AIDS has killed more than 300,000 Americans, and some 750,000 are currently infected with hiv, the virus that causes aids. In the first years of the epidemic, deaths were concentrated among gay and bisexual men. But over the past ten years, the incidence of the disease has surged among women--from 6 percent of reported cases in 1985 to 19 percent in 1995. In about half these cases the virus was contracted through heterosexual sex. The other half were infected through intravenous drug use. The spread has been most dramatic among African-American women, who now make up more than half of American women with aids.
Despite this alarming trend, the rate of new hiv infections in the United States has declined from roughly 80,000 a year in the late 1980s to somewhere between 60,000 and 70,000 in 1995, largely because of programs that promote safe sex among gays. The epidemic appears to have begun stabilizing here, as it has in Europe and Australia. Elsewhere, though, the virus is still spreading rapidly. Since the epidemic’s onset, there have been more than 27 million estimated cases of hiv infection worldwide and some 4 to 5 million deaths--and about 14 million of those cases have been in sub-Saharan Africa, where the rate of new infections is still rising. In Asia the disease is spreading as fast or faster. India, with a population of 950 million, has 3.5 million cases of hiv infection--the largest number of any Asian country.
Thus although recent drug trials in the United States offer hope for the hiv-infected, the disease is most prevalent in countries too poor to afford even the most basic medical treatment. Those countries need condoms and needle-exchange programs more than the new protease inhibitors. In Thailand, public education about safer sex practices has led to a dramatic decline in new infections, says Thomas Quinn, a Johns Hopkins epidemiologist. The new advances in antiviral therapy may limit the spread of infection in developed countries, where people can afford them, says Quinn. But preventive methods provide the most hope for the developing countries.