16 SUB-SAHARAN AFRICA

Dr. M.G.A. Forrest of the SAIMR Pietersburg branch
told SAPA this was a “remarkably low figure” for a
9-month period.

“The AIDS epidemic is only starting to develop in this
part of the country. Our turn will come but at the
moment we only have a small problem with HIV-
positive blood donations.”

He said despite the testing of donated blood there was
still a chance of becoming HIV-infected from blood
transfusions but it depended on the incidence of HIV
positivity in the donor population.

Local AIDS specialist Dr. Ruben Sher agreed there was a
risk—although it is slight—of becoming HIV-infected
from donated blood.

He said there was a period known as the “window of
infectivity” during which a person who had picked up
the virus would still not have developed the anti-bodies
and would consequently test negative. “But that person
will still have the virus and will be infectious.”

Another problem which had been experienced was that
people sometimes simply tested negative whereas they
were HIV-positive. This was known as the “false nega-
tive”,

Dr. Sher emphasised that the chances of becoming
HIV-infected through blood transfusions were excep-
tionally small.

He said homosexual men and drug users were discour-
aged from donating blood but this was no guarantee as
donors were taken on honour.

“Nothing in life is 100 percent certain, but we try and
minimise the risks.”

Government Reports 613 AIDS Cases for 1982-90

MB0701155591 Johannesburg SAPA in English
1509 GMT 7 Jan 91

[Text] Pretoria Jan 7 SAPA—Information released by
the Department of National Health and Population
Development on Monday [7 January] revealed that for
the period 1982 to 1990, South Africa had 613 con-
firmed AIDS cases, of which 270 were reported in 1990.

The geographical distribution chart showed that Johan-
nesburg had the highest number of recorded cases (211),
followed by Durban (90), Cape Town (86), and Bloem-
fontein (12).

The information, based on anonymous data supplied by
the South African Institute for Medical Research,
revealed that during this period 459 males contracted
AIDS in relation to 152 females and two persons of
“unknown sex”.

According to the information, males between the ages of
30 and 39, and females between the ages of 20 and 29
had the highest incidence of the disease.

SJPRS-TEP-91-002
28 January 1991

According to the report the majority of the cases were
either homosexual or bisexual males, of which 263 were
white. The number of heterosexual people who had
contracted the disease to date totals 220,

‘Alarming Growth’ in Pediatric AIDS Cases

MB1401195291 Johannesburg SABC TV I Network
in Afrikaans 1800 GMT 14 Jan 91

[Text] An alarming growth in the number of pediatric
AIDS cases is being experienced in South Africa.

According to the Department of National Health and
Population Development, 78 black babies in the country
are infected with the HIV virus, but no pediatric cases
have been reported by other race groups.

A 30-year-old black nursing sister in the northern Trans-
vaal had her pregnancy terminated after being identified
as an HIV carrier.

SWAZILAND

Medical Official Notes 18 AIDS Deaths Since

MB0901174991 Mbabane Domestic Service in English
1600 GMT 9 Jan 91

[Text] AIDS has claimed one more life, increasing to 18
the number of people killed by the disease since 1987. A
statement released by the director of medicine, Dr. John
Mbambo, said AIDS killed the Swazi national between
October and December in 1990.

Also during the same period, AIDS patients increased
from 27 to 30. This included that of a 15-month-old
whose mother was found to have the HIV viral infection.
Dr. Mbambo said this is a sign that the mother-to-child
transmission is beginning to show its ugly head in this
country, and this will be a new dimension in the treat-
ment of the disease. Dr. Mbambo said AIDS in Swazi-
land is mainly sexually transmitted.

On a positive note, Dr. Mbambo said Kenya has
launched a drug, Chemron, which has been developed by
the Kenya Medical Research Institute for use in the
management of AIDS patients. He said Chemron is not
proven to be a cure for AIDS yet but it does seem to offer
some promise.

TANZANIA

Study Says 90 Percent of Citizens Aware of AIDS

£A0801171091 Nairobi KNA in English 1245 GMT
7 Jan 91

[Text) Arusha, 7 January (PANA)—More than 90 per-
cent of Tanzanians are now aware of the existence of the
Acquired Immune Deficiency Syndrome (AIDS) and
how it is transmitted, according to a recent study.



JPRS-TEP-91-002
28 January 1991

We feel that, despite its outward simplicity, that system
also has a number of flaws.

1, The role that persistent generalized lymphadenopathy
plays in this pathology is known. We cannot, therefore,
understand why the system’s authors attach so little
significance to that symptom (0 points).

2. “Herpes simplex” is mentioned in item 3, but does
herpes zoster really have less significance here?

3. It is unclear as to why varying degrees of weight loss
are indicated as a specific sign of this pathology three
times in the system (items 2b, 6 and 11), and with a
12-point difference in significance at that.

4, Item 2a, which covers too wide a range of pathology,
is nonspecific.

5. The diagnosis presented in item 10 (“delimited
Kaposi’s sarcoma”) actually precludes the possibility of
acknowledging the generalized form of that disease,
which is no less of an important “indicator” of AIDS.

