When the 1st case of AIDS was announced in 1981, nobody predicted a fast spreading, dramatic international epidemic.
This disease can today be defined a mainly sexually transmitted chronic viral infection, partly reversing the relation HIV virus – drug addiction - homosexuality. Today the HIV infection has become a greater international emergency than in the past, because it involves a world that can hardly be defined at risk, unlike drug addiction, homosexuality and other risky behavioural patterns. The so-called “normal” general population’s world is today seriously involved in the HIV epidemic as sexual freedom, intercontinental travel and the dramatic African and South East Asian endemicity make risks related with such mixing patterns statistically relevant. AIDS, the very obvious form of the HIV infection, has today dropped remarkably number-wise, but this data must not deceive us. The reduced yearly prevalence of AIDS cases is due to the effects of anti-retroviral treatment (HAART), which has significantly increased the survival rate of infected patients by partially reforming the immune system and depressing viral replication. In such terms the AIDS’ diagnosis is ONLY DELAYED, and what does this involve? A series of important medical problems that were not even imagined till recent years:

1) lipodystrophia;
2) early vascular alterations;
3) heart disease; and,
4) metabolic alterations.

The prolonged survival rate of patients treated with Haart’s therapy has made the question whether vascular diseases are pathologies of inflammatory and immunological origin intriguing and tragic. Experimental studies performed on patients treated with protease inhibitors have proved that this possibility is concrete and especially related to a heterogeneous series of variables.

The above stresses the concept that AIDS is an emergency! To understand the extent of this international emergency, suffice to recall how, in recent years, this real scourge has involved many aspects of the lives of entire populations, moving from health to an economic and social emergency of extreme international interest. In fact, the succession of articles and reports produced by international “intelligence services ” on this real disaster of our age is certainly alarming. Early in October Repubblica published an interesting article on a CIA report that was rightly defined a shock - the National Intelligence Council, an organization related with the CIA, had noticed that in five of the world’s most populated countries the marked increase in the number of individuals struck by AIDS even represented a potential threat for the safety of those regions and subsequently of the United States. It may seem paradoxical but military interest has become the main concern in a real human tragedy that was instead born of very complex social, economic and sanitary problems and matters of tradition. The epidemic’s development site made the difference in these issues. The report was drafted on information provided to the American Committee by governmental and non-governmental organizations of the countries in question (Nigeria, Ethiopia, China, India and Russia). In Nigeria, for example, the AIDS epidemic could trigger political tensions that would weaken the country’s peace-keeping role in Africa on behalf of the UN. The report reads: “the Nigerian army, worried over the great loss of highly specialized personnel due to AIDS, has introduced a special course to educate soldiers on how to prevent the disease”.

In 1991 in Ethiopia, once the war had ended, thousands of returning soldiers and prostitutes spread the virus and AIDS in villages and cities, causing an uncontrolled increase in the contagion. The sanitary systems of the countries studied are totally inadequate and require drastic changes in a short term - about seven years. But we must consider that disease-spreading methods differ greatly: in India it spread through heterosexual intercourse, in China mainly through infected emigrant workers and in Russia due to the frequent amnesties that freed infected prisoners and due to increased prostitution. The epidemic’s progress is always less when compared to what we see in Central and South Africa and in South East Asia - the worst off regions. Concerning HIV/AIDS cases in the world in 2001, estimated at about forty million: the greatest concentration is in fact noticed in subsaharian African regions with about 28,500,000 cases and in South East Asia with 8,100,000 cases, compared to 560,000 cases in Europe and 23,760,000 cases in the three Americas. 1,400,000 of the latter are only in Latin America. One realizes that it is a real disaster that particularly strikes the world’s economically weakest areas. AIDS is a disease that disrupts countries’ economies leaving behind a continent such as the African one totally devastated from an economic viewpoint. In Africa, in many communities especially in the SUBSAHARIAN AREA, over one fourth of adult workers is affected by AIDS and families who have to take care of an AIDS patient often deplete their small economic resources. A study conducted by Anita Alban, economist of the UN’s HIV programme, on certain urban centres along the Ivory Coast, revealed a dreadful truth. Families that take on the responsibility of looking after an AIDS patient whom the community cannot take on, face such an expense that they tend to save on the children’s education and, something even more disconcerting, they tend to reduce their food consumption by about 40% . Evidence of how African society greatly values interdependence can be found in certain studies conducted in three special geographical areas such as Abidjan, the capital of the Ivory Coast, the Ziwa Magharibi region in Tanzania and the Rakai district in Uganda.

