PRS-TEP-89-015

!5 AUGUST 1989

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JPRS Report—

Epidemiology

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Epidemiology

JPRS-TEP-89-015 CONTENTS 25 AUGUST 1989

SUB-SAHARAN AFRICA

ETHIOPIA

Cases of Meningitis Reportedly Decreasing /Victoria SEYCHELLES NATION, 27 Jun 89/ 1

MAURITIUS

New Data Links Miles to Allergies. Asthma [Port Louis THE SUN,.27 Jim 89] 1

MOZAMBIQUE

Aids Cases in Country Increase to 40 [Maputo NOTICIAS, 8 Jul 89] .:....................... 1

NIGERIA

Japans $7.4 Million Gift for Guineaworm Fight [Lagos DAILY TIMES, 6 Jul 89] 2

SOUTH AFRICA

TB Rise in Cape Flats Causes Concern [Johannesburg THE CITIZEN, 8 Jim 89] 2

Efforts To Combat P. Falciparum Examined [WilfNussey;Cape Town LEADERSHIP. Jim 89] 3

TANZANIA

AIDS Spread To Increase Neonatal Deaths [Dar-es-Salaam DAILY NEWS, 3 Jul 89] 6

AIDS Trial Drugs Cost Estimated at $8,000 [Dar-es-Salaam DAILY NEWS, 2 Jul 89] 7

ZIMBABWE

Rural Medical Crisis as New Doctors Stay in Cities

[Sven Oste; Stockholm DAGENS NYHETER, 4 Jim 89] • •••••• 7

CHINA

Serotypes and Epidemiological Study of Pneumococcal Infection

[Beijing ZHONGHUA LIUXINGBINGXUE ZAZH1 [CHINESE JOURNAL OF EPIDEMIOLOGY]

No 3Jun89[ ...„ : - • - •

9

First Case of Pseudotuberculosis Found in China

[Beijing ZHONGHUA LIUXINGBINGXUE ZAZHI (CHINESE JOURNAL OF EPIDEMIOLOG Y)

No 3 Jun 89[ • • ?

EAST ASIA

HONG KONG

Drug Addict Confirmed With AIDS

[Mariana Wan; Hong Kong SOUTH CHINA MORNING POST, 28 Jim 89] 10

Handling of AIDS Threat'111 Prepared'

[Mariana Wan; Hong Kong SOUTH CHINA MORNING POST, 29 Jim 89] 10

INDONESIA

AIDS—Cases and Prevention [Jakarta KOMPAS, 3 Jul 89/ : •••• ' 1
JPRS-TKP-89-015

25 AUGUST 1989

Scientific Development of Traditional Drugs Suggested

/.lakaeta AX'IAR I Xl.W'S BELLE 1IX. 23 Jul 89/ 12

Report of Deaths Due to Communicable Disease /Jakarta ANGKATAN BERSENJA'EA. 1 Jul 89/ . 12

Communicable Disease Spreads to Bandung Area. More Deaths Reported

/Jakarta AXGKA'IAX liERSEX./AT t. 3 Jul 89/ 13

Last Java Reports Increase in Cancer Cases /Jakarta ANGKATAN BERSEN.1ATA. 30 Jim 89/ 13

THAILAND

608 People in Chiang Mai Test Positive for AIDS /Bangkok BANGKOK POST, 3 Aug 89] 13

Bangkok Reports Tuberculosis Number Four Killer Disease 13

Official Warns on Severe Dengue Outbreak

/Woraphol No Nakhon; Bangkok THAI RAT. LUitn 89/ 14

VIETNAM

Nationwide Malaria Control Efforts. Problems Reported /Hanoi Radio, 1 Aug 89] 14

EAST EUROPE

HUNGARY

Contagious Lung Diseases Caused By Polluted Air /Budapest NEPS7AVA. 13 Jim 89] 16

NEAR EAST & SOI III ASIA

INDIA

Center Reports High Malaria Incidence in Madras /Madras THE HINDU, 10 Jim 89/ 17

W ES I El ROPE

DENMARK

Minister Opposes Plan for Secret AIDS Testing

/Thomas Llirskov: BERL1NGSKE T1DENDE. 9 Jul 89] 1«

AIDS Patients Mav Have Lone Wait for DDI Medicine

/Anne Brockenhiuis-Schack^Copenhazen INFORMATION, 19 Jim 89] 19

Tighter Rules for AIDS Testing /Copenhagen BERIJNGSKE T1DENDE. 25 Jim 89] 20

Studv Finds Health Professionals Poorlv Prepared to Deal With AIDS

/Ruth Northen; Copenhagen DEI 1 Rl AKTEELT. 22 Jim 89/ 20

ICELAND

Officials View AIDS Statistics. Trends /Reykjavik MORGUNBEAD1D. 14 Jul 89/ 22

NORWAY

Tick-borne Encephalitis Virus Threat Viewed /I.ene Skogstrom; Oslo AFTENPOSTEN. I Jul 89/ .. 23

Health Official on AIDS Trends /Tore Oksholen; Oslo AFTENPOSTEN. 14 Jul 89] 23

Survcv Finds Public Less Concerned About AIDS

/(.unil/u Tengvall; Stockholm DAGEXS NY1IETER. 29 Jim 89] 24

TURKEY

Diarrhea Epidemic Reported in Adana /Istanbul GENES. 22 May 89] 26

Measles Epidemic Reported in Southeast /Istanbul GENES, 15 May 1989] 26

Green Locusts Seen Again /Istanbul HERRI YET. 18 Mav 89/ 26
JPRS-TEP-89-015

25 AUGUST 1989 SUB-SAHARAN AFRICA

ETHIOPIA

Cases of Meningitis Reportedly Decreasing

54000095a Victoria SEYCHELLES NATION in French

27 Jim 89 p 7

[Text] The head of the epidemiological department of

the Ethiopian Ministry of Health. Iadelle Tcdla,

announced Tuesday that 1,512 people have died of

meningitis in Ethiopia since an epidemic began last

September.

Mr Tedla told the Ethiopian press agency ENA that

40.350 patients have been treated for meningitis

throughout the country. Since April, the meningitis

epidemic amplified by hot weather and the lack of

vaccination, especially among children, is now on the

wane, he continued.

Medical teams are active all over the country. The

hardest hit areas are in southern Ethiopia, particularly in

the Wolaita region.

Addis Ababa authorities requested 9 million doses of

vaccine from the international community, notably the

European Economic Community, in February.

MAURITIUS

New Data Links Mites to Allergies, Asthma

54000095b Port Louis THE SUN in French

27 Jim 89 p 5

[Text] A recent medical study on asthma provides new

data specific to Mauritius, namely the more or less

striking absence of allergies to the sugar cane plant and

to pollens in general.

The investigation confirmed, on the other hand, that

allergies to mites are the chief culprits in nasal or

conjunctival asthmas. The new data are presented in a

report on this study (Allergic Components of Bronchial

Asthma in Mauritius) put together by the "SSR Centre

for Medical Studies" of the University of Mauritius.

According to Professor S. Baligadoo, who initiated the

investigation, the study as a whole can serve as a basis for

later work focusing primarily on the treatment of

asthma. Treatment would consist, among other things, of

flushing out the mites and developing new medications

such as nonsedative antihistamines and specific immunotherapy.

The investigation itself involved two steps: a study on

allergies to the sugarcane flower involving 110 Mauritians who were clinically examined and another preliminary epidemiological investigation conducted on 49,000

children, aged 7 to 16 years.

The two studies demonstrated that mites play a major

part in allergic pathology. The responsibility of mites in

patients with positive skin tests was defined. The investigation involving children reveals a 5.8-perccnt prevalence rate for the disease and bronchial hypcractivity

that could predispose 13 percent of them to the later

onset of asthma.

Now more than ever, therefore, mites and dust in houses

and especially in bedclothes (sheets, blankets, etc.) must

be combated.

MOZAMBIQUE

Aids Cases in Country Increase to 40

54000096 Maputo NOTICIAS in Portuguese

8 Jul 89 p 4

[Text] At the beginning of this past June, the Ministry of

Health confirmed that 40 cases of AIDS had been

recorded in this country, an addition of 13 cases as

compared with the figures for last December. Nineteen

of the 40 cases (48 percent of the total) were recorded in

Maputo, where the sensitivity and refinement of diagnostic techniques arc greatest. The age groups most

affected arc between 20 and 49 (69 percent ofthe cases).

Among them, the most affected age group is young

people between 20 and 29 (35 percent of the cases).

The variation in age of the people with AIDS is quite

large; it includes a child of 10 months and an individual

who is 60. Of the total. 26 are males and 14 females.

Since the first case of AIDS was recorded in Mozambique in 1986. it is known that 11 of the 40 people

affected have died (more than 25 percent of the total).

The number may be even higher since, due to problems

in communication, it has not been possible to track all of

the cases in the various provinces.

In trying to understand the significance ofthese data, we

must bear in mind the unfavorable geographical characteristics of this country. A look at the map shows that

Mozambique is located at the frontier of a region that

has been sorely affected by the virus that causes AIDS.

Our country is practically surrounded by countries that

have already recorded a high incidence of cases, as with

Malawi (2,586 cases), Tanzania (4,158 cases), and

Zambia (1.296 cases). These countries, in turn, border

on Burundi (1,408 cases), Kenya (2,732 cases) and

Uganda (5,998 cases).

Mozambique is therefore located in an area marked by

risky behavior that favors the spread of the illness. It

would be unrealistic for us to think that, for whatever

reason, we would be spared by the epidemic, unless we

mobilize effective preventive measures.

But why has the low number of Mozambicans with AIDS

continued, when we know that the frequent movement

of people between Mozambique and the neighboring

countries is a factor that greatly favors the spread of the

disease?
SI B-SAHARAN AFRICA

JPRS-TEP-89-015

25 AUGUST 1989

Actually, wo lire aware that the number of officially

recorded eases in our country is lower than the real

number of individuals who have AIDS. The reasons for

this are several: a laek of health personnel and infrastructure is areas affected by the war; insufficient diagnostic

capability on the part of health personnel who arc still

inexperienced in dealing with this new illness: the need

for official notification of laboratory confirmation of all

suspected cases diagnosed in the provinces, which, for

technical reasons, is only possible in Maputo. This

requires the sending of blood samples of those diagnosed, which involves complicated problems of transportation and communication, especially at the district

level: the lack in the marketplace of tests that arc easily

performed and low in cost, requiring no complex infrastructure. Such tests would offer a sensitivity that is

adequate to the detection of the AIDS virus abroad in

this country: in comparison with neighboring countries,

for various reasons, there may be a retardation of entry

of the virus into Mozambique.

Available information, meanwhile, allows for a series of

conclusions: The number of cases is on the rise, and at a

rale that is similar to that of neighboring countries in

vcars past: the illness affects mainly those individuals

who are sexualh active (between 20 and 49 years of age),

and especially young people between 20 and 29. the

group that represents the main productive strength ofthe

country: the number of deaths among those with the

illness is about the same as that in other countries: given

the proximity of countries affected by AIDS, and the

frequency of movement of people across our borders, as

well as the dynamics of the transmission of the illness, it

can be expected that there will be a continued aggravation of the situation in Mozambique. This confirms the

need for awareness among the authorities and the general population of this country regarding the urgent

adoption of the preventive measures and behavior recommended by the educational messages issued by the

National Program for the Fight against AIDS.

MGI RIA

Japan's S7.4 Million (Sift for Guineaworm Fight

3400IH>S7z Lagos DAILY TIMES in English

6 Jill S'J i> 2,S

[Text] The Japanese government has given Y969 million

(about $7.4 million) to the Federal Government for

guineaworm eradication campaign and potable water

supply to rural communities in Anambra Slate.

This follows the signing of an additional agreement of

Y3I I million (about $2.3 million) yesterday in Lagos by

the Finance Minister Dr C'hu Okongwu. and the Ambassador of Japan. Mr Mitsuro Donowaki on behalf of the

two governments.

The first pail of the aid package of Y658 million (about

$5.1 million) was initiated last year between the two

governments.

At the exchange of notes for the additional aid grant. Mr

Donowaki said thai his government sympathized with

the Nigerian Government on the fact that a large number

ofthe rural populace fall prey to the guineaworm scourge

leading to serious health problem of the population,

which in turn inflicts adverse effect on the economy of

the country.

According to Mr Donowaki. the Government of Japan

decided in the light of the foregoing to come to the

assistance of the Federal Government and Anambra

State in particular in their effort to eradicate the disease.

He added that bore-holing activities with Japanese assistance would begin at the end of the rainy season in a bid

to providing fresh potable water for the rural populace in

the state.

The Ambassador observed that the additional agreement

signed yesterday is to ensure the continuation and completion of Japanese assistance embarked on last year.

In his response. Dr Okongwu. on behalf of the Federal

Government and Anambra State, thanked Japan for

aiding Nigeria in these two projects.

SOUTH AFRICA

TB Rise in Cape Flats Causes Concern

5400()(W4a Johannesburg THE C1TE/.EN in English

S Jim ,W p 4

[Text] An estimated 12 million people in this country

have "dormant'" tuberculosis, and an estimated 15 percent of those people will contract full blown TB, with

between 10 and 20 dying every day.