6. Item 12 refers to HIV-induced encephalopathy. But if
an individual is identified as an HIV carrier, use of the
system for diagnostic purposes loses its meaning.

SOVIET UNION 37

Thus, the system described above also needs improve-
ment.

Noteworthy, from our point of view, is a clinical classi-
fication approved by the WHO in 1985,* according to
which every case of AIDS in an adult must have at least
two so-called major signs of disease and at least one
“minor” sign in the absence of any known causes of
immune suppression—causes, for example, such as
cancer or extremely poor nutrition. According to that
classification, the three “major” signs are constitutional:
(1) loss of more than 10% of initial weight; (2) diarrhea
lasting longer than 1 month; (3) prolonged fever (longer
than 1 month), constant or intermittent. The six
“minor” signs include the following: (1) persistent cough
lasting 1 month or longer; (2) generalized pruritic der-
matitis; (3) recurrent herpes zoster; (4) nasopharyngeal
candidiasis; (5) chronic progressive disseminated infec-
tion evoked by herpes simplex virus; (6) generalized
lymphadenopathy.

In order to study the feasibility of using that classifica-
tion in the clinic, we examined a group of patients at the
specialized AIDS treatment hospital (Vidovr). The
patients had been diagnosed as having AIDS and were
undergoing inpatient treatment from April 1988 to Sep-
tember 1989. Nineteen patients in whom the disease
diagnosis had been confirmed when HIV was found in
the blood were examined. Medical histories were
obtained by interviewing the patients, while direct-
observation data were obtained by examination. Table 3
presents some data obtained as a result of the survey.

Table 3. Main Symptoms of Disease in 19 Patients Infected With HIV (and diagnosed as having AIDS)

Number of Patients
Disease Symptom Absolute % of Total Number of Patients Rank
1. Substantial weight loss (more 12 63 4
than 10%)
2. Chronic diarrhea lasting longer 3 16 6
than 1 month
3. Prolonged fever lasting longer 18 95 1
than 1 month
4, Pronounced general weakness 18 95 1
5. Night sweats 14 74 2
6. Persistent cough lasting longer 14 74 2
than | month
7. Generalized pruritic dermatitis 1 5 8
8. Recurrent herpes zoster 2 10 7
9, Nasopharyngeal candidiasis 10 33 5
10. Chronic progressive dissemi- 0 0 :
nated infection induced by herpes
simplex virus
11, Generalized lymphadenop- 13 68 3
athy

Unlike the authors of that classication,* we do not
consider generalized pruritic dermatitis, herpes simplex,
or herpes zoster to be convincing, frequent signs (““mark-
ers”) of HIV infection; that is also confirmed by the
results of the survey: dermatitis was observed in only | of

the 19 patients (i.e., in less than 5% of the cases); herpes
zoster infection was observed in two (around 10%); and
herpes simplex virus infection was not found in any of
the subjects. Nor did we observe very frequent cases of
diarrhea among European patients (four cases—20% of



JPRS-TEP-91-002
28 January 1991

Alma-Ata Woman Found HIV-Positive After
Lengthy Testing

907C0814B Moscow IZVESTIYA in Russian 28 Aug 90
p2

[Article by Vladimir Ardayev: “A Case of Extraordinary
Delay. Medics Needed More Than Two Months to
Discover the AIDS Virus in the Blood of a Donor”)

[Text] At the end of May specialists were suspicious of a
blood sample from a nineteen-year-old woman resident
of Alma-Ata taken at the republic transfusion station. An
entire series of analytical tests for the presence of a virus
did not yield clear results. The tests were continued at
several Moscow institutes, but it was only in August that
news had reached the capital of Kazakhstan that the tests
were shown to be positive...

Throughout this period the suspect patient was under
observation in the republic. Authorities established what
her surroundings were and the persons with whom she
was in contact, a total of about 200 persons. Now that it
is clear that many of those persons could turn out to be
sources of a new infection, their blood is also being tested
for AIDS. In addition, the Kazakhstan Ministry of
Health has undertaken a check of instrument and mate-
rial disinfection and sterilization procedures at poly-
clinics, and has assumed supervision over barber shops
and beauty salons. It is also testing the blood of foreign
students and representatives of the risk groups.

The first AIDS case was identified in Alma-Ata in
December 1987 when a foreign student was found to be
infected. Later, seven other foreign students were found
to be infected, and naturally, all of them were obliged to
leave our country immediately. Now, a woman resident
of the city has contracted AIDS... It is very good that
Kazakhstan medics were so timely in giving their atten-
tion to a “suspicious” donor blood sample. But how are
we supposed to combat the “plague of the twentieth
century” if so much time is required to test blood
samples?

