From: matthew@ooc.uva.nl (Matthew Lewis)
Subject: Conference newspaper - Tuesday, July 21 - part 4
Note: non-commercial reproduction.
Archive-Number: 5746
Organization: Center for Innovation and Cooperative Technology, University of Amsterdam
Date: 21 Jul 92 20:10:26 GMT

CONFERENCE NEWSPAPER - Tuesday, 21 July - part 4 of 4

(article continued from part 3)

Judith Wasserheit: 
A dangerous synergy 

Firm evidence is accumulating about the connection between HIV 
infection and other STDs, and it's not good news. According to        
Dr Judith Wasserheit, director of the division of STD/HIV 
prevention in the National Center for Prevention Services at the 
Centers for Disease Control in Atlanta, Georgia, "We now have fairly 
substantial evidence that most of the STDs, both genital ulcer 
diseases (GUDs) and nonulcerative STDs - discharge syndromes 
like gonorrhoea and trichomonas - facilitate HIV transmission."Data 
so far are more substantial for the GUDs (chancroid, herpes, 
syphilis and the like) Dr Wasserheit says, but there appears to be at 
least a three-to five-fold increased risk of HIV transmission 
associated with all STDs. If evidence linking nonulcerative STDs 
with HIV transmission is confirmed, the overall impact of the 
discharge syndromes on HIV transmission will be much greater 
than that of the GUDs, because STDs that do not involve ulceration 
are much more common, says Wasserheit. 
Recently the picture has become even more ominous. HIV seems to 
prolong the period of infectiousness and spread of other STDs, 
either by making them more infectious or by making it harder to 
cure them. STDs, in turn, seem to facilitate HIV transmission. If 
these trends hold true, says Wasserheit, "We are seeing an unusual 
epidemiological synergy, a mutually reinforcing spiral. In fact, in 
some parts of the world, particularly in Africa, that synergy may 
underlie the explosive growth of the HIV epidemic."
What does this mean for efforts to curtail the spread of HIV? 
According to Wasserheit, it implies that improved prevention and 
control of STDs must be a critical component of HIV control 
programmes throughout the world. It also means that behavioural 
interventions like condoms that act to prevent the spread of both 
STDs and HIV are likely be particularly effective. 
It is less clear to her whether traditional measures to control STDs 
- such as contact tracing and partner notification - should be 
applied to HIV. These strategies have been inadequately studied, 
Wasserheit says. There are fairly good data to suggest that, for some 
STDs, such as syphilis, these can be very effective. But HIV carries 
with it a set of social issues that are more difficult to address than 
for the other STDs. "If we use strategies like partner notification in 
an effort to reduce the biological impact of disease, we have to 
make sure we are not harming people's opportunities for personal 
freedom and employment,"Wasserheit says. 

**********************************************************
Public health at the crossroads
by Janis Kelly 

A firm foothold in the community and a strong commitment to 
human rights are the keys to the AIDS-related work of the Red 
Cross/Red Crescent Societies, but something more is needed, says 
Dr Anne Petitgirard, AIDS Coordinator for the International 
Federation of the Red Cross/Red Crescent Societies. 
"Maybe I am naive, but I feel that we are really at a crossroads. We 
need to invent something new in public health, something closer to 
the needs of the people."Her office helps to establish the overall 
direction of the Red Cross/Red Crescent AIDS strategies - an 
example is the stand against workplace discrimination - and 
provides resource material for the individual societies to use in 
their AIDS-related programmes.

Strategy
The growing involvement of the Red Cross/Red Crescent societies 
in the broader issues of the AIDS pandemic was highlighted by a 
1991 resolution reaffirming the societies' commitment to the fight 
against AIDS and expanding their strategy to include plans for more 
educational programs, more care and counselling of people who 
have HIV, and more opposition to discriminatory legislation. In 
particular, the Red Cross/Red Crescent societies have objected 
vigorously to plans to hold any international or major regional AIDS 
meetings in countries with discriminatory government policies, 
including the US and Japan, which is the proposed venue for the 
1994 international conference on AIDS.

Basic principles
Petitgirard says: "Although the Red Cross/Red Crescent societies 
are identified with blood collection in many countries, we are 
actually involved in a much wider range of health activities. As in 
many of these areas, the fight against AIDS brings us back to one of 
our own basic principles, which is the defence of fundamental 
human rights. If we don't solve that problem, we will not be able to 
solve the major health problems facing the world at this time, 
including AIDS."
She says she was amazed at the unprecedented number of 
questions and suggestions from Red Cross/Red Crescent offices in 
the field on what topics should be covered at the Red Cross/Red 
Crescent AIDS Seminar being held in conjunction with this week's 
international conference. "I am greatly encouraged by this evidence 
of growing involvement with AIDS prevention and control. At times 
I have experienced, as nearly everyone does, the feeling of being 
overwhelmed by the job to be done, but I am now more and more 
convinced that we can make a difference.