Dormant TB means they are infected by the TB bacillus,

which with proper nutrition and lifestyle, will not usually

affect people.

Figures for the disease in the Western Cape arc among

the "highest in the world", according to acting Medical

Officer of Health for Regional Services Councils, Dr

Stewart Fisher.

Referring to conditions on the Cape Flats, he described

the disease as a "socio-economic disease with medical

complications".

In ("ape Town City Council areas in 1987, there were

3.709 cases, with an increase of nine percent in 1988 and

an eight percent increase for the first four months of this

year—a total so far of 1.459.

The prime causes for the disease in the Peninsula were

malnutrition and "atrocious" living conditions on the

Cape Flats.

Dr Fisher said. "We are now trying a new method

whereby we arc using volunteers to go to the community
JPRS-TEP-89-015

25 AUGUST 1989 SUB-SAHARAN AFRICA

to adopt TB patients". The pilot scheme was aimed at

making people aware of the probability of a cure, if they

were treated consistently.

Stress, caused by unemployment, had become a major

factor in contracting the disease. Added to that, a large

percentage of sufferers were alcoholics, said Dr Michael

Popkiss, Medical Officer of Health for the Cape Town

Citv Council.

Efforts To Combat P. Falciparum Examined

54000094h Cape Town LEADERSHIP in English

Jun89pp 101-102, 104-105

[Article by Wilf Nusscy: "The Malady Lingers"]

[Text] The rumours have been rife for years. Malaria is

spreading once again. Our Boys on the Border are

coming down with some sinister new disease. Don't go to

the Kruger National Park in summer; there's a new,

mutant mosquito in the area that shrugs off insecticides.

You can forget about your anti-malaria pills: they just

don't work anymore. Cerebral malaria is spreading down

from black Africa, and it's a real killer.

White peoples' fear of malaria is as old as the Portuguese

explorations of Africa, when many of those who dared to

venture into the interior died of it. The Voortekker Louis

Trichardt lost 20 of his party to malaria on his epic

journey to Delagoa Bay, and then it claimed his own life

in Lourenco Marques. Black people fear it too, but

philosophically; it has been with them always, and will

remain with them for a long time to come. Africa is by

far the world's worst-infected area.

Every year, people die of malaria in South Africa and its

associated homelands and independent black states. The

deaths arc usually few and go largely unnoticed—except

when they occur in Johannesburg, Pretoria or another

urban centre where the disease is rare.

Yet the fears and rumours persist, fuelled by ignorance

and undampened by the inadequate official efforts to

explain this ancient, and to scientists, quite fascinating

pestilence.

What are the facts? Malaria occurs seasonally over a

large section of South Africa; in much of Swaziland; in

parts of Zimbabwe, Botswana and Namibia; and is rife

in Mozambique. While malaria control has broken down

in some southern African countries, the disease is not yet

gaining ground in South Africa itself.

There arc no sinister new diseases attacking our Boys on

the Border—just variations of the ones we've known

before. There is a new strain of malaria that is resistant

to the main prophylactic drug in use in southern African

until now. But it responds to other drugs and no disaster

is threatened on this score. Neither is there a looming

invasion of invincible mutuant mosquitoes.

Cerebral malaria is extremely dangerous—in fact, usually fatal—but it is not a new disease; just an avoidable,

advanced stage of the old.

There would be more than ample grounds to fear malaria

were it not for a remarkable, though little appreciated,

campaign—a sort of cpidemiological border war—which

has been conducted against it in South Africa for many

years. It is a sizeable operation, costing RIOm to 15m a

year and involving scientists in various disciplines in

several institutions and many hundreds of field staff,

working under the umbrella of the Department of

National Health and Population Development.

Its headquarters is a pleasantly colonial building behind

imposing white gates on the outskirts of Tzanccn. the

steamy little town in the northern Transvaal Lowvcld.

About' 20 entomologists, health inspectors, technicians

and others work here, in cool, spacious offices and

laboratories looking out over a lush tropical lawn and

garden.

Together with the people at smaller branches in Eshowe.

Messina and in Vcnda, they form the staff of the

National Institute for Tropical Diseases (NITD). which

has existed under various names since 1920 and has been

an important liaison centre in southern Africa for

malaria control since the early 1970s.

Its director is Dr Frank Hansford, a greying man of great

geniality whose name is known internationally among

those who specialise in the laborious, under-appreciated

task of tracking down and combating disease that, but

for them, would scourge the world.

Hansford hastens to explain that the NITD staff do not

do the actual physical work of controlling malaria. They

are the scientific detectives—investigating, pooling

information, communicating with other countries and

the World Health Organisation, and directing the campaign. Despite political barriers, he keeps in touch with

counterparts in other African countries. "The important

thing is that our control operations are run along the

same lines." he says. •There is co-ordination. We are

getting along pretty well."

Actual control is exercised by national health field

teams, hospital and clinic personnel and general practitioners—thousands of people in a host ofseparate organisations. What binds them together is the ever-present

threat of malaria which, but for their vigilance, would

spread like wildfire.

Proof of this can be found in a comparison of charts

showing that in 1938 malaria occurred throughout the

eastern, northern and central Transvaal, an area

including Pretoria and almost reaching Johannesburg,

and in a large section of Natal stretching to the south of

Durban. The severity ranged from continuous infection

throughout the year in the low, hot, humid regions, to

annual epidemics in the Middlcvcld, and occasional but

no less dangerous epidemics in the Highveld. In badly hit

areas like Zululand and Sekhukhuniland, as many as
SUB-SAHARAN AFRICA

JPRS-TEP-89-015

25 AUGUST 1989

10.000 people died in a single year. The 1986 chart

shows malaria wiped out on the Highvcld. drastically

reduced in the Middleveld and held down to seasonal

occurrence in the worst areas, mainly along the northeastern and eastern horders. Fora longtime, malaria was

all but eliminated in South Africa, with the infection rate

brought down from 20 percent - 30 percent of the

population in affected areas to 1 percent or less. Then it

surged again...and now a new threat has appeared.

To understand why. one has to appreciate the complex

malaria control system. And this is not possible without

understanding the disease itself, which is no less complex.

There arc nearly 3.000 different kinds of mosquitoes in

the family Culicidae. which science has classified into

three sub-families, one of which is the Anophclinac. This

sub-family contains the genus Anopheles, which in turn

contains some 40 known species present in southern

Africa.

Two of these species are malaria carriers, or "vectors'",

as the specialists call them: Anopheles funcstus. which

has been effectively wiped out in South Africa and is

therefore of no further interest, and Anopheles gambiae.

To complicate things further, a Gambiae was recently

found to contain at least six sub-species. Of these, one

lives in Uganda, two are limited in scope by their

preference for salt water, another feeds on the blood of

cattle, and a malaria-carrying fifth, the original A Gambiae. has. like A funcstus. been wiped out.

That leaves just one. inexplicably named Anopheles

arabiensis. This tiny creature, a few millimetres long, is

now the villain. The disease it carries adds to the

complexity. It is not a virus or a bacterium but a

protozoa, one of a host of microscopic creatures forming

one of the great divisions of the animal kingdom. This

one is of the genus Plasmodium. belonging to the suborder Haemosporidia of the class Sporozoa. Four species

of Plasmodium infect man. All are found in South

Africa, but only one—Plasmodium falciparum—causes

serious infection.

"This is the cause of about 99 percent of the malaria in

this part of the world.'" says Hansford, "and is the only

one liable to cause complications such as cerebral

malaria."

Just as the female A arabiensis is dependent on human

blood for the protein to develop her eggs, so P falciparum

must have both the mosquito and the human for its own

reproductive cycle. It goes through an extraordinary

breeding process in the stomach of the mosquito, then

enters the mosquito's salivary glands and is transmitted

into the human host when the mosquito sticks in its

proboscis lo feed on blood.

Once in the human, the protozoa travels in the bloodstream to the liver, undergoes more changes and eventually re-emerges, after which it develops further in the

red blood cells. Finally it takes on male and female

forms, floats freely in the bloodstream and is ingested by

the feeding mosquito—and the whole cycle starts all over

again.

"What makes P falciparum different to other forms of

malaria, and also far more dangerous, is that they reach

a stage where they make the walls of the red blood cells

sticky." Hansford explains. "This makes the red cells

stick together and create blockages in the blood vessels

which causes a condition like thrombosis. When that

happens in the brain, you have cerebral malaria."

This, he emphasises, is not a different kind of malaria

but purely an advanced form of it. generally resulting

from late diagnosis of the disease. People sometimes

dismiss malaria symptoms as those of influenza. And in

areas where malaria is rare, doctors do not routinely test

for it.

The ongoing attack on malaria is three-pronged: kill the

mosquito carrier, build defences against both the insect

and its parasite passenger, and tackle the disease clinically when it finds victims. Measures have changed in

fascinating ways over the past decades.

In the last century there wasn't much people could do

about malaria except stick to high ground, avoid

camping near water, take quinine, and drink lots of gin

and tonic.

With increasing knowledge and the growing settlement

of the Transvaal Lowvcld and northern Natal from the

turn of the century onwards, the defences become mosquito nets over beds and hung from the brims of hats;

fine gauze on doors and windows; and expensive, fastspreading oil sprayed onto water where mosquitos could

breed, although this last was an impossible task to

complete.

Paradoxically, then as now, malaria is most dangerous in

areas where it is least common. This is because people

who are constantly exposed to it tend to develop a

tolerance. When a malaria epidemic spreads to the

vulnerable population of a non-endemic area, it strikes

hard. When, up to the 1930s, occasional epidemics broke

out in places like Rustcnburg. Pretoria, Middclburg,

Newcastle. Vryhcid. Durban and Umzinto, many people

died. During one bad epidemic in Durban, victims were

buried in mass graves.

The first breakthrough came in the mid-1930s with

pyrcthrum. the quick-acting and deadly insecticide made

from the pretty white flowers ofthat name.

Mosquitos were known to feed on people in their homes

(especially black people, who could not afford the luxuries of gauze and netting) for two or three days, then to go

out to lay their eggs, and to return. Dr Siegfried Anncckc,

the peppery, dynamic director of the anti-malaria drive

at the time, and Dr Botha dc Meillon. another prominent

figure, decided to "hammer the mosquito inside the
JPRS-TEP-89-015

25 AUGUST 1989 SUB-SAHARAN AFRICA

houses". They cooked up a stock of poison from pyrethrum blossoms and tried it out in the Lowveld's

Letsitcle Valley, spraying either weekly or fortnightly.

"Thcv were absolutely amazed by the effect." says Hansford. It was so dramatic that the spraying was extended

into Natal, with similar results. Mosquito populations

crashed. Two problems remained, however: pyrethrum's

deadlincss was short-lived., and spraying every two week

demanded a huge and expensive operation.

But then, just after World War Two. came dichlorodiphenvltrichloro-ethanc—or DDT. Although it stands

widely condemned today for its devastating cumulative

effect on ecology and the environment, and its use has

been generally prohibited. DDT has saved an immeasurable number of lives through its use against malaria

alone.

In fact. DDT is still used in the struggle against malaria,

but indoors only, so that it cannot escape into the

environment.

The effect of DDT was even more dramatic than that of

pvrethrum—akin to the discovery of penicillin.

"Annccke went to town on it." says Hansford.

"Returned soldiers were hired to carry out mass spraying

of houses." In Lowvcld areas like Ofcolaco. where 20

percent-30 percent of the children were known to have

malaria parasites in their bloodstreams, the infection

rate dropped to I percent and less. The campaign was

extended to Zululand. and the results were the same.

Today, in the Transvaal, nearly one million structures

are sprayed every year. In the Transvaal and Natal about

80 control teams, comprising 10 sprayers, a couple of

supervisors and a team leader, spray homes between

September and March, and for the rest of the year test

people for malaria. Each team is responsible for 15,000

to 20.000 people.

It was during the house-spraying that the local Anopheles gambiac was discovered to be not one but five

different mosquitoes (with a sixth cousin in Uganda),

of which two were malaria vectors: the original A

gambiac and A arabiensis. The spraying virtually

wiped out A gambiae and A funestus, which were

largely house-bound feeders, but when A arabiensis

became irritated by insecticide, it promptly went to

seek its human blood supply outdoors. So it survived

and continues to spread its dangerous load. The irony

is that the campaign against malaria was so successful

that it laid the foundations for future epidemics. Great

tracts of formerly malarial country were opened up to

farming, forestry and other development.

The Lowveld in particular thrived. People flocked in and

towns mushroomed. Bush was cleared, enhancing mosquito-breeding conditions. Much the same thing happened in northern Natal, if on a smaller scale. And

because malaria was always present, although not widespread, all these people were vulnerable as they had no

tolerance to the disease. These factors combined to lead

to a renewed outbreak of malaria from the 1960s

onwards.

The upsurge started in 1967 with the help of the

weather—a^ cyclone, accompanied by heavy rains. A

sugar factory was being built at Malelane on the southern

edge of the Krugcr National Park. In the general shambles, many workers were sleeping in tents and under

plastic. A arabiensis multiplied and malaria flared up.