AIDS Screening in Uzbekistan

91WE0030B Moscow PRAVDA in Russian 4 Sep 90
Second Edition p 6

[Article by correspondent V. Artemenko: “AIDS Is Not
Sleeping”)

[Text] The fourth case of AIDS among Soviet citizens
was registered in Uzbekistan. Preparations are being
made in the republic for the fight against the “plague of
the 20th century.” A network of diagnostic laboratories
is being created. Over 40 of them are already operating at
central rayon hospitals and blood banks. They have
examined around 2 million donors and pregnant women,
over 15,000 foreign citizens and 23,000 drug addicts.

SOVIET UNION 33

Aralsk Plague Quarantine Lifted, AIDS Case
Discovered

91WE0030A Moscow IZVESTIYA in Russian
27 Sep 90 Morning Edition p 6

[Article by correspondent V. Ardayev: “AIDS During
Plague”)

[Text] “Plague in Aralsk”—such was the name of an
article in IZVESTIYA, No 261, about an outbreak of the
terrible disease in this rayon center of Kazakhstan’s
Kzyl-Orda Oblast. This week the rayon extraordinary
plague control commission lifted the quarantine on
Aralsk.

Entry into and exit from the city are now unrestricted.
However, there is still much work to do to prevent an
epidemic. According to a report from Aralskiy Rayon
Executive Committee Chairman A. Aimbetov, chairman
of the extraordinary commission, plague patient Zh. is
receiving intensive treatment in the hospital. His condi-
tion is satisfactory. The doctors promised to release him
from the hospital before the week is out. New cases of
plague have not been revealed. All 237 persons that were
under observation have returned home.

Inasmuch as a camel butchered by local residents was the
source of infection, special attention has been turned to
the condition of these animals. Eight special brand Duk
washers were delivered to the city, where they were used
to cleanse all 11,175 camels in the rayon. Nonetheless, a
prohibition was imposed on the slaughter of camels and
human consumption of their meat until December. The
population is undergoing universal vaccination, which
should be completed by 28 September. As many as over
11,000 persons have been immunized with plague vac-
cine as of today. All residential building are undergoing
disinfection and disinfestation.

“We are grateful for the assistance provided to us by
medical workers, internal affairs associates and trans-
port drivers,” said Adilbek Izbasarovich. Owing to the
selfless, literally 24-hour work of these people sent to the
rayon by the oblast’s extraordinary plague commission,
we were able to nip the outbreak of the terrible disease in
the bud. The help was considerable. Automotive fuel was
delivered to the rayon from the oblast center without
interruption in the quantities required, even though all
urban transportation in Kzyl-Orda itself was on the
brink of collapse. But at the same time, there are
problems as well. For example, the additional foodstuffs
for the city, which are so urgently necessary in such
cases, were allocated from, of all places, our own supplies
for the fourth quarter.

It is all well and good, of course, that we managed to
surmount the plague in an efficient and organized
fashion. But the population of Kzyl-Orda Oblast has now
been shaken by another piece of news: AIDS virus was
revealed in the rayon center of Chiili, in patient D., who
was initially diagnosed as suffering tick-borne typhus. A
special team of medical personnel has already arrived in



42 SOVIET UNION

Povar: But there are victims when it comes to this
disease—especially children. Are there plans for material
assistance for them?

Nekrasova: Since 1 September 1990, the Soviet charity
fund “Ogonyek”-“Anti-AIDS” has been paying out
monthly assistance to families that have HIV-infected
children. The monthly assistance amounts to 100 rubles.

Povar: Lyubov Sergeyevna, it’s understood that the
charity funds cannot save people from the AIDS epi-
demic, but they will help in controlling this disease.
What is the account number of the republic fund for
controlling AIDS to which contributions can be made?

Nekrasova: The current account number is No. 700126
operative task force of the Kiev city administration,
Housing and Social Services Bank of the USSR, inter-
branch circulation 322012.

JPRS-TEP-91-002
28 January 1991

Povar: And what if a young person wants to be tested for
AIDS, where can he have that done?

Nekrasova: At the anonymous testing laboratory, which
in Kiev is at 20 Vorovskaya Street. Such laboratories are
in operation in all of the oblast centers and cities of the
Ukraine.

Povar: I would like to know what are we doing in the way
of producing disposable syringes and “articles of discre-
tion”?

Nekrasova: The state of affairs with respect to that is
unsatisfactory. The Belgorod-Dnestrovskiy Plant for
Disposable Polymer Medical Products, which produces
200 million syringes annually, gives only one-tenth of its
production to the republic. That is because all of the
plants engaged in such production are subordinate to the
USSR Ministry of the Medical Industry. As for con-
doms, the only plant is located in Armavir of Krasno-
darskiy Kray, and it fills only 15 percent of the republic’s
requirements. The rest must be purchased abroad.



10 SUB-SAHARAN AFRICA

which causes them to want to isolate, quarantine, or even
eliminate infected or afflicted individuals whom they
perceive as threatening and dangerous to the health of
others in everyday contacts. In future education cam-
paigns, it will be important to develop the themes of
nonrejection and support for AIDS victims, in particular
to prevent victims from having to adopt secretive
behavior and anti-social attitudes. Enabling AIDS vic-
tims in Chad to tell their stories would help raise the
public’s sense of concern.