"I have come around again to thinking that community-based 
organisations such as the Red Cross/Red Crescent societies are 
particularly important because they are often closer to the people 
and can play a role as intermediaries between the community and 
government policy-makers. We need a type of solidarity which is 
more than just working together. We need to reinvent our common 
goal. We need to go back to the community and ask, What is really 
needed? Where should we put our resources?"
Unpopular positions
Petitgirard tries to help the individual Red Cross/Red Crescent 
societies feel free enough and secure enough to advocate for 
unpopular positions in the face of government opposition. This can 
be very effective, as when steadfast Red Cross/Red Crescent 
opposition contributed to the demise of discriminatory proposals 
on visa requirements in Thailand. "It is often difficult to get the ear 
of the government. One of my goals is to find ways to help Red 
Cross/Red Crescent societies be more effective at this kind of 
lobbying,"she says.

Caption:
Petitgirard: "We need to be more effective at lobbying 
governments."
Credit: Rob List
 
**********************************************************
How epidemiology raises awareness of AIDS
by Simon Rozendaal

In 1984, Dr. Praphan Phanuphak saw a sick American who was 
referred to his laboratory in Bangkok, Thailand. From what he had 
read, Praphan suspected that this would be his country's first AIDS 
patient. He was right. The American had pneumonia and in 
February 1985 was diagnosed with AIDS. 
The epidemic in Thailand, as in many other Asian countries, began 
late. The first recognized cases were in homosexuals: this American 
and a retrospectively identified Thai graduate student who returned 
from the US in mid-1984.
Today, the AIDS epidemic in Thailand is largely among 
heterosexuals. Of the 400,000 Thais thought to be infected with 
HIV, the majority are heterosexual and equally distributed among 
women and men. 
Officially, the number of AIDS patients in Thailand is 500, but, says 
Praphan, "the number is probably two or three times as high."
AIDS cases double
Praphan, a 47-year-old professor of medicine and immunology and 
the director of the Thai Red Cross Programme on AIDS, agrees 
with epidemiologists who fear that the epidemic in Asia will reach 
the same proportions as in Africa. India and Thailand have already 
witnessed the number of cases doubling at the same rate.
According to Praphan, one of Thailand's problems is that the many 
young male Thais have their first sexual experience with a 
prostitute. "That is different from, for instance, the US, where boys 
of 15 or 17 have their first sex with girlfriends from next door or 
from school."
Praphan believes that Thailand followed anything but the ostrich-
approach in its approach to AIDS and sexuality. Several ministries 
joined forces in the project "100% condom usage", an information 
campaign directed primarily towards prostitutes and massage 
parlour workers, but also at other workers in the sex industry, 
police officers, owners of massage parlours and customers. Teams 
equipped with videotapes went to prostitutes and showed them 
how to convince a customer that he should use a condom.

Sex education
Sex education for young people has also turned out to be a 
necessity. "Fifty percent of the Thais leave the school system after 
primary school so you have to reach them there,"says Praphan. "In 
the past there existed at some schools what we called family health 
education. But today it is very directly geared to sex, AIDS, STDs 
and contraception."
Data from epidemiological surveys proved essential to increasing 
awareness about AIDS in Thailand. Every province tested the blood 
of at least ten and often hundreds of people in categories such as 
pregnant women, blood donors, patients with sexually transmitted 
diseases (STDs), military personnel and so on. The survey was 
conducted over three and a half years and showed that hundreds of 
thousands must be infected.

Responsibility
Praphan believes that this kind of survey helps increase awareness 
about AIDS. "The survey made us address the problem 
openly,"Praphan says. "I think that if other Asian countries were to 
do the same kind of surveys, there would be more awareness of the 
importance of AIDS in Asia."
Praphan believes Asian researchers and clinicians can take a more 
prominent role in the AIDS crisis. "There is uncertainty about the 
role of the WHO,"says Praphan. "Thai authorities think that the 
WHO will do the job. But we should take the responsibility 
ourselves, otherwise it takes too long."
**********************************************************
Conference Newspaper 
VIII International Conference on AIDS/ 
III STD World Congress
Amsterdam, The Netherlands 
19-24 July 1992

Editor: 	Sharon Kingman
Deputy Editor:	Cindy Patton
Writers: 	William Check
	Janis Kelly
	Simon Rozendaal
	Wim Zeijlemaker
Translators:	Elena Hanselaar 
	Annette Eskenazi
Managing Editor:	Jackie Bailey
Production Manager: Karin Balster
Layout & Design: 	Kuiper & Company
Photography: 	Rob List 
	Fotografie BV

Published by: 	Medialert Projekten BV
Publisher:	Willem Korteling
Printing: 	Salland Rotatie 		Drukkerij, Deventer
Conference Directors 
of Communications: 	Hilary Rao
	Nono Landheer
Conference Com-
munications staff: 	John Willoughby
	Pien Witteveen

Supported by an educational grant from 
The opinions expressed are those solely of the authors.

The Conference Newspaper gratefully acknowledges the generous 
assistance of 
Van Beek Automatisering.
**********************************************************

-- 
Matthew Lewis, University of Amsterdam		Grote Bickersstraat 72
+31-20-52 51 220				1013 KS  Amsterdam
Internet: matthew@ooc.uva.nl			The Netherlands
Newsgroups: sci.med.aids