It has happened repeatedly since. Epidemics followed by

Bushbuckridge and in Barberton. In Lebowa. 2.000

people suddenly fell ill. The Lebowa health authorities

nipped the outbreak in the bud by taking 24,000 blood

smears and immediately providing treatment. A few

years ago. Cyclone Domoina prepared the way for a

similar upsurge in Natal. Botswana usually has some 200

cases a year. After good rains last year, it had 21,000.

The NITD keeps voluminous computerised records of

malaria cases, compiled from the reports it gets from all

its sources, including the people doing the annual

spraying and taking blood smears as a continuous check

for its appearance—35,000 smears in the Transvaal

alone every month.

"We can get only so far by controlling the mosquito."

says Hansford. "So the other thing is to go for the

parasite and to try to get every case diagnosed and

treated properly."

For this massive detection job, investigators visit

malaria patients in hospital to find out where they

picked up the infection. Then they go out to the scenes of

infection, take hundreds of blood smears to test other

people, and treat those who show up positive.

A recent report in the SOUTHERN AFRICAN

JOURNAL OF EPIDEMIOLOGY AND INFECTION

by doctors P. W. Strcbel, Hansford and H. G. V. Kustner

states:

"Compared to the malaria distribution in 1938. the

maps of 1978 and 1981 both indicated a reduction in the

extent of the malaria-endemic areas. However, since

1984 the number of malaria notifications has shown a

marked increase. The 1985 total of 11,322 notifications

represents the highest annual total since malaria became

a notifiable disease in 1956."

There were 7,061 cases in South Africa in 1986. of which

all but 503 were in the Transvaal and Natal (including

their homelands).

Fully 44 percent of "the Transvaal and Natal cases were

"imports": migrant workers from Mozambique. Swaziland and, to a lesser extent, Zimbabwe.

While this internal and cross-border migration persists,

says Hansford (and it is never likely to end), there is no

hope of permanently eradicating malaria in South

Africa. Migrating Mozambicans arc rigorously checked.

But such barriers are inevitably loopholed. And several
SUB-SAHARAN AFRICA

JPRS-TEP-89-015

25 AUGUST 1989

of South Africa's neighbours cannot cope with malaria.

"Many African countries can spend perhaps 50 cents or

Rl a year per head of population to cover all illnesses.

Malaria control alone might cost R2 per head. They just

can't afford it." he says.

Now a fresh menace has appeared—the source of all the

rumours about the Boys on the Border. It is a drugresistant form of the culprit parasite P falciparum.

The main drug in current use for preventing malaria is

chloroquine. the staple of several proprietary preparations. "Five or six years ago you could tell people, 'just

take chloroquine and you won't get malaria'," says

Hansford. "You can't do that any more."

Resistant P falciparum strains were first found in

Colombia in 1961. and in Thailand in 1962. It became a

problem among U.S. troops in Vietnam. In 1977 it was

found in East Africa, very probably brought in by

Chinese labourers working on the TanZam railway.

From Kenya and Tanzania it spread down the Mozambique coast, through West Africa and into Angola, and

has reached the northern border of Namibia.

In 1983. the resistant strain appeared in Natal and

KwaZulu—obviously brought in by cross-border travellers—and by 1987 some 20 percent of malaria suffers

were carrying it. It has also appeared in the Transvaal

where 20 to 30 of the annual average of about 4,000

malaria victims have it.

"It is probable this resistance will extend." warns an

NITD publication, but Hansford is quick to stress that

there is no cause for alarm. There is most definitely no

epidemic looming, as the gloomsaycrs would have it. It

docs respond to other drugs and can be contained,

though with more effort than the familiar old P falciparum parasite.

There arc 10 or more brands of malaria prophylactics on

the market containing various drugs or combinations of

them. But Hansford and most other experts still recommend chloroquine as the number one drug, despite P

falciparum's resistance to it.

The other drugs arc all good and attack the parasite in

different ways, but also have different side effects. One.

for example, may affect the white blood cells in about

one in 10.000 people/perhaps fatally. Others arc sulphanomides, to which some people are allergic.

"Wc believe chloroquine is probably the safest. So use it,

but be warned that, even in moderate-risk areas, you

may still contract malaria because of the resistant strain.

"Then, if you do become ill. use the proprietary preparation Fansidar. It contains sulphadoxine and

pyrimcthaminc and works quite well against the resistant

parasite. The use of Fansidar in Natal in 1987 cut the 20

percent relapses of the resistant strain down to 0.6

percent." The only problem, he adds, is that some people

might react allcrgically to the sulphadoxine.

Hansford also urges a return to the precautions ofthe old

days. Anglers should wear long sleeves and trousers, use

insect repellent, even wear mosquito netting draped

from their hat-brims, and keep moving to disturb the

insects. Sleep under netting, and place gauze over windows and doors. Pregnant women should take special

care because they arc liable to severe attacks which can

kill them or their unborn children.

Also, prophylactic pills, whether chloroquine or any of

the others, should be taken regularly and not haphazardly, which might mask the sickness.

The symptoms of all kind of malaria arc similar. Those

of P falciparum appear seven to 10 days after A arabiensis has bitten. Initial symptoms arc lassitude and

vague pains. Then comes a sudden attack, usually early

in the morning, consisting of a headache and pains in the

muscles and joints; shivering, followed by a high temperature and a sensation of heat; and then sweating.

An attack can last 36 hours, followed by a week of rising

and falling temperatures. Do not wait that long—call a

doctor. The longer the delay in treatment, the likelier it

is the disease will progress to one or more severe and

extremely unpleasant complications, and possibly death.

By far the greatest defences against this ancient scourge

of mankind arc knowledge and vigilance, in the individual and in the whole community.

TANZANIA

AIDS Spread To Increase Neonatal Deaths

54000092h Dar-es-Salaam DAILY NEWS in English

3 Jul 89 p 3

[Text] The spread of the Acquired Immune Deficiency

Syndrome (AIDS) is likely to reverse the success

achieved in Tanzania so far in reducing neonatal and

infant deaths, according to Dr. W. M. Nkya of the

Kilimanjaro Christian Medical Centre (KCMC) in

Moshi.

He told the on-going workshop in Arusha on population

and family life education curriculum review that the

proportion of infected women transmitting HIV to their

newborn children "is expected to increase resulting in an

epidemic of paedriatric HIV infection and death."

Dr. Nkya, who represented the northern zone reference

centre for parasitic and infectious diseases said over the

weekend that the spread of AIDS would "definitely add

to the already intolerable levels of neonatal and infant

deaths."

He said in some areas the prevalence rate of the disease

was up to 14 per cent among pregnant women and in

high risk groups such as prostitutes the prevalence rate

was up to 88 per cent.
JPRS-TEP-89-015

25 AUGUST 1989 SUB-SAHARAN AFRICA

The main thrust of control of transmission, he said

should be health education for all sexually active men

and women.

He advised that education about AIDS should begin at

an early age in order to make adolescents approaching

sexual maturity aware ofthe devastating effects of AIDS.

"Preventing the development of a life style or habit has

a higher chance of success than efforts aimed at modification of an established behaviour," he said.

The most common mode of transmission of the virus is

sexual intercourse.

Transmission of AIDS in Africa, he said, was further

complicated by the existence of "infected pools of people

and mobile transmitters."

Dr. Nkya explained that professional prostitutes and

barmaids were likely to be in the infected pool while

young businessmen, truck drivers and privileged civil

servants were likely to be among the transmitters.

Health education focusing on AIDS is being included in

the revised curriculum on population and family life

education.

Meanwhile, Kagera residents have been called upon to

step up efforts in the fight against AIDS, which has

reached alarming levels in the region.

The call was made by a Member of the National Executive Committee (NEC), Ndugu Abdallah Rashid

Abdallah who is also the Zanzibar Deputy Minister for

Communications and Transport.

Ndugu Abdallah was addressing hundreds of Bukoba

residents who turned up for the Solidarity Walk at the

Kaitaba Stadium.

He said the AIDS epidemic was more fatal than the

Kagera war against dictator Idd Amin and asked the.

residents in the region to double efforts to combat the

disease which had so far claimed hundreds of lives.

AIDS Trial Drugs Cost Estimated at $8,000

54000092a Dar-es-Salaam DAILY NEWS in English

2Jul89p3 .

[Text] The Minister for Health Dr. Aaron Chiduo has

said that the cost of treating an AIDS patient differs

according to the drugs used, adding that in some cases it

amounted to Tshl.2m ($8,000) per year if dispensed

with AZT drug.

Answering Professor John Machunda (Ukerewe), the

minister said several drugs have been tried but so far

none has proved to be of effective cure against Acquired

Immune Deficiency Syndrome (AIDS). He said the

majority of medicines have only helped improve the

condition of the patient, but not cured the disease.

He named such drugs as "SURAMIN, HPA-23, AZT,

DDC, MM1" and countless other drugs being experimented all over the world.

Answering another question from Major Sigcla Nswima

(Mpanda), Dr. Chiduo said local herbs which were being

experimented in the country were among the many drugs

whose names have not been disclosed by cither the

traditional medicinemen or researchers.

In his initial question Professor Machunda had wanted

to know which medicines were being experimented

upon, at what cost and which drugs were showing signs

of success.

ZIMBABWE

Rural Medical Crisis as New Doctors Stay in

Cities

54002502 Stockholm DAGENS NYHETER in Swedish

4Jun89pll

[Article by Sven Oste]

[Text]They come to the mission hospital in Mnene from

193 poor villages—with bronchial infections, malaria,

venereal diseases, and job injuries. As they have in all the

years past.

But venereal diseases are now on the rise—and slipping

in under that heading is AIDS.

Gunnar Isaakson, assisted by two black nurses, was at

work in the small operating room. He was cutting an

abscess from a patient's chest. It would be examined to

determine whether the old man had cancer.

It was done quickly and expertly. Gunnar Isaakson is a

surgeon, and he has been in Mnene several times. Work

there provides wide experience because one is faced with

so many diseases and problems, he says. Statistics show

that more than 1,600 major or minor operations were

performed at the Mnene Hospital last year.

A Church of Sweden mission has been at work here since

the turn ofthe century, and the first doctor arrived more

than 60 years ago. Now the hospital, with 218 beds, is

one of the largest rural hospitals in Zimbabwe.

Missionaries

The Church of Sweden pays a small share of the costs.

Responsibility for salaries and most of the meager

budget rests with the Zimbabwean Government. But the

six doctors in the Mberengwa District, which has.193

villages and 190,000 inhabitants—are all foreigners and

missionaries.

Zimbabwe's government maintains that the country's

young doctors who have received their medical training

at the state's expense should serve 5 years in the rural

areas. But that idea meets with strong resistance. Zimbabwean doctors claim that the district and provincial
SUB-SAHARAN AFRICA

JPRSTKP-89-015

25 AI CHS I 1989

hospitals do not pay enough. They point to all the

disadvantages: long workdays, a lack of medicines, primitive conditions, and isolation.

Without the missionaries, there might not be a single

doctor here in the Mberengwa District.

Undernourishment

It is a poor district with a few small mines but no

industry. The people make a living from small patches of

land and a few cows. Drought, which prevailed for a

number of years up to 1988. means undernourishment or

starvation, and disaster is averted thanks to food assistance from northern Zimbabwe. And with rain, which

has occurred last year and this year, comes malaria.

About 20,000 new patients were admitted to the Mncnc

Hospital last year. The corresponding figure for all

hospitals and clinics in the district was 178.000. The

breakdown of diseases (diagnoses) in the entire district

in 1988 was as follows: bronchial infections: 30.000:

injuries received at work or as a result of violence:

11,000; venereal diseases: 10,500; skin diseases: 8.900:

eye diseases: 8.300; diarrhea (mostly among children):

6,700: and malaria: 4,900.

That is a typical picture of tropical diseases and of

poverty. When I visited the hospital in Bindura north of

Harare. I found the distribution of diseases there to be

more or less the same, although malaria ranked somewhat higher among adults.

Both in Mbercngwe in the south and in Bindura in the

north, estimates indicate that about 60 percent of all

births take place in hospitals.

Venereal diseases arc high on the list and reflect the

living pattern. A survey of 100 expectant mothers in the

Mbercngwe District provides some of the background.

On average, the women had attended school for 6 years,

and 73 of the 100 surveyed felt that they could read

satisfactorily, while 11 could not read at all.

Home Brewed Beer

One-third of the men lived far from home, and 20 had

more than one wife. Sixty-two ofthe families had cows—

an average of five—but their income came from agricultural products and the sale of home brewed beer: 75 of

the 100 surveyed made beer at home, and 67 of them

brewed it for sale.

Of the women. 26 had been battered by their husbands

during the previous year—and in 15 of those cases, the

man had been drunk. Fifty of the men go regularly—

three times a week—to a beer hall. It is the poorest who

go there most often.

Fifty-eight of the women answered yes when asked if

their husbands visited prostitutes. Only 14 said no.

One-tenth of the women had had a venereal disease at

some time in the past. One-third felt that their husbands

had been infected at some point.

Ciunnar Isaakson and his wife (iimvor emphasi/e thai

the entire pattern is extremely dangerous. They see

venereal diseases increasing, with AIDS as the new

clement among people whose resistance is undermined

by poor eating habits and periodic famine.

Through December of last year, the Mncnc Hospital had

handled six or seven cases of HIV infection. But it

admitted seven new cases just in January and February

ofthis year. There is reason to believe that the number of

undetected cases is very high, say the doctors in Mnene.