These beliefs are also partially responsible for the idea
that AIDS is unavoidable and that it is impossible to
escape infection by taking precautions at the behavioral
level. There again, essential knowledge of the ways in
which the disease is transmitted must be disseminated
and health-care workers can exert a decisive influence
but only in the long-term.

In view of the large percentage of respondents with a
higher education who believe that AIDS can be cured
and in view of their role as relayers of information in
public opinion, there is an urgent need to correct this
misperception with accurate information on the theme:
“Yes, AIDS can be ’cured“‘—by prevention.”

The general public must be made aware that AIDS is
avoidable and that it is neither an inescapable fate nor a
punishment. To accomplish that, the notion that “unsafe
behavior” alone can lead to the possibility of catching
AIDS must be conveyed to the public, and at the same
time, the public must be informed of “protective behav-
ior” (faithfulness to one’s partner, sexual abstinence, and
the use of condoms during sexual contact with individ-
ual’s one does not know well).

As condoms are little known in Chad, a selective infor-
mation and promotional campaign is necessary once it is
has been made certain that condoms can be effectively
distributed without interruption of supply at an afford-
able price to those concerned.

Because the large majority of respondents is willing to
take an AIDS test and to be informed of the results, care
will have to be taken to ensure that the meaning of
negative results are correctly understood, i.e., that a
negative test result does not mean protection from AIDS
and that unsafe behavior cannot be continued without
fear.

The still poorly understood notion of a “healthy carrier”
of the infection should, if made generally known, also
help to put into perspective the “danger” posed by those
ailing with AIDS to the extent that they represent merely
the visible portion of a larger group of people. Also in
this context, it is important to qualify the notion of “risk
group” which too often allows people to identify the
disease with “others” and to overlook the fact that they
themselves could be led to engage in unsafe behavior.

SJPRS-TEP-91-002
28 January 1991

GHANA

Seventy-eight AIDS Cases in North in Three
Years

AB2612195890 Accra Domestic Service in English
0600 GMT 26 Dec 90

[Text] A 29-member AIDS committee has been inaugu-
rated in Tamale as part of efforts to create awareness
about the disease. It is also to educate the public on how
to avoid contracting AIDS. Speaking at the function, the
coordinator of the Northern Regional AIDS Committee,
Mr. John Bona, disclosed that the region has recorded 78
cases since the first three were diagnosed three years ago.
The regional director of health services, Dr. Sam Bugri,
said education on AIDS should not be the prerogative of
health workers alone, but should be the task of all.

IVORY COAST

Paper Reports Authorities Playing Down AIDS
Threat

AB1111091890 Paris AFRICA INTERNATIONAL
in French Nov 90 pp 56, 57

[Article by Catherine Morand: “Where is the Money for
the AIDS Campaign?”]

[Excerpts] AIDS is in our midst. Reggae singer Waby
Spider is the latest person to sing his head off on Ivorian
Radio and Television to warn his countrymen against
the terrible disease, but still it was in homeopathic doses
that the excellent clip of his song “Protect Ourselves” is
shown on TV. The reason is very simple: For the past
year in Ivory Coast people do not speak about AIDS.
Curiously, while the disease—as is the case in other
countries—is assuming proportions of a national catas-
trophe, the media have become silent. The radio and
television have kept silence, while the print media only
mention the disease in general terms without giving any
figures on the alarming situation in the country. They are
so quiet that people have started asking: Why do people
no longer speak about AIDS in Ivory Coast? And an
additional question for those who know about its exist-
ence: What is the National Committee for the Fight
Against AIDS doing?

That is, indeed, the question that many people are going
to ask Professor Odehouri Koudou who, as chairman of
the National Committee for three years, became the
Ivorian Mr. AIDS. Very active and competent, a man in
the field in contact with the everyday realities of the
disease since he is the director of the infectious diseases
ward at the Treichville Teaching Hospital, Prof. Ode-
houri presided over a working group on AIDS as early as
1985 when the HIV virus was diagnosed for the first time
in Ivory Coast. Then, with the encouragement of the
WHO, the working group was resolved into a National
Committee for the Fight Against AIDS (CNLS).



20 SUB-SAHARAN AFRICA

Mothers have a great influence on the family, particu-
larly on children. Women should contribute to the edu-
cation of children to be aware of the dangers of AIDS
and to avoid being infected. Women should therefore
influence the whole family in this awareness campaign,
and the adoption of sexual behaviour that is free of risk
to AIDS infection.

At the time of delivery where women traditionally play a
greater role than men, and also during care for AIDS
patients there may be danger of infection to the care
given. But guidelines have been carefully prepared by the
Ministry of health. Women are advised to follow the
advice of health workers.

The escalating numbers of orphans is one of the conse-
quences of the AIDS epidemic. This has added to the
burden of the war orphans, created during the civil
conflicts of the recent past. The total number of orphans
in this country is estimated to be close to a million and
they are steadily increasing. The basic responsibility of
caring for orphans belongs to relatives and the commu-
nities. However, the community requires support.

