Announcements at the recent international conference on AIDS in Vancouver have brought the first tangible hope to those devastated by a disease hitherto regarded as inevitably fatal. Medical experts have spoken of combinations of drugs known as protease inhibitors which, in limited tests, reduced the presence of the virus in the blood to almost imperceptible? levels, and there is talk from optimists of a major breakthrough in which AIDS will become a treatable if chronic disease.
The expressions of imminent success may be premature for a number of reasons. Even before the experts in Vancouver spoke of their new discoveries there had been evidence of a dropping of the guard, a slackening in preventive measures, among those whose behaviour might place them at high risk. Many gay men in the United States, for example, are facing what is known as "second wave infection". Ill founded optimism for the future could engender further complacency.
New drug therapies in themselves could yet cause as many problems as they solve. They could, according to some experts, further increase the versatility of a virus which has already shown a frightening ability to mutate. Faulty administering of the drugs by physicians or inaccurate application by patients may present the virus with the opportunity to become resistant to the new drugs. There is a salutary example in the manner in which tuberculosis, once thought to have been virtually eliminated, has fought its way back, particularly in developing countries and in areas off the developed world where an "underclass" lives in poverty, and especially among those with AIDS.
The success of the new treatments, tested admittedly on extremely small groups of people, while opening heartening prospects for some, has also widened the existing gap in opinions between activists in the rich and poor countries. At present, almost 90 per cent of AIDS cases are to be found in the third world where the new and highly expensive treatment is irrelevant for economic reasons. One delegate put it this way: "If the treatment for AIDS was one glass of clean water we still would not be able to control it because most people don't have access to clean water."
Physicians in the third world are calling for the development of a cheap vaccine rather than an expensive method of managing the disease. Drug companies have been inhibited from taking this path due to fears of being found liable if their vaccines don't work and growing concerns that an AIDS vaccine might not be commercially viable. Treatment holds out the prospect of ease for a small number of people at the cost of retaining a vast reservoir of population in which the virus can continue to mutate and from which it may still spread. The medical as well as the moral evidence points to the provision of a vaccine as the better course.
In the meantime, there are glimmers of hope from the Third World itself. Preventive measures rather than expensive treatment have begun to bear fruit in countries such as Uganda and Thailand where the disease had previously ravaged large sections of the population: proof, if it were needed, that the practice of "safe sex" is the most effective method of containing this modern pandemic. This is likely to be the case for a long time to come.