AIDS Threat

Up in the government district in Harare, there is a

reluctance to dramatize the AIDS threat in Zimbabwe.

When I discussed the matter with Minister of Health

Felix Muchemwa a few months ago, he exploded:

"If I make a lot of noise about AIDS. I can get as much

money as I want from abroad. But it is malaria and the

other traditional diseases which arc the big killers. And

appeals for help are arriving constantly from the provinces and districts. We lack medicines and vaccines for

the fight against widespread diseases."

The doctors in Mnene understand that reaction. As long

as the outlook remains what it is in today's situation, but

not from the standpoint of the situation in the future.

Along toward evening, many people leave the hospital's

low buildings and wander down to the church. There

they all—including many patients—gather for prayers in

the Shona language. Afterward, they greet each other

outside the church.

The next morning, some of them will go back to their

home villages healths'. Back to undernourishment, the

lack of water, and seven or eight people living in one hut.

The old man who lay on the operating table could not be

helped by Ciunnar Isaakson. The test showed that he had

cancer. After a few days, he would return to his home

villacc to await the end.
JPRS-TEP-89-015

25 AUGUST 1989 CHINA

Serotypes and Epidemiological Study of

Pneumococcal Infection

54004815a Beijing ZHONGHUA LIUXINGBINGXUE

ZAZHI [CHINESE JOURNAL OF EPIDEMIOLOGY]

in Chinese Vol 10 No 3 Jim 89

[Article by Shen Senju and the Cooperation Group on

Pneumococcal Serotyping, Jiangxi Institute of Medical

Science]

[Abstract] During the years 1982 to 1985, 482 strains of

S. pneumoniae were isolated in 18 provinces (cities) in

China. There were 67 strains from the patients of pneumococcal pneumonia, 169 strains from pneumococcal

meningitis and 246 strains from pneumococcal otitis

media. Their serotypes and epidemiology were studied

and the following results were obtained. The rate of

pneumococcal pneumonia, meningitis and otitis media

was 14.26 cases, 79.08 cases and 68.14 cases per 1,000

homologous disease cases, respectively. Most of the

infections occurred in infants while 73.7 percent pneumococcal meningitis, 63 percent otitis media and 40.3

percent pneumonia were in the 3 year old group. The

mortality of patients with pneumococcal pneumonia was

16 4 percent and with pneumococcal meningitis was 16

percent. All of the isolates of S. pneumoniae were

identified using typing antisera (Statens Serum Institut,

Copenhagen). The main types were 5, 6, 1, 19, 2 and 14,

which accounted for 56.8 percent (274 strains) ot total

numbers of strains. Type 5 was the main scrotype and

accounted for 13.3 percent (63 strains).

First Case of Pseudotuberculosis Found in China

54004815b Beijing ZHONGHUA LIUXINGBINGXUE

ZAZHI (CHINESE JOURNAL OF EPIDEMIOLOGY)

in Chinese Vol 10 No 3 Jim 89 p 148

[Abstract] The first case of pseudotuberculosis in China

was reported. From the patient's stool, a strain of Ycrsinia pseudotuberculosis was isolated. The isolate has all

the classical characteristics of Yersinia pseudotuberculosis and belongs to serotype IV.
10 FAST ASIA

JPRS-TKP-89-015

25 AUGUST 1989

IION(; KONG

Drug Addict Confirmed With AIDS

54004029 Horn* Kona SOI I'll ClIIX I MOR\l\(,

POST in English 2S Jim <W p .?

[Article by Mariana Wan]

[Tcxl] The government is strengthening its anli-AIDS

campaign following the discovery of Hong-kong's first

ever intravenous drug addict to be tested positive for the

HIV antibody.

The AIDS carrier, a Chinese male, was tested positive in

a Government rehabilitation centre last month, confirming a fear that more IV drug users could be infected

by the deadly disease, as in Thailand and European

countries.

The new case brings the number of AIDS carriers in

Hongkong to 145. of whom 22 have developed fullblown AIDS. There have been 13 AIDS deaths.

The head of the AIDS Counselling and Health Education

Service. Dr Patrick Li Chung-ki. said the Government

was now stepping up its AIDS prevention campaign

among drug users.

There arc about 39,000 active drug users in Hongkong.

with about 20,000 heroin addicts injecting the drug.

The government plans to produce videos for the highrisk group. This is in addition to the current health

education campaign for drug addicts and voluntary

workers in rehabilitation centres.

A Government consultant and chairman of the AIDS

scientific working group. Dr Ycoh Eng-kiong. said the

newly diagnosed AIDS carrier was likely to have contracted the disease through the use of contaminated

hypodermic needles shared with other users.

A recent survey on the behaviour of local drug users

revealed that 23 I [2] per cent had shared needles on at

least one occasion.

Of the 2.743 polled. 435 admitted having shared their

needles with others the first time they used the method.

AIDS experts attending the Fifth International Conference on AIDS in Montreal earlier this month expressed

fears that the number of AIDS cases related to IV drug

users might outgrow the number of cases among homosexuals.

By 1990. about 28,400 AIDS cases will be related to IV

drug users in Europe, compared with 26.100 cases which

will be homoscxuallv spread.

In Thailand, the number of IV drug users found to be

HIV carriers has also mushroomed from one per cent of

the total drug addict population in 1987 to 40 per cent.

But Dr. Ycoh said the number of HIV-infected IV users

might not grow as fast in Hongkong because sharing

needles among local addicts was less prevalent.

Needles were easier to get in Hongkong than in most

other countries, so large scale sharing was unlikely.

The presence of a methadonc program in Hongkong was

also one way of combatting the spread of the virus, he

said.

But since the surveillance program on drug addicts is

optional, only 3.446 drug users have been tested in

government laboratories, which means more addicts

might have contracted the disease unknowingly.

Once contracting the disease. IV drug users arc capabablc of spreading it either through sexual activities or

through parental transmission.

AIDS Seminar

AIDS experts from 10 Asian countries are in Hongkong

today to discuss ways of combatting the deadly virus.

During the three-day seminar. 70 researchers will

present 40 papers and discuss the possibility ofsetting up

a regional information centre on AIDS and the prospects

of regional collaboration on the prevention and control

of the disease.

leading speakers include local professionals Dr Ycoh

Eng-kiong. Dr Patrick I.i Chung-ki and Dr Yeung Hinvving: Dr M. Essex of Harvard University, Professor

Zeng Yi of the Chinese National Commission on AIDS

Prevention, and Dr M. Carballo of the World Health

Organisation.

An exhibition on Understanding .AIDS will also be

staged at the New Town Pla/a in Sha Tin to promote

public awareness of the disease.

Members of the public are welcome to attend the seminar, which will be staged at the Clio Yiu Conference

Hall of the Chinese University.

Handling of AIDS Threat 'III Prepared'

54004030 Ilona Eong SOUTH CIIIKA MORXlXd

POSE in English 29 .Inn S9 /> 3

[Article by Mariana Wan)

[Text] The Government was yesterday strongly criticised

for its "short-sighted approach" in tackling the worsening AIDS problem in Hongkong.

Dr Jeffrey Day. from the University of Hongkong's

Faculty of Education, took the Government to task for

not allocating funds for AIDS research.

He said although figures showed the disease had a hold

in Hongkong, the territory was still "desperately ill

prepared for it."
JPRS-TEP-89-015

25 AUGUST 1989 EAST ASIA 11

"Hongkong's reaction to the threat of AIDS has been

essentially the same as its response to any problems," Dr

Day said on the opening day of an AIDS conference.

"It is the response of a near-sighted Government to

whom five years is long-term planning."

He also warned that Hongkong's future teachers were

ill-prepared to counsel or educate future pupils on AIDS,

the disease which kills by destroying a person's immune

system.

Dr Day, who is also chairman of the Community Drug

Advisory Council, was speaking at a seminar, "AIDS in

Southeast Asia and the Pacific Region: Strategies for

Prevention and Control—the Role of Institutions of

Higher Education," at the Chinese University.

In Hongkong, there were no reports of research into

either the medical or sociological aspects of AIDSrelated diseases, he said.

"This is perhaps not surprising in a territory notorious

for under-funding of all research and where, in most

faculties and departments, higher degree research is

undertaken on a part-time basis and post-doctoral

research is hampered by exceptionally heavy teaching

loads," he said.

Dr Day said Hongkong should waste no time in strengthening its long-term commitment in combatting the

spread of AIDS, with the increased emergence of carriers

and patients in the territory.

Since the start of a Government surveillance program in

1985, the number of AIDS carriers has grown to 145, of

whom 22 have developed the full-blown disease.

The number of AIDS patients who remain alive has

almost also doubled from five in 1987 to nine.

Dr Day said the Government might have underestimated the problem as it put the actual number of carriers

at only 1,000 in a population of 5.5 million.

The Government should use part of its huge budget

•surplus to fund AIDS research, he said.

He warned that Hongkong's medical and sociological

experts would see research work on AIDS as a low

priority until funds were made easier to obtain.

"In Hongkong, we have no place to quietly lose a

population of AIDS victims wailing to die," he said.

Dr Day said tertiary institutions had a moral responsibility to provide students with the means to protect

themselves and prepare them for the future role of

educating or counselling others.

However, recent research had found that students at

colleges of education, which train teachers for primary

and junior secondary schools, were generally too illprepared to counsel or educate their future pupils.

In the University of Hongkong, students majoring in

Biology Education received only one lecture to prepare

them for sex education courses in the future, which Dr

Day considered inadequate.

Government consultant and chairman of the AIDS scientific working group, Dr Yeoh Eng-kiong. agreed thai

Hongkong had suffered from the lack of research funds.

He further identified the problem as one which lacked

community support when compared to other Western

countries.

Dr Hamish Dyer, senior medical adviser (Southeast Asia

Zone) of Wellcome Singapore Pte, also stressed the

importance of education in preventing the massive

spread of AIDS in the region.

"At the moment, the problem is still relatively small in

scale," he said, adding however that the number of AIDS

carriers was increasing rapidly.

"This will result in a major problem within the next few

years as carriers begin to develop symptoms." he

warned.

He quoted Thailand as "a sobering example," in which

the number of AIDS carriers had risen within two years

from under 10 to over 5,500.

As of March this year, 70 cases of AIDS have been

reported to the World Health Organisation in nine

Southeast Asian countries. A combination of official and

unofficial sources, however, record this figure as being

98 until the end of April, with only 21 of these patients

still alive.

The number of identified HIV carriers in Southeast Asia

including China, the Philippines, Hongkong and Thailand, totalled almost 6,000.

This figure may well be an under-estimation. as China

has only recorded 18 carriers, with 14 of them being

foreigners who were asked to leave the country and four

Chinese haemophiliacs who became infected with

imported blood.

This figure was described by Professor Zcng Yi, vicechairman of China's National AIDS Committee, as

revealing only "the tip of an iceberg" and an "underestimation."

Professor Zeng told yesterday's conference this was a

result of limited screening, targeting only the high risks

groups.

INDONESIA

AIDS—Cases and Prevention

54004323d Jakarta KOMPAS in Indonesian

3 Jul 89 p 6

[Text] After the two other sexually-transmitted diseases

syphilis and gonorrhea, AIDS has become the health
12 KAST ASIA

JPRS-TKP-89-015

25 AUGUST 1989

problem which requires the strongest reponse in Indonesia. However, monitoring these three diseases is not

easy considering the social and cultural factors involved:

most of the victims do not go to a Public Health Center

(PUSKESMAS).

At the opening session of the Congress of Indonesian

Dermatologists and Vencrologists (PADV1) Thursday

afternoon [29 June] the Minister of Health's opening

statement was read by Dr Gandung Hartono. director

general for Eradicating Communicable Diseases (I'2M).

The minister staled that it is difficult to obtain accurate

data on the number of cases of these diseases. Based on

the 1988 report, however, the figures are 2.25 cases of

syphilis and 16.9 cases of gonorrhea per 100.000 people.

Up to now there have been four known cases of AIDS in

Indonesia, three foreigners and one Indonesian male. All

four have died. In addition. 11 others have tested serumpositive for HIV.

Before the start of the sixth PADVI Congress, attended

by 300 participants and 100 other invited guests, there

were exhibits, panel discussions and guest lectures. The

Congress will conclude on Saturday [8 July].

Difficult to Prevent

The minister stated that because Indonesia is an open

society it is obviously difficult to prevent AIDS from

coming into the country. One way to increase awareness

of the problem is to place it in its proper proportions.

He said that the highest priority set by health ministers

throughout the world has been placed on education and

the dissemination of health information. A way must be

found to motivate high-risk groups to use protective

devices during sexual activities: this could prevent at

least 90 percent of cases of the spread of the disease.

In addition to sexually-transmitted diseases, the minister

also said, the highest priority for communicable skin

diseases is for the eradication of leprosy and yaws.

Leprosy, always misunderstood by the public, actually

can be cured. The problem is how to control the regular

administration of the medicine. Because leprosy is usually discovered and treated too late, the disease can

develop and cause severe deformities.

There are about 120.000 cases of leprosy in Indonesia.

About one third of them are registered as communicable

cases. Nevertheless, there now exists the MDT [expansion unknown] course of treatment recommended by the

World Health Organization: leprosy can be cured in the

relatively short time of 6 months to 2 years.