Government is handling the orphans problems with the
cooperation of several NGOs through the ministry of
relief and social rehabilitation. But other Ministries and
sectors including education, justice and agriculture, will
be assisting with the education, feeding, clothing and
development of orphaned children, protecting their legal
and inheritance rights, as well as establishment of sus-
tainable income generating projects such as agricultural
farms.

You will recall that the majority of people affected by
AIDS are in the age range between 15 and 40 years. This
is the most productive group in terms of social and
economic development. AIDS is therefore robbing the
country of its most productive man power and loved
ones in whom society had high expectations.

Society must therefore fully participate in the struggle to
eradicate this dangerous epidemic and in the manage-
ment of its consequences. AIDS day is the occasion for
rededicating ourselves to the struggle against the disease.

In conclusion, may I invite all Ugandans to mark the
World AIDS Day | December as a way of strengthening
our struggle against AIDS.

Please join other people in solidarity and carry messages
to other Ugandans so as to assist in change of social
behaviour and stop the transmission of AIDS.

‘Executive’ Clinic for AIDS Testing Opened

91WE0141B Kampala WEEKLY TOPIC in English
7 Dec 90 p 20

[Excerpt] AIDS is on the increase and the worst is yet to
come. This alarm was sounded by the Deputy Director
of AIDS Information centre at Bauman House, Tukwasi-
ibwe Byaruhanga.

SJPRS-TEP-91-002
28 January 1991

Speaking to WEEKLY TOPIC at his office on Tuesday,
Tukwasiibwe said that the country is going to have the
highest ratio ever of dependents, decreased productivity
less efficiency and high mortality rates: which double
every three months.

On what the centre is doing to contain the situation, he
said that they were intensifying the AIDS education
programme.

For instance, he said, an executive branch was opened
last week for HIV testing and counselling services to
executives and leading citizens. The clients can ring
231528 and make an appointment. Branches will also be
opened in Jinja, Masaka, Mbarara and Gulu.

He disagreed with the opponents of the condom saying:
“We are faced with a life threatening epidemic and we
have limited options so we can’t afford to do away with
the few we have.”

According to him people should be taught how to use
condoms. For example, people should be educated that
condoms expire, need to be stored in a cool place and are
not to be carried in trousers pockets and brassiers.

He explained that a condom has a shelf life of 3-4 years
and should never be exposed to flourscent light.

On the allegation that most condoms are unsuitable for
African men, Tukwasilbwe said that African men should
use size 52.

ACP Head Reports on Lack of Public Response

91WE0141 Kampala WEEKLY TOPIC in English
7 Dec 90 pp 1, 12

[Article by Sensasi Benjamin]

[Text] Over 1.3 millon people are now HIV positive, and
975,000 of these are likely to develop full-blown AIDS in
the near future. The rate of infection will also not
decrease in the foreseeable future.

This was revealed by the Director of AIDS Control
Programme (ACP), Dr. Warren Namara, in an interview
with WEEKLY TOPIC in his office at Entebbe this
week, He did not disclose how the ACP arrived at these
figures.

Dr. Namara said AIDS is spreading at a rate of 11
percent, though the level of awareness in the country is
about 80 percent which means people are not responding
to the anti-AIDS campaign. This, according to Dr.
Namara is a major frustration to ACP, which has been
vigorously campaigning against AIDS for four years.

Namara said that Uganda is going to witness more
deaths as a result of AIDS than so far witnessed, and the
number of orphans will be too much to manage. “The
future is bleak because we are going to lose many
people,” he said. He said ACP will continue to give



38 SOVIET UNION

the subjects). However, we still feel it justified to include
the term “chronic diarrhea” in that classification, espe-
cially in developing countries.

Thus, according to our data, the clinical specialist can
propose AIDS if there is a lengthy course (at least one
month) of a combination of three or more of the indi-
cated symptoms: a feverish state, extreme weakness,
pronounced sweating (especially at night), substantial
weight loss, generalized lymphadenopathy, nasopharyn-
geal candidiasis, prolonged cough, or chronic diarrhea
with no “visible” causes.

Conclusion

The AIDS classifications proposed to date (by WHO, CDC,
etc.) have been intended to facilitate identification of the
disease by practicing physicians on the basis of clinical
symptoms. Those classifications were created when labora-
tory techniques for detecting the virus or antibodies to it
were still under development. Accurate diagnosis of HIV
infection became possible with the advent of those tech-
niques. Detection of HIV in the body is evidence that the
individual is in one of the phases of the disease. Therefore,
when HIV infection is confirmed in the laboratory, any
classification based on clinical symptoms and pursuing
diagnostic goals loses its significance, though in some cases
it might retain prognostic value.

In light of the above, despite having certain positive
aspects, the classifications of HIV infection and AIDS
that have been recommended by WHO, the CDC, and
others for diagnostic purposes are not, in our opinion,
suitable for use in the clinic. Those classifications are not
specific enough, are cumbersomeness, and are difficult
to use in the absence of a laboratory service. On the basis
of the experience of various researchers and on the basis
of our data (19 AIDS patients), we would like to propose
a complex of symptoms (a system) that could be used to
identify HIV-infected adults (aged 16-60).