These studies reveal how families become a real “supportive infrastructure” that offers special assistance to orphans, whose maintenance is not included in the state’s budget. But this mechanism of social defence against urbanization and the migration of work phenomena undermines the image of families increased in size. It is obvious that orphans undergo great discomfort despite their relations’ attempt to take care of their situation. In fact, orphans do not eat as well as others their age and they certainly do not have the same schooling opportunities. Certain states such as Zimbabwe have attempted to seek a remedy for these so-called “unjust discomforts” by giving grants to families that accept to take in an orphan, but these expenses cannot find a reliable response - suffice to think that adults affected by the virus are 26% and the estimated orphans are about 600,000 up to the year 2000. The disease’s impact on the economy of countries with a high growth rate of the epidemic, such as for example Botswana and Uganda, is certainly hard to quantify from a macroeconomic viewpoint because economists always refer to economic models built on a series of assumptions. But the World Bank, taking countries such as Botswana and Uganda as a reference and wishing to calculate the sum required to finance a sanitary system through the savings of workers, realized that an allocation of 0.5% of the resources (though a 0.5% reduction in the increase of the domestic product per capita may not seem excessive) in one generation determines a 56% increase in the same period in the presence of AIDS and an 81% increase when the disease is absent. A planned cumulative effect on the economy of these countries can clearly be observed. Paradoxically it cannot be noticed by standard macroeconomic assessment criteria because, according to the cold demand-offer ratio’s logic, the abundance of labour in most African economies implies that the victims of AIDS are easily replaced without a loss in productivity. These countries lack a central culture on matters of human well being, on the quality of life and on the very value given to life. Hence many are the problems born of the different demands, behavioural patterns, needs and priorities of such different segments of the population in the many corners of the world. Another glaring example is the situation in Zambia where 800,000 children have been orphaned.

The epidemic is exterminating an entire generation. Here the word future “represents the time the virus concedes between the contagion and death”. It is believed that there are 10,000 children in the streets in Lusaka. Here, in tortured Zambia’s capital, in a population of less than 9 million inhabitants at least 800,000 children are orphaned of even one parent due to HIV. It is estimated that about 10,000 of these orphans live in the capital’s streets. Emmanuel Kasonde, former Minister of Finance who has recently become Chairman of Zambia’s Anti-AIDS council, presents distressing data and confutes the official information, which estimates that 2% of the population between 15 and 49 years of age is HIV-positive. “From what I see around I would double the percentages. As long as we do not make the data available on the Web, we will not be in a position to define the catastrophic proportions nor will we be able to establish how long it will take to invert the trend. In my time life expectancy was 55 years, now it has come down to 37”. Hence in an extremely poor country such as Zambia (the eleventh poorest country in the world, with a per capita income of 320 dollars), which sees “a drastic cut in the number of its population that is active sexually and work-wise, those who have a grandmother hold fast to her - the only sheet anchor in this generational gap that swallows parents. But she must be old – if she is too young, hence sexually active, she too is at risk”. The government relies on the role played by teachers in spreading prevention, but very often they too are HIV-positive or ill like the other citizens, to the extent that it is not hard to find the older and more expert students at the teacher’s desk, due to the latter’s absence. The future is an accessory in subsaharian Africa. Let us focus once again on Europe, which presents an entirely different picture. We must face different situations and new demands, as I already mentioned at the beginning of this “report”. This emergency is also understood as prevention, strategy and study of those human pathologies that now express the HIV virus - host interaction, which is influenced by the immune response, or rather, by the different degree and quality of the latter. Once again a virology – immunology - pathology circuit keeps man’s health in check and invites an atmosphere of greater political and social awareness of this great international problem. Translated by interpres sas

THE AIDS REFERENCE CENTRE FOR THE CAMPANIA REGION (Ce.rif.A.R.C.)
Scientific Director: Oreste Perrella
E.R. Magaldi, G. Belli, V. Borrelli, R. De Caro, S. De Rosa, B. Gentile, V. Lanzetta, D. Mariniello, M. Muto, A. Orlando, S. Piccininno, W. Tiani

Translated by interpres sas