Yaws, always considered an indication of a country's

backwardness, now exists in Asia only in Indonesia and

Papua New Guinea as well as in some countries in Africa

and Latin America. There are no longer as many cases as

there used to be. However, efforts must be made to

eradicate it completely because it is still found in villages

in 15 Indonesian provinces. Ironically, many young

doctors do not recognize the disease, and this itself is a

factor in obstructing its total eradication.

Scientific Development of Traditional Drugs

Suggested

54004ns Jakana ANTARA NEWS BULLETIN

in English 23 Jul <S'9 p AS

[Text] A public health expert has expressed his concern

over the absence of scientific development of the use of

traditional drugs of herbal origin in Indonesia, in spite of

the fairly large number of experts in this field in the

country.

Dr. Nugrobo Iman Santoso told newsmen here Friday

that traditional drugs are considered more superior than

"modern" medicines, whose side effects can endanger

human health.

He said that public health experts in Indonesia, now

totalling 1.095. should be called upon to discuss various

measures to prepare the scientific development of traditional drug utilisation.

For this purpose, the University of Indonesia's public

health faculty alumni association will hold two seminars,

concerning rational utilisation of traditional drugs for

the promotion of public health, and popularisation of

public health funds and other forms of health insurance.

Nigroho. who is also general chairman of the faculty's

24th anniversary commemoration committee, said that

each of the seminars is expected to be attended by

around 200 public health experts from throughout the

countrv. besides interested individuals in society.

Report of Deaths Due to Communicable Disease

540043211* Jakarta AN(iKAT AN BERSENJATA

in Indonesian I Jul <S'9 p 2

[Text] Eight villagers died from an epidemic of diarrhea

and vomiting [cholera] which attacked three villages in

Ciampca. Bogor County [West Java]. Sixty others arc

being treated in the hospital.

Villagers in the Ciampca area were hit by last month's

epidemic of diarrhea and vomiting. Drs Oscar Saragih.

head of public relations for Bogor County, said that it is

hard to prevent such an epidemic until the masses adopt

a cleaner and healthier way of living.

Eddie Yoso Marladipura. Bogor county chief, hopes that

the masses will be able to repond quickly to the epidemic

of diarrhea and vomiting. He emphasized that all levels

of the local government should tirelessly continue to

provide information down to the lowest level of society.

He mentioned as examples the Kemantren Babakan

Madang Citeureup. Ciavvi. Ciampca areas, which have

been hard hit by diarrhea and vomiting. He has

instructed the POSYANDUs [Integrated (Health) Service Posts] to serve residents of the area 24 hours a day.
JPRS-TEP-89-015

25 AUGUST 1989 EAST ASIA 13

Several rivers have become polluted with waste matter

and might be causing this epidemic of diarrhea and

vomiting. He gave an example the area around the

Cikias in Kemantren Babakan Madang in which nine

people died and 200 had to be treated.

Communicable Disease Spreads to Bandung Area,

More Deaths Reported

54004323c Jakarta ANGKATAN BERSENJATA

in Indonesian 3 Jul 89 p 5

[Text] The epidemic of diarrhea and vomiting [cholera]

has begun to spread to Bandung County. Twelve people

from Cicalengka were reported under treatment at the

local PUSKESMAS [Public Health Center]. Three of

them are seriously ill.

People in the area say that there have been many more

cases. Some of them did not go to a hospital for treatment because they recovered at home. Those who are

being treated at the PUSKESMAS have been placed in a

separate ward and are being fed intravenously.

PUSKESMAS officials say that the epidemic of diarrhea

and vomiting comes from unstable [as published] food

and water.

It was reported that the same epidemic has attacked 10

female workers at a textile factory in the Cimahi district.

These workers at the KH Textile Plant are being treated

at Cibabat General Hospital in Cimahi. They contracted

the disease at work. The first victim was Sukismiati, a

resident of Leuwigajah, Cimahi. After visiting

Sukismiati in the hospital, Nurhayati, 24 years old, also

contracted the disease. During the visit she lay down on

the patient's bed for a while. When she went home, she

got sick and had to be taken to the hospital. The next day

other coworkers got sick and had to be sent to the

hospital. As of last Tuesday [27 June] five people were

still in the hospital. They are all residents ofCimahi. The

best hunch is that the disease was caused by unhealthy

conditions in the plant and by infected food and drink.

Bandung County has been well-known for the past few

years as an area often attacked by epidemics of diarrhea

and vomiting. Almost every time there is a change of

season the disease become epidemic and there are many

victims, some of whom die.

East Java Reports Increase in Cancer Cases

54004323a Jakarta ANGKATAN BERSENJATA

in Indonesian 30 Jun 89 p 4

[Text] The Jember [East Java] branch of the Cancer

Institute's managing board, part of the Jember Health

Service, told ANGKATAN BERSENJATA recently that

thousands of cases of breast and uterine cancer have

been seen in the Jember area.

One of the members of the managing board interviewed

by ANGKATAN BERSENJATA admitted that most of

the cancer patients did not come for an examination

until it was too late. Treatment therefore takes a verylong time. It is not hard to cure cancer in its early stages.

Examinations show that in general these cancers are due

to viral infections and to other factors. The men usually

have cancer of the lungs and liver.

The Jember branch of the Cancer Institute, which was

established a year ago, has created 30 PKK [Family

Welfare Development] cadre positions whose job it is to

provide the public with information. This information is

passed along as part of the PKKs activities and for the

time being can be found in Rambipuji. The creation of

more of these cadre positions is being encouraged with the

hope that they will be able to provide the public with

information [repeated section omitted] and that more and

more cancer cases will be examined and discovered at an

early stage. When it is still small, cancer can be prevented,

said that director of Jember's Cancer Institute.

THAILAND

608 People in Chiang Mai Test Positive for AIDS

BK0308020189 Bangkok BANGKOK POST in English

3Aug89p3 '

[Excerpt] Some 267 active prostitutes tested HIVpositive during the latest survey by the provincial Public

Health Office, Dr Anuson Sitthirat, deputy public health

officer, said yesterday.

Dr Anuson said that of 7,000 people tested since January

1988, 608 were HIV positive. This number includes 267

prostitutes, 86 drug addicts, 170 blood donors. 10 prisoners, and 75 others.

He also said AIDS is spreading at a faster rate in this

northern tourist destination than in the provinces of

Songkhla, Phuket and Chon Buri. [passage omitted]

Bangkok Reports Tuberculosis Number Four

Killer Disease

BK0108110189 Bangkok TNA in English 0727 GMT

1 Aug 89

[Text] Tuberculosis [T.B.] is the number four killer

disease in Thailand with more than 120,000 patients

throughout the country, senior physician said here

Monday.

Dr. Thira Ramasut, director of the Communicable Disease Control Department here told reporters that there

are more than 120,000 people suffering from the disease.

He said hospital throughout the country could accommodate only 60 percent of the number and the rest arc

still spreading the disease. He said his department

received increased annual budget of 77 million baht (26

baht is worth one U.S. dollar), a rise of 130 percent from

the previous year.
14 EAST ASIA

JPRSTKP-89-0I5

25 AUGUST 1989

T.B. is considered a public health problem because it is

still not possible to control the spread of the disease. Dr.

Thira said.

He pointed out that the Public Health Ministry now has

a new medication capable of curing patients in only six

to eight months, instead of the two-year treatment it was

offered last year.

Dr. Thira said the ministry has set a deadline at the end

ofthe Sixth National Economic and Social Development

Plan to control tuberculosis to the extent that no more

than three out of 10,000 people will be affected by the

disease.

Meanwhile Deputy Permanent Secretary of the Ministry

Dr. Pralom Sakuntanat said the Bangkok Metropolitan

Administration is joining the ministry in organising an

anti-tuberculosis week between August 7-13 at one ofthe

leading shopping complex here. The aim of the exhibition is to promote public awareness that T.B. is a chronic

disease which drains human resources of the country.

Official Warns on Severe Dengue Outbreak

54004322 Bangkok THAI RAT in Thai 13 Jim 89 p 5

[Article by Woraphot Na Nakhon: "Know How To

Control Mosquitoes; Beware of Dengue During the

Rainy Season"]

[Excerpt] [passage omitted] "In many places, there have

been reports that the number of people with dengue is

increasing. This is the rainy season and so many containers that were empty during the dry season arc beginning to fill up, providing an excellent breeding place for

mosquitoes. It lakes less than 10 days for the larvae to

grow into adult mosquitoes. The mosquitoes are

spreading dengue fever just as in previous years." said

Prakhong Phan-urai, the director of the Division of

Medical Entomology, Department of Medical Sciences,

concerning how mosquitoes spread dengue fever. He also

said:

"Dengue fever is caused by the dengue virus, which is

transmitted by the aedes mosquito. Thus, to control

dengue, we have to eradicate aedes mosquitoes, which

bite during the daytime and which breed in such places

as earthen jars, water tanks in bathrooms, and other

water containers in houses.

"Even though dengue is an old disease, it is still a very

worrisome disease, because it is still very prevalent in

Thailand. The number of cases has declined somewhat,

but the number of patients is still very high. This is only

May and we have not really entered the rainy season, but

already more than 27,500 people have contracted this

disease." said Mr Prakhong.

Two years ago, that is, in 1987, there was an epidemic of

dengue fever. The number of cases of dengue was the

highest in 29 years, that is, there were 154,230 cases.

That year, the Ministry of Public Health issued a report

stating that 794 people died from dengue fever. In 1987.

the number of people suffering from dengue fever was

five times higher than in 1986. Hardest hit was the

northeast. This was followed by the central region, the

north, and the south in that order. The provinces with

the largest number of cases were Mukdahan, Tak.

Nakhon Phanom. Krabi. Sakon Nakhon, Ulhai Thani,

Samut Songkhram, Phctchaburi. Phctchabun, and Chanthaburi.

As for why there was an epidemic of dengue fever in

1987. a research report by the Epidemiology Division

stated that this was caused by an increase in the number

of breeding grounds for mosquitoes. Also, 80 percent of

the breeding places were located near heavily populated

areas.

The report from the Epidemiology Division also stated

that another reason for the serious outbreak of dengue in

1987 was that epidemics of this disease seem to occur in

2-ycar cycles. Thus, we arc due for another outbreak this

year based on this deadly 2-year cycle. This year, special

precautions must be taken to guard against dengue.

In order to prevent dengue from becoming a serious

problem this year, based on the lessons learned in 1987,

the Department of Medical Sciences cannot remain idle.

At the beginning of the year, it discovered a solution to

test for dengue fever. This solution is the first such

solution developed in Thailand. The main substance in

the solution is red blood cells from geese. This can be

used in hospital laboratories to check blood samples for

the presence of the dengue virus without having to send

the blood sample to a test center.

This solution has been tested for quality and can be kept

for up to 6 months. Each bottle ofsolution is sufficient to

test 30 patients. The results arc available within 2 days.

The results can be evaluated by comparing them with the

tests or using the methods accepted by the World Health

Organization. Both arc equally reliable.

Even though we now have an efficient solution to test for

dengue fever, which makes it easier to treat patients,

control is still more important. This year, there will

probably be a large number of cases of dengue. That is

why the director of the Division of Medical Entomology

has been recommending ways to prevent contracting this

disease, [passage omitted]

VIETNAM

Nationwide Malaria Control Efforts, Problems

Reported

BK0308091989 Hanoi Domestic Service

in Vietnamese 1430 GMT 1 Aug 89

[Text] Over the past 6 months, under the National

Program for the Prevention and Control of Malaria in

Vietnam, great efforts have been made in coordinating

the activities of those sectors dealing with malaria control in rubber plantation areas, at water conservancy
JPRS-TEP-89-015

25 AUGUST 1989 EAST ASIA 15

project sites and new economic zones, and in those

areas—belonging to various provinces and cities—highly

infested by malaria. So far. the malaria infestation rate in

various northern provinces has been relatively stable. In

southern and central highland provinces, malaria continues to be in an alarming state.

To prevent malaria nationwide, since early this year the

Ministrv of Public Health has used $200,000 to buy

medicine and other means to serve various antimalaria

programs. While the state has made substantial investments in the antimalaria program, many provinces and

cities have not yet concerned themselves with this task.

In certain areas, the funds allocated by the state to

antimalaria activities have only been on paper and have

not been sent to the recipients. Antimalaria drug and

mosquito control chemicals have continued to be piled

up at provincial and district levels and have not yet

reached the hands of the patients.

A number of localities such as Ha Son Binh. Lam Dong.

Song Be. and Gia Lai-Bong Turn, health cadres have

failed to pav attention to antimalaria activities. While

busving themselves with the task of territorial reorganization, some provinces have not yet been able to provide

guidance for this preventive task.
16 EAST EUROPE

JPRS-TKP-89-0I5

25 AUGUST 198«)

HUNGARY

Contagious Lung Diseases Caused By Polluted Air

54003008 Budapest NEPSZA VA in Hungarian

13Jun89p 11

[MTI report and commentary by "(nogradi)": "All Data

Must Be Made Public; Polluted Air Causes Contagious

Lung Disease at Pecs; Environmental Protection Also

Constitutes Policy; Babies Drink Water Containing

Nitrate; Data Pertaining to Radioactive Contamination

Kept Secret"]

[Text]

Official News Agency Report

By now, even environmental protection has become the

subject of political battles in Baranya County, where a

number of environmental concerns have arisen in recent

times, according to a statement at Monday's County

Council meeting in Pecs. Emotions were and continue to

be stirred by topics like the Ofalu nuclear dump, uranium mining in the Mecsek region, and the case of

contamination in Pecs. Demonstrations, open letters

and responses, petitions, and accusations excite the

public. This is one reason why the county council undertook to make a thorough and critical examination of the

environmental protection situation.