The complex of symptoms manifested in adults infected
with HIV includes the following:

I. Prolonged (longer than one month) presence of two or
more of the listed symptoms
1. Unexplainable progressive weight loss (weight
loss of more than 10%)
2. Feverish state of unclear origin, with temperature
elevated to 38°C or higher
3, Heavy, previously unnoted sweating, especially at
night
4. Persistent cough of unclear origin
5. Diarrhea of unknown origin
6. Considerable, previously unnoted general weak-
ness, rapid tiring

II. Presence of at least one of the following factors in the
medical history
1. Classification in one of the “risk groups”:
a. Homosexuals, prostitutes
b. Drug addicts administering drugs with
syringes
c, Persons given frequent blood tranfusions
d. Hemophiliacs

SJPRS-TEP-91-002
28 January 1991

2. Sexually transmitted diseases

3. Recurrent infections

4. Neoplasms

5. Time spent abroad in regions endemic for AIDS

III. Presence of at least one of the following pathological
signs identified revealed by direct-observation examina-
tion
1. Changes in skin and mucous membranes (her-
petic rash, leukoplakia, mycosis, papillomas, etc.)
2. Polyadenopathy, lymphoma
3. Candidiasis
4, Recurrent pneumonia, pulmonary tuberculosis
5. Encephalopathy (in individuals under 50)
6. Kaposi's sarcoma

It should be noted that all of the 19 AIDS patients
discussed above had some of the signs listed in that
system. In our opinion, the system is sufficiently simple
and convenient for examining an individual upon his
first visit for medical assistance. Presence of two or more
of the listed complaints, of one or more of the anam-
nestic factors, or of one or more of the signs detected by
medical examination (see the chart) serves as grounds for
further examination and observation of the patient, with
mandatory elimination of the possibility of HIV infec-
tion by laboratory tests.

The system is offered here for clinical verification on a
large number of patients in order to assess its specificity
and sensitivity.

Bibliography

1, Blattner, W. A., Biggar, R. J., Weiss, S. H. et a/., ANN.
INTERN. MED., Vol 103, 1985, pp 665-670.

2. Burke, D. S. and Redfield, R. R., “AMA Staging
(Walter Reed Army Institute of Research),” Maryland, 5
July 1989, p 23.

3. Haverkos, H. W., Gottlieb, M. S., Killen, J. U. and
Edelman, R., J. INFECT. DIS., Vol 152, 1985, p 1095.

4, Morrison, F., “Consultation on the Classification of
HIV Infections for ICD-10,” Geneva, 1988, pp 13-14.

5. Redfield, R. R., Wright, D. C. and Tramont, E. C.,
NEW ENGLAND J. MED., Vol 314, 1986, pp 131-132.

6. United States: Centers for Disease Control, “Classifi-
cation System for Human T-Lymphotropic Virus Type
III/Lymphadenopathy-Associated Virus Infections,”
MORBID. MORTAL. WEEKLY REP., Vol 35, No 20,
1986, pp 334-339.

7. World Health Organization: “Global Programme on
AIDS. Draft Report of the Informal Consultation on
Staging Criteria for HIV Infection’ (WHO/
GPA/BMR/89), Geneva, 1989, pp 8-11.

COPYRIGHT: “‘Klinicheskaya meditsina’, 1990



SJPRS-TEP-91-002
28 January 1991

CAMEROON

New Cases of AIDS Detected

AB1I101124091 Dakar PANA in French 1749 GMT
9Jan 91

{Text] Yaounde, 9 Jan (CAMNEWS/PANA)—The
number of AIDS cases in Cameroon increased from 195
in August 1990 to 243 by the end of December, an
official source disclosed today in Yaounde, where there
is concern over the increase in the scourge. The source
added that these fresh cases were detected all over
Cameroon through laboratory tests.

The chairman of the Cameroon AIDS control com-
mittee, Prof. Lazare Kaptue, asserted that all the coun-
try’s provinces had been affected by this disease of the
century. There is a high prevalence of AIDS among
prostitutes, which Professor Kaptue evaluates at approx-
imately nine percent, adding that about one percent of
the population is seropositive, that is about 100,000
persons.

Cameroon AIDS control officials note that the number
of cases has developed very rapidly. They went from 21
declared cases in 1985- 1986, 155 cases in May 1990
(with 117 deaths), 195 cases in August 1990, to 243 cases
in December 1990. Faced with the increase in the
disease, the national AIDS control committee set up a
monitoring system in Yaounde, Douala, Bamenda, and
which will be extended very soon to Garoua (northern
Cameroon), and Bertoua (eastern Cameroon).

