werner@aecom.UUCP (Craig Werner) (10/09/86)
<<>>
[I couldn't do this justice as part of the summary, so it's a one time
article focusing on a much misunderstood aspect of AIDS.]
Focus: AIDS and Africa
A lot of the hysteria about AIDS in this country seems to revolve
around the observation that AIDS is both "widespread" in Africa and
spread by a predominately heterosexual route. Therefore ..... (etc.)
Let's examine these observations:
First, 86% of all AIDS cases worldwide occur in the United States,
and another 10% in Western Europe. So the number of cases actually occuring
in Africa represents less than 4% of the total cases, somewhere on the order
of 1-2%. So in terms of numbers, the number of AIDS cases in all of Africa
is of the same rough numbers as the number of cases treated at the
affiliated hospitals of the Albert Einstein College of Medicine (Bronx NY),
where I might add, AIDS is also predominately heterosexual.
To digress, at North Central Bronx and Bronx Municipal (Jacobi),
most of the cases fall into three classes: Drug abusers, sexual partners
of drug abusers, and children of infected mothers.
In Africa, AIDS has been blamed on many things: 1) Mosquitoes,
except that mosquito disease strikes hardest those who are between the
ages of 3-20, while AIDS is seen in (age < 3) and (age > 20), with very
little overlap.
2) the practice of female circumcision and/or the increased
prevalence of anal intercourse among heterosexuals -- the problem
being in the first case that AIDS is an urban disease in Africa and
ritual female circumcision is a rural custom, AND in the parts of Africa
where it is still practiced in its most extreme form (imfibulation),
AIDS is absent.
And for the latter, well the evidence just doesn't support it,
but it sounds good, I suppose.
What does correlate?
Most evidence suggests that AIDS in Africa is primarily a
sexually transmitted disease. In one survey in Rwanda, 75% of the
prostitutes tested has been exposed to the virus (or a similar one).
The average AIDS patient in one country in Africa has had an average of
17 lifetime sexual partners.
Of course, there are other things. Needles are commonly reused
in rural clinics, possibly incompletely sterilized. Other diseases
(malaria, filariases, intestinal parasites) might accelerate the course.
However, there is no indication that AIDS in Africa is spread
any differently than in the United States, and the apparent differences
arise only from a disproportiate number of cases among 2 groups in the
United States (Promiscuous Gay Males and Intravenous Drug Abusers) that
are essentially absent in Africa.
--
Craig Werner (MD/PhD '91)
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(1935-14E Eastchester Rd., Bronx NY 10461, 212-931-2517)
"The DNA genetic system is the one library in which it is worthwhile to browse"