Submissions to the council clearly reveal that despite all

efforts and accomplishments, environmental deterioration in the county has not been stopped, moreover, in

certain areas and in certain respects the situation has

become aggravated. A report presented by the Public

Health and Contagious Disease Station revealed some

shocking data. Day after day, two-thirds of the people of

Baranya are forced to breathe polluted air. The situation

is particularly critical in Pecs, where the odor and

bacterial contamination of the Southern part of the city

provides increased concern. Physicians have detected

certain contagious lung diseases heretofore barely known

in Hungary. By the end of last year 79 persons had fallen

ill, and 331 were contaminated by airborne pathogenic

agents from the sewage treatment plant. Within the

county 163,000 persons drink water that is harmful in

one way or another. As a result of consuming water with

a high nitrate content, 285 babies have fallen ill during

the past 20 years. Five of them died.

The county council adopted a position according to

which all data pertaining to environmental protection

must be made public. In this context the council deems

unacceptable the secrecy that surrounds data pertaining

to the uranium ore mining activities in the Mecsek

region, or more accurately to radioactive pollution and

charge. If needed, the relevant Hungarian-Soviet interstate agreement should be modified. The council decided

to develop a long-range plan for the solution of environmental protection problems. Within that plan the discontinuation, or at least the moderation, of pollution

sources directly affecting human health will receive

special priority, because the death rate in Baranya is

higher than the national average, and health damage

caused by the environment contributes greatly lo the

higher death rate.

Commentary

It is terrifying to think about the number of sins we and

other people committed against the earth—our once and

forever nonrcncwablc treasure—in the years when vigilance was demanded. I am reminded of the bitter words of

an acquaintance of mine: Don't grumble, there were times

when "in order to mislead the enemy" even the mention of

uranium mining in the Mecsek region was prohibited, and

everyone said that they were mining bauxite. The subsequent openness—similarly restricted from the outside—

opened our eyes, and those who were muzzled for years but

knew a lot opened their mouths. And now we could

ascertain that we had dealt ruthlessly with the people, body

and soul, and with the environment.

The MTI report refers to some shocking data. It is indeed

shocking that in the city and environs of Pecs—often

referred to jokingly as "The West"—the death rate is

higher than average. This was caused by an outlook on

life which claimed that "the human being is of the

greatest value." In this university city, and in the counts

in which the city is located, two-thirds of the people

inhale polluted air. In a city proud of its famous medical

school, whose clinics most certainly employ outstanding

professionals, some hardly known contagious diseases

arc registered.

The force of the people's voice has provided nourishment to the leaders of the county council to make their

terrible troubles public. We know that nothing will

change just by talking about it. But the force of the

spoken word, of openness, is greater than ever. But is il

large enough to bring about change?
JPRS-TEP-89-015

25 AUGUST 1989 NEAR EAST & SOUTH ASIA 17

INDIA

Center Reports High Malaria Incidence in

Madras

54500128 Madras THE HINDU in English

10 Jim 89 p 3

[Article: "Incidence of Malaria High in Madras"]

[Text] Madras accounts for 60 to 70 per cent ofthe total

malaria cases recorded in Tamil Nadu and has become a

centre for disseminating the disease to other parts, says a

recent study of the Malarial Research Centre, New

Delhi.

Large-scale construction activity in the last decade,

resulting in an increase in the number of labourers from

different parts ofthe State, and the expansion of the city

without adequate drinking water supply, proper drainage

system and the construction of flats with open overhead

tanks and wells were responsible for the proliferation of

mosquitoes, especially the vectors of urban malaria, the

study said. The poor drainage and open water-storage

structures served as ideal breeding sites.

There is an urgent need to establish an organisation

which could handle the situation effectively. Alternatively, the existing mosquito control programme should

be modified to produce better results both qualitatively

and quantitatively, the report said. A master plan for the

control of malaria in Madras has been drawn by the

Centre.

Inclusion of entomologists at different levels of operation, and continuous evaluation and monitoring of the

programme are recommended in the master plan. Health

education in schools, social organisations and other

institutions is also proposed, and the entire programme

may be evaluated by a steering committee headed by the

Chief Secretary. The committee should remove the bottlenecks in the programme.

In the city, there are about 41,400 overhead tanks,

77,717 wells, 51,320 cisterns and a network of 452.4 km

of sewage drains, which harbour malarial mosquitoes.

The 38-km stretch of waterways such as Cooum, Adyar,

Buckingham canal and Otteri nalla are replete with water

weeds (water hyacinth and others) and are fertile

breeding grounds for the vectors. They have to be

cleaned periodically to arrest the multiplication of mosquitoes, the report said.

The transmission of malaria in the city is perennial, and

it peaks during July-August and October-November.

Malaria control is a challenging problem. Peak incidence

was recorded in 1985 when 51,376 persons suffered the

attack of malaria. In 1986, the number declined to

39,197. The city witnessed a sudden spurt in the incidence of the fever in 1975, when a 15-fold increase was

recorded compared to the previous year in the number of

patients who showed positive symptoms of the fever.

From 1975 to 1984, the number of malarial cases in the

city hovered between 30,000 and 45,000 a year.
18 WEST EUROPE

JPRSTEP-89-015

25 AUGUST 1989

DENMARK

Minister Opposes Plan for Secret AIDS Testing

54002510 Copenhagen BERUNGSKE TWEN'DE

in Danish 9 Jut 89 Sec! I p I, Seel II p 2

[Article by Thomas Uhrskov: "Plan for Secret AIDS

Test"]

[Text] The National Health Service desires to test people

in secrecy for AIDS. Minister of Health Elscbcth KockPclcrscn is resisting, and finds the idea offensive.

In order to get a clear picture of AIDS among heterosexual people the National Health Service wants permission to carry out AIDS tests on people who. for entirelydifferent reasons, arc having blood tests. The tests would

be carried out without the people concerned being

informed of them. "These 'secret' and totally anonymous investigations arc absolutely necessary if wc want

to limit AIDS infection. But since the procedure is a

clear departure from past Danish research practice, we

need the acceptance of the politicians." said chief physician Michael von Magnus, who is responsible for the

National Health Service AIDS Secretariat. Michael von

Magnus maintains that the spread of AIDS outside of the

risk groups is not alarming. "But wc are required to keep

track of it."

The procedure, which is called "anonymous unlinked

testing," is recommended by WHO [World Health Organization], which is normally very reluctant to allow

research methods which arc open to ethical criticism.

Today secret testing is used in the United States.

England, Sweden and Norway, among others.

"But it is not being done in Denmark. I will oppose it

anyhow," said Minister of Health Elscbcth KockPctcrscn (Liberal Party). "It is an unbelievably bad idea,

which I find very offensive. I do not approve of it!"

Michael von Magnus emphasized that the tests would be

totally anonymous: "Nobody will be able to trace the

people behind the blood tests, and there will be no

registration of names or places."

Today there is no requirement for actual juridical

approval in order to introduce the secret testing. But at a

meeting on 22 June at the National Health Service

Danish AIDS researchers and those treating AIDS

patients agreed not to introduce the method without first

having political approval.

The desired AIDS test includes periodic and secret

investigation of all patients who for some other reason

have had blood tests taken, for example in the emergency

room, gynccology clinic, venereal disease clinic or in a

doctor's office.

The wishes of the National Health Service should be

considered in light of the fact that AIDS has spread to

the heterosexual population. One hundred thirty-five

Danish women have the first stages of AIDS. Of these. 35

believe they were infected through heterosexual contact.

Danger of AIDS Not Exaggerated

At the same time that people are getting tired of hearing

about the danger of AIDS, politicians have cut down on

funding. "That is dangerous, indefensible and a waste of

money" say AIDS researchers and doctors. Every month

there are 20-25 new cases of the illness. The increase is

greatest among heterosexuals.

There was a time when all Danish TV viewers whistled

the three notes from the jingle "Remember the condom!"

But today this minimal hit is more or less forgotten. City

buses are no longer equipped with meter-long eondomn

ads. Newspapers have stopped publishing the latest news

about the AIDS epidemic. And the politicians have long

ago stopped voting special appropriations for information about and research in AIDS.

The effect was predictable:

"Now that AIDS business was certainly a bit overdriven.

The nightmare forecasts did not come true. AIDS is

certainly an overstated phenomenon." Those are the

attitudes. So claim the doctors, anyway, and others

whose work forces them to take AIDS seriously.

And in the meanwhile the statistics continue to climb.

Almost certainly not as rapidly as during the fright of

1987. but across a much broader field.

Every month between 20 and 25 Danes get the message:

"You arc in the first stages of AIDS." During the same

period between 10 and 12 people arc hospitalized with

an outbreak of the illness. And an increasing number of

them do not belong to the known risk groups. Thirty

percent of the 115 women who have the first stages of

AIDS (HIV positive) arc believed to have become

infected through regular heterosexual contact.

"Therefore it is extremely dangerous to de-escalate the

AIDS campaign." maintains Senior Doctor Jens Ole

Nielsen, who treats half ofthe country's AIDS patients al

Hvidovrc Hospital. He continues: "Large amounts of

effort and money have been expended to create awareness of this disease. If we do not continue now with a

little more emphasis, people will be left behind in a kind

of a vacuum. People believe that the danger is exaggerated. It is not. And what is worse, we have no cheek

against the spread of the disease among heterosexuals."

In 1987 the politicians appropriated an extraordinary 10

million kroner for AIDS information. The next year the

special appropriation rose to 18 million. Bui this year a

corresponding amount (18 million kroner) alone will not

cover the campaigns against the spread of AIDS and

preventive work against other diseases. It is estimated

that the AIDS campaign pool is thereby reduced by 5

million kroner.
JPRS-TEP-89-015

25 AUGUST 1989 WEST EUROPE 19

"Minister of Health Elsebeth Kock-Pedersen, why is

that?"

"Because the applications that we received for support of

the AIDS campaigns did not have the necessary quality."

"Does that mean that if they had 'the necessary quality'

the appropriations would not have been reduced?"

"I really cannot say anything about that. The applications were just not good enough!"

The minister of health does not agree with hospital

personnel at the country's AIDS clinics, who say that

"the population no longer takes AIDS seriously." Elsebeth Kock-Petersen says: "I definitely believe that they

do, but it is not possible to prove the very great amount

of attention being paid to the disease. Now that attention

has found its proper resting place. Henceforth we will

give higher priority to the diseases which affect a great

many people. Namely, cardiovascular disease, traffic

accidents and cancer."

This year an estimated 20 million kroner will be spent on

information about AIDS. The money will come from the

state, counties, municipalities and private funds. As a

comparison, the Swedish state alone spends five times

that much money for information campaigns—more

than 100 million Swedish kronor. Also AIDS researchers

notice the declining political interest in the disease.

Professor Join Olsen, leader of the adjudicating committee for AIDS research, the medical science research

council, says: "In 1986, 1987 and 1988 we received

research money almost before we asked for it. This year

none was appropriated—but we are still hoping. If we do

not continue the work, part of the past three years'

expenditure of funds will be wasted, as much of it was

invested in education of people and technical equipment."

Doctor and scientist Jan Fouchard, who is active in the

National Organization of Gays and Lesbians said: "It is

very important to determine whether AIDS campaigns

are effective. But today it is unbelievably difficult to get

money for behavioral research. Last year we received

300,000 kroner—this year nothing. In the organization

much of the work is done on a volunteer basis, and that

cannot continue."

Treatment of an AIDS patient costs between one-half

and one million per year. Despite financial problems the

research has made progress.

Senior doctor Jens Ole Nielsen, head of the AIDS

department at Hvidovre Hospital said: "Today it is

possible for us to fight some ofthe resulting diseases that

AIDS patients are dying of, including pneumonia. By

giving Retrovir it is possible to prolong a patient's life a

little, and a new substance, Isoprinosin, which has

proved to postpone the time when AIDS breaks out in

those who are HIV positive."

And meanwhile the statistics continue to grow. This was

the situation as of 1 June this year:

—1800 known cases of HIV infection, of which 115 are

women.

—5000 estimated to be HIV infected.

—435 cases of AIDS, of which 28 are dead.

AIDS Patients May Have Long Wait for DDI

Medicine

54002509 Copenhagen INFORMATION in Danish

19 Jim 89 pp I, 12

[Article by Anne Brockenhuus-Schack]

[Text] The drug DDI is five times as active and seems to

have fewer side effects than Retrovir.

It may be as long as a year before Danish AIDS patients

can participate in a trial of a new drug, Dideoxyinosin,

DDI, promising results of which were reported recently

at the international AIDS conference in Montreal.