International financiers released 976 million CFA francs
in May 1990 to finance AIDS control in the country. It
will also be recalled that more than two million condoms
were, in a parallel manner, distributed to prostitutes. A
packet of four condoms costs 50 CFA francs in
Cameroon,

CHAD

Government Conducts AIDS Awareness Poll

91WE0165A Ndjamena REVUE SCIENTIFIQUE DU
TCHAD in French Vol I No 1, 1990 pp 3-12

[Article by Merci Danyod, medical doctor, Office of
Preventive Medicine and Rural Health, Ministry of
Public Health, in Ndjamena, Chad]

[Text] Summary: AIDS, a world-wide scourge of unprec-
edented proportion, is the greatest public health chal-
lenge existing today as there is neither a cure nor a
vaccine for the disease. Under these circumstances, the

SUB-SAHARAN AFRICA 1

sole means of preventing AIDS are information, educa-
tion, and communication. Behavioral change related to
sexual activity is one means of prevention.

Prevention is a matter for the entire population. In order
to achieve the desired result, Chad has conducted a
survey on the knowledge, attitudes, beliefs, and behav-
ioral patterns of the population in Chad’s five major
cities, which has enabled it to determine the population’s
level of awareness about AIDS. With the results of this
survey, a solid foundation for an anti-AIDS strategy can
be laid out.

Key words: Chad, AIDS, surveys of knowledge, atti-
tudes, beliefs, behaviors.

Introduction

From October 1988 to February 1989, a survey on
“Knowledge, Attitudes, Beliefs, and Behavioral Pat-
terns” was conducted in Chad’s five principal cities:
Ndjamena, Abeche, Bongor, Moundou, and Sarh. These
cities represent 16 percent of the country’s total popula-
tion and more than 80 percent of its urban population.
The conditions required for conducting a nationwide
survey were not all present.

Less than | percent of the sample (nine individuals out
of the total) refused to answer questions. There are
several explanations for their refusal. Among them, the
simplest explanation is distrust on the part of the respon-
dent who suspects the survey taker of knowing some-
thing about his health; some individuals were surprised
and disconcerted at being randomly chosen for the
survey. In the end, 1,991 persons were involved in the
survey, 981 of them women and 1,010 of them men.

I. Awareness of AIDS
1) “Have you heard of AIDS?”

This question drew an affirmative response from 60
percent of those surveyed in the cities. Men are more
familiar with AIDS than women; young people more
than older people; those with schooling more than those
without schooling; and Christians and Animists more
than Muslims. (See Table 1.) Residents of the cities of
Moundou, Sarh, and Bongor had more often heard about
AIDS than residents of Ndjamena and Abeche. This
finding is explained by the fact that World AIDS Day
occurred after respondents had been questioned in Ndja-
mena and Abeche but before respondents in the three
southern cities were questioned. These three cities thus
had the benefit of information broadcast extensively by
radio on the occasion of World AIDS Day. This also
demonstrates the significant influence of a radio cam-
paign and of the other events organized for this occasion.



SJPRS-TEP-91-002
28 January 1991

Fernandez: It is well-known that our country faces many
limitations. What efforts is the revolution making to
continue offering the same level of assistance it currently
gives to AIDS victims?

Terry: Well, we continue to have the same level of
assistance as in previous years. Despite the current
situation, our government has established clear rules in
this regard. [Words indistinct] possibility to have access
to the necessary medicine, which is very expensive.
Medicine for the treatment of AIDS is very expensive
and it is imported. We spend between $6,000 and $8,000
per year in medicine on each AIDS patient.

Fernandez: Is this cost strictly in dollars?

Terry: Yes, yes, in dollars. This only comprises expenses
in terms of medicine. It does not include hospital equip-
ment or other costs. This is strictly on medicine costs.
Therefore, imagine what will be the impact on the
national health service and the national budget if AIDS
surpasses our estimates. In view of this, we must con-
tinue struggling against this problem through all means
available [passage indistinct] granting the very best treat-
ment to our patients in line with the public health
principles upheld by the revolution even before the
victory of the insurrection.

Fernandez: Based on the research being carried out in
Cuba, could you tell me the number of AIDS victims and
the work that is being carried out by the laboratories?

Terry: Well, by the end of 1990 we had conducted a total
of 9.34 million tests since the start of the program in
1986. We conducted about 3 million tests in 1990. From
this overall figure and until yesterday, we have reported
a total of 528 AIDS virus carriers. Of these 528 carriers,
42 have already died. But there are 28 individuals who
are infected with the AIDS virus. Therefore, we continue
to monitor all AIDS cases; to record all clinical cases that
are reported to our health institutions, that is, to all
hospitals such as gynecological-obstetrics centers. We
monitor women who are in the first trimester of their
pregnancy, people in prisons, all Cuban personnel
arriving from abroad where they have been serving for a
long time; and, other personnel related with tourism, etc.
This is because tourism personnel are more exposed to
AIDS not because tourists are infected but because if this
person engages in sexual relations with unidentified
individuals, this person may contract the disease. It is
not that tourists have AIDS. Therefore, if normal work
relations are maintained between workers with [words
indistinct] consumers in our country, no problems
should arise.

