escaped the epidemic are seeing an explosion in the number of cases, mainly among IV drug users and their heterosexual contacts.

And then there is Africa, across much of which the disease continues to rage unchecked. Already the sub-Saharan region accounts for more than 60% of people living with HIV worldwide, or some 14 million men, women and children. As many people will die there this year from the disease as were massacred two years ago in the Rwandan holocaust. The social consequences of this die-off are catastrophic. By the year 2000, nearly 2 million children in Kenya, Rwanda, Uganda and Zambia will have lost their parents to the disease.

For the majority of those with HIV outside the U.S. and Europe, the cost of the new "cocktail" treatments seems a cruel joke. The average Kenyan would exhaust his annual income in less than a week on the regimen. In India, where the government imposes 100% to 150% customs duty on pharmaceuticals brought from overseas, even a two-drug treatment can run to $3,500 a month, or more than 75 times the monthly earnings of poor laborers, who are the prime victims of the disease. "The new drugs will help the yuppies of the world," says Thailand's Mechai Viravaidya, a parliament member and leading advocate of AIDS prevention in Bangkok, "but for most people with AIDS, it's like a dog looking up at an airplane: he can see it, but he can never get a seat."

A more effective alternative is prevention, through public education and safe-sex programs. Such efforts have made some progress in recent years. In Uganda, which in the mid-1980s was the first African country to launch a genuine anti-AIDS campaign, billboards and government warnings appear to be paying off: HIV infections among young women dropped 35% between the periods 1990-1993 and 1994-1995. Elsewhere in Africa, however, and in some parts of Asia, similar programs have stalled, due to a combination of poverty, official indifference and, at times, paranoia. As a result, public understanding of even the most basic information about AIDS is still piecemeal. Most of those dying from the disease in rural parts of Africa have no clear idea of what is killing them, let alone how to prevent it.

Virtually every AIDS expert agrees that only an effective vaccine can halt the epidemic. Yet after more than a decade of trying to develop one, scientists have made little headway. The failure can be traced in part to the notorious craftiness of the virus itself. Researchers still aren't sure what part of the immune system confers protection against HIV, and until they are, they won't be able to induce immunity with a vaccine.

Yet the problem is only partly technical. It also lies in the priorities of those funding the research. Even after the announcement two weeks ago of a new AIDS-vaccine initiative at the U.S. National Institutes of Health, vaccine research remains the poor stepsister of the anti-AIDS effort. It still constitutes less than 10% of NIH's overall AIDS budget.

That is because those pushing hardest for AIDS research are Westerners who already have HIV, says the U.N.'s Piot. "Their primary concern is to find a cure," he says. "The same pressure hasn't been there for healthy people from the developing world." Private drug companies, for their part, have been disinclined to spend heavily on vaccine development because vaccines are generally less profitable. Piot explains, "In most countries, vaccines are purchased by governments, not by individuals. Taxpayers are footing the bill, which keeps prices down." The same is not true of therapeutics. According to a report by U.S. market researchers Frost and Sullivan, sales of antiviral drugs for AIDS and its accompanying infections reached $1.3 billion in 1995 alone.

Following this year's discoveries, public health experts have urged that more attention be paid to the hunt for a vaccine. Such an effort, Piot argues, should be undertaken not just on humanitarian grounds but also out of self-interest--since the only way to end the epidemic is to stop the virus wherever it lurks. The question remains whether governments, and taxpayers, will agree, to the tune of billions of dollars. Until they do, AIDS breakthroughs in the West will continue to be a distant murmur for people like Aline Disashi, an AIDS patient in Zaire. "Can we live off hope?" she asked one morning last month. The answer, unfortunately, is all too clear.

--With reporting by Peter Graff/Nairobi, Tim Larimer/Bangkok and Tim McGirk/New Delhi

With reporting by PETER GRAFF/NAIROBI, TIM LARIMER/BANGKOK AND TIM MCGIRK/NEW DELHI