Hvidovre Hospital will start out by asking the drug's

producer, Bristol Meyer, for permission to conduct laboratory tests, senior physician Lars Mathiesen, MD, told

INFORMATION.

Researchers at the National Institutes of Health in the

United States tested DDI on 18 patients with AIDS and

AIDS-related syndrome and noted an improvement in

the patients' immune systems and a decrease of HIV

virus in their blood. The patients had an average weight

gain of 2 kg, which was regarded as an indication that

they were doing better. At the same time there are some

indications that the product also has an effect on patients

with HIV.

The drug is very similar to the only previously known

effective medication, Zidovudin, which is known as

Retrovir in this country, but the new drug is five times as

active and appears to have fewer side effects. In particular it does not have such a violent effect on bone

marrow as Retrovir where severe anemia can make it

necessary to inject red blood cells. However two of

twenty-odd patients who were given DDI had to stop

because it had an adverse effect on their bone marrow,

according to Lars Mathiesen.

He said it is much too early to say anything about side

effects and they are just making a decision now in the

United States concerning a dose for large-scale tests

involving several hundred patients.

Price

The senior physician also said it is too early to say

whether DDI will be as expensive as Retrovir because

the price of the drug has not yet been established. Nor is

he sure whether this is an entirely new drug or a so-called

"shelf product," i.e. a drug developed for other purposes

that was not tested on AIDS patients until later, as was

the case with Retrovir. Retrovir was originally produced
20 WEST EUROPE

JPRS-TEP-89-015

25 AUGUST 1989

from herring sperm but later it proved possible to

produce this active substance synthetically.

Concerning a Danish tryout of the drug Lars Mathicsen

said, "It depends entirely on how much of it is available.

But it will probably take a year to reach a satisfactory

agreement with the manufacturer and receive permission from the Health Agency to test it on Danish

patients."

Isoprinosin

Danes attending the Montreal conference presented

results from the Danish-Swedish test of isoprinosin's

ability to prevent HIV-positive patients from developing

AIDS. Some 886 HIV-infccted people took part in

so-called placebo tests for half a year, with one group

receiving the active substance and the other ordinary

calcium tablets. In the first group only two people, or 0.5

percent, developed AIDS during the period while 17, or

4 percent, of the second group developed the disease.

Senior residcnl Jan Gerstoft, MD, said at the AIDS

Fund's press conference Friday that there was no significant difference between how advanced the HIV infection was in the two groups and that the results of the

experiment can hardly be attributed to chance. No

objections to the Scandinavian research were raised at

the AIDS conference cither.

Change of Course

There were signs at the international conference that

research is in the process of changing course and

applying entirely new principles. As an example of this,

Lars Mathicsen pointed to soluble CD4, which American

AIDS researcher Robert Gallo is working on. CD4 is the

molecule in the white blood cells to which the virus

attaches itself. The hope is that if free CD-4 molecules

are injected into the organism the virus will prefer them

to the white blood cells. Furthermore there is a possibility of combining the injected CD4 with a poisonous

substance that inhibits or kills the HIV virus. A largescale American experiment is currently under way at

several centers simultaneously, but the results arc not yet

available.

Heterosexual Infection

Dr Mads Mclbyc, of Cancer Prevention, who also

attended the conference, said that heterosexual infection

is a growing problem outside Africa too—especially in

Central and South America at the moment, but the same

tendency can be detected in the United States. Europe

and Asia. It is estimated that at the end of 1990 there will

be more new AIDS cases among drug abuscrs than

among homosexuals.

In the big American inner cities the incidence ofsyphilis

among blacks has tripled since 1984 and it is feared that

this development along with the rising abuse of "crack"

will lead to a hetcroscxually-transmittcd HIV epidemic

in these areas in the near future.

"Crack" is a synthetically produced drug that is cheaper

than heroin and is especially widespread among nonwhites. Like other narcotic drugs it reduces judgment—

also with regard to the selection of sex partners and sex

practices—which could affect the size of the epidemic.

Tighter Rules for AIDS Testin«

54002507b Copenhagen BERL1NGSKE T1DENDE

in Danish 25 Jun H9 p 7

[Article by RB: "Precise Rules for HIV Testing"]

[Text] Conservative Folketing member Karen Hojte

Jensen wants to ask Minister of Health Elscbcth KochPctcrsen (Liberal Party) to make sure that the National

Health Service makes precise rules as to when physicians

must subject their patients to HIV testing.

"It is every individual's right to decide whether he or she

will be given an HIV test or not. It must be completely

clear, as a general starting point, that the patients will

take part in all decisions concerning themselves," says

the Conservative Party spokesman on the subject of

AIDS.

In a study conducted by Doctors Allan Krasnik and Jan

Fouchard. half of the 700 physicians who were questioned answered that they would subject patients to HIV

tests without first asking their permission if they felt it to

be medically warranted.

The report also says that more than one fourth of

approximately 2.000 doctors, nurses and nurses' aides

feel powerless and uneasy at having to work with HIVinfected individuals. "It is shocking that Danish health

professionals arc lacking in knowledge regarding AIDS

to that extent." says Karen Hojte Jensen.

Study Finds Health Professionals Poorly Prepared

to Deal With AIDS

54002507a Copenhagen DEE ERI AKTVEE'l

in Danish 22 Jun 89 p 20

[Article by Ruth Northern "The Agonizing Fear"]

[Text] The authors of the big new study of the attitude

toward AIDS of health service personnel are frightened

by the results. Poor training regarding AIDS results in

fear and a desire for HIV-positive individuals to be

prevented from engaging in sexual intercourse.

People who are employed in health services have been

left in the lurch. They arc the victims of their own fear of

the new disease, AIDS, and their terror at the thought of

being infected with it. The training that has been provided has been far from sufficient, and health professionals also have not been able to discuss the matter with

each other and other people thoroughly because there

has not been enough time and there have not been

enough opportunities to do so.
JPRS-TEP-89-Ü15

25 AUGUST 1989 WEST EUROPE 21

The result is that more than one out of every four feels so

much fear and repugnance in regard to the possibility of

coming in contact with HIV-positive patients in their

work that they would prefer to have nothing at all to do

with HIV-infected individuals. Still more of them—70

percent—say that they cannot imagine working in a ward

filled with HIV patients and nobody else. The reason for

this is a feeling of inability to do the work and fear of

infection.

Forgotten Training

"In actuality, it is such a long time since we in Denmark

have had any experience with epidemics involving

serious diseases that health professionals have forgotten

how to go about tackling that sort ofthing," say the two

doctors, Allan Krasnik and Jan Fouchard, who carried

out the big new study among a total of fewer than 2,000

physicians, nurses, and nurses' aides.

They themselves are a bit frightened by the results

obtained from the study. The intention was to get a

general idea of professional reactions to dealing with

HIV at the present time, when the AIDS epidemic is

actually present, even though it has not developed as

violently as was feared at first.

But they did not expect to be confronted with as strong

a feeling of inadequacy and hesitancy as is indicated by

the figures.

In particular, the widespread fear took them by surprise.

"We must do a better job of analyzing what forms the

basis for that fear," the two physicians say. "Naturally,

AIDS has to do with a large number of familiar taboo

concepts: blood, sex, death, and so on. But it is nevertheless hard to understand how otherwise well-trained

groups of personnel, with a tradition of responsibility

and commitment toward sick people, allow themselves

to be dominated by the new disease to that extent,"

Fouchard and Krasnik say, and they refer, among other

things, to the part of the report that indicates that, for

example, close to 12 percent of nurses' aides do not dare

to sit and hold an AIDS patient's hand without wearing

a glove.

"Sixty percent feel that they are in danger of being

infected with the HIV virus in their work, even though

all experience up to now shows that the danger is

minimal and is much less than with other diseases that

also are dangerous. That must indicate that even the

'technical' training that is given is inadequate. Most

people in the health service think the same. A third ofthe

health service personnel as a whole say that they actually

have not had any instruction at all on AIDS. Where

nurses' aides—the people who have the most frequent

contact with patients—are concerned, that holds true of

more than half of them.

"And we have been in the midst of the epidemic for

seven or eight years!" Jan Fouchard and Allan Krasnik

say.

In their opinion, it is both embarrassing and dreadful

that training initiatives have been so infrequent.

It is also embarrassing and dreadful because there is a

clear-cut connection between poor training and fear and

inhibiting attitudes toward those who have contracted

the HIV virus.

As a glaring example of the latter, they mention that 20

percent of all those responding to the survey thought that

it would be reasonable to demand that people infected

with the HIV virus should not have sexual intercourse

with anyone for the rest of their lives.

Alone

At meetings they themselves have held at various locations, they have witnessed agitated discussions because

some people cannot understand why one cannot just

administer tests without permission. "Such strong reactions also make many individuals respond, in the survey,

that HIV-positive people should not work in operating

rooms. In particular, they say that a fair chance to

discuss or think the consequences through properly has

not been provided," the two authors of the report say.

Their study shows that many ofthe employees feel alone

in their uncertainty. They do not talk very much at work

about their feeling that they are in an awkward situation.

They do not give each other support by sharing accounts

of their experiences.

Jan Fouchard and Allan Krasnik hope that the study

itself has perhaps constituted an incentive to get such

exchanges started, and they say that some people added

to the questionnaire the following information: "We sat

down in the ward and talked over the questions and

answers in connection with the study.

An educational function [regarding the AIDS issue] is

clearly a good thing, the two doctors say. However, they

have more concrete proposals for an integrated effort

that can give health professionals the knowledge they

need and provide an opportunity to carry out the needed

remolding of attitudes.

Organizations Get Moving

That will require that professional organizations become

involved too. In addition to the Medical Association, the

Danish Nurses Council and the Municipal Workers

Union were involved in the preparatory work for the

study, while the National Health Service and the Medical Science Research Council were in charge of the

financing. There is going to be another chapter, but there

should be many others. Essentially, it could provide

information on how the population in general feels about

HIV and AIDS since such big differences in views have

become apparent among health professionals, Fouchard

and Krasnik say.
22 WEST EUROPE

JPRS-TRP-89-015

25 AUGUST 1989

On the whole, research on behavior will constitute an

important basis for the entire AIDS effort in the future,

too, and one cannot rely on studies from other countries

here, either.

"We ourselves must set aside money and designate

people for these studies if they are to be of any importance," they say.

"What is involved is Denmark, with Danish traditions

and attitudes," the two doctors say.

ICELAND

Officials View AIDS Statistics, Trends

54002506 Reykjavik MORGUNBLAD1D in Icelandic

14 Jul 89 p 25

[Article: "Five More Infected With AIDS Since Turn of

the Year: Difference of Opinion Whether to Look for the

HIV-2 Virus in the Blood"]

[Text] Five more individuals have been added to the

group of people who have been diagnosed to be infected

with AIDS since the turn ofthe year. This brings the total

number of people known to be infected with the HIV-1

virus up to 53, and of those, 12 have been diagnosed as

being in the final stages of the disease. According to

Deputy Surgeon General Gudjon Magnusson, 4 of those

were infected through blood transfusions, and 3 of those

were diagnosed this year. No one in the country as been

diagnosed infected with the HIV-2 virus which was first

discovered in 1986 in West and Central Africa and has

been detected in the West, for example, in Portugal and

Belgium and one case has been diagnosed in Sweden.

Because of limited spread of the infection, opinions

differ whether to start looking for both viruses in the

Blood Bank. It is estimated that in 60-70 percent of the

cases, HIV-2 will be found when testing for HIV-1.

HIV-2 Test a Must

According to Dr Haraldur Briem, internist at the City

Hospital, it was first thought that the HIV-2 virus was

less dangerous than the HIV-1 virus but it has come to

light that it causes AIDS just as well. Dr Briem said that

the test which is used in diagnosing AIDS in Iceland in

almost all instances does detect the virus, however, he

said, there is a new test which measures both viruses

which he expects to be implemented here. "It is difficult

not to test for both viruses, as it is known that the HIV-2

virus is found in Western Europe, although the likelihood [of its occurencc] is very minor the way things arc

today, said Dr Briem. "I don't know how it could be

excused if the virus were to be found after these tests are

on the market." Dr Briem said that the HIV-2 virus is

probably just as dangerous as the HIV-1 virus, but in the

beginning it was considered somewhat less aggressive.

The virus has not yet had the time to spread like the

HIV-1 and it takes 8-9 years from the time of infection

until infected people develop AIDS.

HIV-2 Diagnosed in 60-70 Percent of the Cases

According to Blood Bank Director Olafur Jensson, no

decision has yet been made whether to start testing for

HIV-2. The test used today is said to detect the HIV-2

virus in 60-70 percent of the cases. In a status report

issued by directors of Nordic Blood Banks on both the

HIV-1 and the HIV-2 virus, it is stated that only several

cases involving the HIV-2 virus have been found in the

Nordic Countries and that in each and everyone of these

cases, the infected persons came from the Western part

of Central Africa. It also came out that the tests used

cover most of the persons who carry the HIV-2 virus,

and as there has not been a definite case involving an

individual infected with both viruses in the Nordic

Countries, it is not recommended to make the HIV-2 test

mandatory.

"It is said that it is very costly to reach the cases that

might exist and they arc not very numerous after most of

the virus carriers have been isolated," said Dr. Jensson.

"One person here and there is added to the list, but I

think that it is known that those who arc in the risk

groups take this into consideration and do not give blood

and look elsewhere to find out about their own condition."

Most Cases From Africa

Prof Margret Gudnadottir says that people everywhere

are wondering how much emphasis should be put on

testing for the HIV-2 virus. Where there is a high

frequency of AIDS, emphasis is put on testing for the

virus if the HIV-1 virus cannot be found and the

patient's condition justifies further examination. Blood

Banks have not started testing for the HIV-2 virus

anywhere, and in the United States, where there is a

great crusade under way to test for the virus, only very

few cases have been diagnosed among immigrants from

Africa. The same applies to the very few cases that have

been diagnosed in Europe. "The spread is not at all

similar among these two viruses, whatever may happen

later," said Dr. Gudnadottir. "I only hope that the

education and information blitz conducted in the past

years will result in less spread of the virus. If suspicious

cases occur and the HIV-1 test is negative, we will, of

course, look for the HIV-2 virus but there will not be any

group testing for the time being. There is no reason for

that anywhere in the West, as far as I know. Where this

has been done, nothing has been found, but if the virus

starts to change, immediate measures will be taken to

start testing in the Blood Banks."

Five Died of AIDS

Five people have died from AIDS from the time the first

case was diagnosed in 1984. Of the 53 persons who have

been diagnosed infected, 36 arc homosexuals or biscxuals; 8 are drug addicts; 1 is both a homosexual and a

drug addict; 4 arc heterosexual and 3 of those arc

women. According to Deputy Surgeon General Gudjon

Magnusson, 3 of the 4 people who contracted AIDS

through blood transfusions arc women. It is known that
JPRS-TEP-89-015

25 AUGUST 1989 WEST EUROPE 23

one of the women died from AIDS, but it is unknown

whether the two others died from AIDS, as there were

other diseases involved. When the people who have been

diagnosed infected with AIDS are divided by sex, the

ratio is one woman for every five men. Most of the

infected people are between 20-29, or an average age of

27,, and 13 are between age 30 and 39.

NORWAY

Tick-borne Encephalitis Virus Threat Viewed

54002511b Oslo AFTENPOSTEN in Norwegian

1 Jul89p 20

[Article by Lene Skogstrom: "European Tick With Dangerous Virus"; first paragraph is AFTENPOSTEN introduction]

[Text] Should you go on a hiking trip in Central Europe,

or a camping trip in Sweden? Be on the lookout for forest

ticks, or get vaccinated. The virus disease TBE is worse

than the disease carried by the Norwegian tick.

So far this year the National Institute of Public Health

[SIFF] has vaccinated about 100 people against the virus

disease TBE, or "tick-borne encephalitis."

"The vaccine is not recommended for the average tourist," said Senior Doctor Vigo Hasseltvedt at SIFF. "It is

only people who are especially exposed to tick bites who

get the vaccine, for example orienteering runners or

forestry workers. The vaccine is available in limited

quantities in Norway, and a recommendation is required

from the country that one is going to visit that the

vaccine is necessary."

Paralysis

The Norwegian forest tick transmits bacteria which, can

cause the disease "tick-borne borreliosis." This can

cause both painful joints and paralysis. But fortunately

antibiotics can overcome borreliosis—provided one first

gets the correct diagnosis.

It is worse with the European variant of the virus. There

is no medicine against it. The symptoms of TBE are

similar to those of brain membrane inflammation—

fever, headache, and stiff neck. In 10 percent ofthe cases

paralysis appears, especially in throat and arm muscles.

Cramps and memory disorders can also occur. As much

as 3 weeks of acute illness are expected, but it can take

weeks or months to become entirely healthy.

Swedish Tick

"The disease appears to have spread in Europe," said

researcher Reidar Mehl. "In Sweden it has appeared in

the tourist paradise Gotland, the Malar Islands and parts

of the coast of Svealand and Gotaland. Also on land we

find the intoxication illness, which goes by the name

'Kumlinge disease,' because it was first discovered on

Kumlinge Island."

The vaccine provides very good protection against the

disease—90-95 percent. One can also protect oneself

against tick bites by wearing long stockings and high

boots. Ticks often fasten themselves to the ankles.

"The TBE virus has also been detected in Norway, but in

a much weaker form," said Mehl. "The illness becomes

worse the farther east one travels in Europe. In some

places in the Soviet Union there is a 20-percent mortality

rate among those who are infected."

In Sweden the number of cases that are treated in

hospitals has risen steadily in recent years. During the

60's and 70's there were about 20 cases reported per

year. In 1987 there were 65 cases reported, and 71 in

1986.

The Swedish Ministry of Health recommends vaccine

for persons who are traveling to the most tick-infested

areas along the coast where many cases of the disease

occur. In certain places in Austria vaccination is

required.

Norwegian Coast

Here in Norway there are forest ticks along the entire

coast, except for the northernmost counties.

There is no reason to panic if you are bitten by a tick this

summer. Only 20-30 percent of the tick nymphs and

40-60 percent of the adult ticks are carriers of the

bacteria which can give borreliosis.

"The chance of being infected increases with the number

of times the tick attaches itself and sucks blood," said

Mehl. "After 24 hours the danger begins. Pay attention

to the symptoms. Often there is a red ring around the

place of the bite a week or two later. That is a sign that

the bacteria is leaving its mark. But there is no need to

ask the doctor for antibiotics the moment you get a tick

bite!"

Health Official on AIDS Trends

54002511a Oslo AFTENPOSTEN in Norwegian

14 Jul 89 p 3

[Article by Tore Oksholen: "15,000 Norwegians Are

Risking HIV Infection"]

[Text] The sexual behavior of over 15,000 Norwegians is

such that they run the risk of being infected with HIV.

More heterosexuals are continuously being infected. In a

few years many drug addicts are going to develop AIDS

in Norway.

So far this year 19 new AIDS cases have been reported in

Norway. Of a total of 801 HIV-infected persons in this

country, 18 percent admit that they were infected heterosexually. This percentage is rising.

"Fifteen thousand people have caught sexually transmitted diseases in this country. This involves diseases
24 WEST EUROPE

JPRS-TKP-89-015

25 AUGUST 1989

such as chlamydia and gonorrhea. The means of infection is the same as with HIV, and one thereby enters the

risk group for being infected with HIV." said Senior

Doctor Arve Lystad in the Division of Preventive Medicine.

The latest figures for HIV and AIDS were presented and

commented on at a press conference in Oslo on

Thursday. Participants in the panel delected a significant increase in the number of AIDS patients beyond the

1990's. Many drug abusers will get AIDS in a few years.

So far 279 drug addicts arc infected with the HIV virus.

That is over one-third of all those who are infected with

the HIV virus. At the same time non-drug addicts make

up more than 4 percent of all AIDS cases in Norway.

"We must be prepared for a sharp increase in the group

of drug addict AIDS patients. Over the entire world the

drug addict percentage of AIDS patients is growing. In

Bangkok the percentage rose from 1 to 40 percent in less

than 1 year, from 1987 to 1988. The reason why the

number is so low in Norway is that we arc behind in the

development of the disease." according to Martin Blindheim from the journal DRUG ABUSE.

Private Testing

Senior Doctor Johannes Thorvaldsen. in the Environmental Department of the Oslo Municipality, discussed

the legal problems around HIV testing. Public institutions do not have access to testing their employees, while

there is no regulation against that for private firms. In

the United Stales such testing is extensive. Dr Thorvaldsen knows of no specific cases of this in Norwegian

firms. But it is known that SAS [Scandanavian Airline

System] tests its pilots, as do most other western airline

companies.

Survey Finds Public Less Concerned About AIDS

54002503 Stockholm DAdF.NS KYUETER in Swedish

29 Jim p 9

[Article by Gunilla Tengvall: "Fewer Frightened BRAIDS Threat"]

[Text] The AIDS threat has become somewhat less

frightening and the use of condoms has declined during

the past year. This is evident from a study undertaken by

assistant professor Bengt Brorsson at the Department of

Social Medicine al Uppsala.

Bengt Brorsson has studied the Swedes' views on AIDS

each year since 1986. In 1987 AIDS ranked first among

important social issues. This year, the disease ranked

fourth after drug use. criminal violence and environmental destruction.

Of the 4,000 interviewed. 25 percent had intercourse

with a condom "about once during ihc last month." The

figure was 27 percent the year before. In 1986 it was 20.

Single persons without a steady partner use condoms

much more frequently than others: 40 percent this year.

44 percent last year and 25 percent in 19X6.

The persons interviewed were between 16 and 44 years

of age. Thirty percent of them had been celibate during

the last month, compared to 28 percent in 1986. The

changes in Swedish sex life are consistently this marginal, according to the study.

Spontaneous intercourse between persons relatively

unknown to each other is still quite common. In most

cases a condom is not used.

The tolerance toward those who arc HIV-infecled is still

limited. In 1986 52 percent said that they would avoid

contact with an infected person in the workplace. In

1989 this figure is 30 percent.

This could be due to the fact that the classic misconceptions about how HIV is spread continue to exist, [for

example] in public toilets, through kissing, and so on. As

many as 26 percent believe that the virus is spread

through insects.

Just as the National Accounting and Audit Bureau. Bror

Bcngtsson is critical of the AIDS delegation's campaigns:

"It focucs too much on condoms. Those infected could

simply get the idea that 'as long as 1 use a condom it's

OK."' he says. "A condom is not a 100 percent protection. It is obviously the infected person's own moral

obligation to tell an intended sex partner that he or she is

HIV-infccted."

"The moral aspects have been pushed aside in the

Swedish campaign, and thus the rights of the uninfected

as well."

Risk Groups

Bengt Brorsson is also of the opinion that the risk groups,

homosexuals and those who inject drugs, should be

pinpointed more clearly.

"As it is now, there is much indication that the wrong

people are using condoms and having themselves tesled.

usually unnecessarily. And the tests are the most expensive items in the entire HIV budget. The Swedes are the

most HIV-tested people in the whole world."

Bengt Brorsson also calls for simpler language in technical matters, such as the danger of anal intercourse.

"The anal mucous membrane has an entirely different

absorption capability than the mucous membrane of the

vagina. That is why it is possible to use the anus to

medicate with suppositories."

However. Bengt Brorsson rales the AIDS watch of the

mass media very highly.

"It is considerably more factual than the delegation's

campaigns."
JPRS-TEP-89-015

25 AUGUST 1989 WEST EUROPE 25

Has not Reached Its Target

"I am disappointed that the AIDS information in mass

media and through campaigns has not produced the

intended result." says Assistant Chief Physician Borje

Akerlund at Roslagstull Hospital in Stockholm. "Both a

change of attitude and safer sex practices are needed."

"Apparently, the condom is still waiting for a comeback

after the contraceptive pill revolution of the 1960's. It is

also sad that the intolerance against those with the

disease is still so great."

"I believe it is because of the terror propaganda during

the first AIDS years, 84-85, that the change in attitude is

taking so long."

"At that time AIDS journalism was not as factual as it is

now. Then, the newspapers were filled with one extreme,

horrifying, case description after another. It gave the

impression that what was described was universally

applicable, that the disease struck blindly, and so on."

Give Rise to Thinking

Borje Akerlund thinks that the famous youth rail-pass

bag distributed by SJ [State Railways] and RFSU

[National Association for Sexual Information] is nevertheless a good initiative.

"The intention is not. after all, to send out Swedish girls

with a bag of condoms around their necks as bait for

love-sick Italians. The idea is to make young people

think."

"Temporary sexual liaisons without condoms involve

HIV risks, as well as about 10 or so other venereal

diseases, which will impact one's future life."

"But it would be better, of course, if the whole thing

weren't so Swedish and so depersonalized. It should be a

person, a parent or a teacher giving this good advice, not

a state agency."

TURKEY

Diarrhea Epidemic Reported in Adana

54002514 Istanbul GUNES in Turkish 22 May 1989

[Editorial Report] Istanbul GUNES in Turkish on 22

May 1989 carries on page 3 an article by Yasemin

Ercenk, who reports from Adana that diarrhea has

reached an alarming level there. Specialists say that the

onset of the summer heat and the consumption of

unwashed fruits are the causes of this situation. There

are 230 children in the state hospital under doctors' care,

and four children have died of the disease.

Measles Epidemic Reported in Southeast

54002513 Istanbul GUNES IN Turkish

15 May 1989 p 3

[Editorial Report] The measles outbreak in the southeast

has reached an alarming level, with 400 children hospitalized and five pronounced dead. Reports indicate that

the age group most affected is from birth to 6 years.

Specialists say that the reason for the epidemic is the lack

of adequate preventive measures such as shots.

Green Locusts Seen Again

54002512 Istanbul Hurriyet in Turkish 18 May 89

[Editorial Report] 'Green locusts' have been seen in the

Kusadasi, Germencik, Karacasu, and Kuyucak Districts

in the western part of the country. According to experts,

the locusts normally live in the mountains, but this year,

due to conditions caused by the drought, they have come

down to the lower lands to survive. Since they live on

vegetation, they inflict damage particularly on vegetable

gardens, cotton plants, and tobacco fields, as well as

fruits and olives. Special precautions are being taken in

Germencik and Albeyli since the primary produce of

these areas is figs.
s

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44

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