We are working with these main groups and with vene-
real disease group. Experience shows that venereal dis-
ease victims are more apt to become another zero
positive case. Therefore, if an individual suffers from a
venereal disease such as gonorrhea, syphilis, etc.; there is
a great possibility that he is also an AIDS virus carrier.
This means that we must combat AIDS, or any other

LATIN AMERICA 31

similar disease, in a comprehensive way if we are to
decrease the spread of venereal diseases.

Fernandez: I believe that the people are also interested in
the steps that international and Cuban science is making
to counteract the spread of the illness and of the AIDS
virus.

Terry: Well, Cuban health centers, not only public health
centers but others as well, are carrying out research
programs to seek therapeutic and preventive methods,
such as an AIDS vaccine.

Weare taking serious steps in this regard and we hope we
can obtain results. However, these may not be achieved
in the short-term. But this shows that Cuba has a
scientific potential which has devoted its efforts to this
important activity.

Fernandez: Could you give us any other related informa-
tion on what scientists from other parts of the world are
doing in this regard?

Terry: Right now, scientists are mainly working on the
search for vaccines and medicine. There are new medi-
cines which have not yielded great results. (Zidotimi-
dine), that is, AZT continues to be the best medicine. We
have read in the latest [passage indistinct] have been able
to develop a medicine called (Neglicine) [passage indis-
tinct]. But we have to have more information on this. It
seems that the first tests made abroad have been suc-
cessful. Therefore, we are trying to make contacts to see
what are our possibilities.

There are many groups working on the development of
vaccines such as the Americans, the French, and the
Belgians. All of them are working on some research
vaccine projects but we cannot see any promising results
in the short-term. [passage omitted]

DOMINICAN REPUBLIC

AIDS Cases From 1983 to 1990

FL2012185290 Santo Domingo Radio-Television
Dominicana Radio Network in Spanish 1600 GMT
20 Dec 90

[Text] Some 2,241 cases of individuals infected with
AIDS were reported from 1983 to 30 July 1990 to the
Epidemiology Care Unit of the Sexually Transmitted
Disease Control Program {Procets]. According to the
report, on the evolution of the infection with the HIV
virus and the number of cases of AIDS in the country up
to this past July, 1,375 Dominicans suffered from the
disease at the time of the report. Most of the Dominicans
suffering from AIDS are between 25 and 34 years of age
for the 1983 to July 1990 reporting period. Procets
reported 852 cases of the disease among those belonging
to this age group.



SJPRS-TEP-91-002
28 January 1991

Based on the findings of the study, AIDS health promo-
tion activities in the country would now be aimed at
target groups which by nature of their lifestyles and
environmental setting are more likely to be exposed to
the HIV infection. These target groups, according to a
report on AIDS health promotion activities in Tanzania,
include barmaids, prostitutes, truck drivers, guest-house
operators, sailors, military personnel and students.

Most of the health promotion activities in 1989/90 in
Tanzania were geared towards provision of general
AIDS information to the public. The report says between
January 1990 and June 1990 the National AIDS Control
Programme (NACP) distributed about 3,000 copies of
posters aimed at promiscuous groups. The posters were
displayed at public places, bars and guest-houses and
other public places. Newsletters were also produced
specifically for community leaders and the public. Some
video cassettes and a locally produced film titled Jikinge
na Ukimwi (Protect Yourself Against AIDS) have been
shown widely in the country, according to the 12-page
report. A script for another film on AIDS has already
been written and it is under production, The NACP’s
long-term strategy in introducing AIDS education in
schools is to make it an integral part of the curriculum.

Meanwhile, basic information on knowledge, attitude,
beliefs and practices of Tanzanians as regards to AIDS
has been collected using a sample of 5,000 people from
various parts of the country. The study, together with
another one on sexual behaviour, was initiated by the
World Health Organisation (WHO) in collaboration
with the university of Dar es Salaam’s Faculty of Medi-
cine. A study called AIDS and Condom Awareness
Among Students in Post-Secondary School Institutions,
has also been carried out by the university in collabora-
tion with the family planning association of Tanzania
(Umati).

A major setback to the AIDS control programme, the
report says, was lack of baseline data on knowledge,
attitudes, beliefs and behavioral patterns of the Tanza-
nian communities upon which the health education
intervention strategies could be based. This shortcoming
resulted into development of various education mes-
sages and materials based on limited and sometimes
erroneous information on what is actually taking place in
the communities, the report said. The first cases of AIDS
in the country were reported in 1983 but the NACP took
off in 1988.

Uganda

AIDS Cases Double Every 6 Months
91WEO116A Kampala THE NEW VISION in English
2 Nov 90 p 12

[Article by Hellen Mukiibi: “AIDS Threatens More
Ugandans”)

[Excerpts] It is estimated that by the end of this year
Uganda will have over 60,000 new people with AIDS,

SUB-SAHARAN AFRICA 7

while 52,000 people are likely to die of AIDS in the same
year.

This was revealed yesterday by Mr Stephen K. Lwanga,
a WHO delegate at the multi-sectoral approach AIDS
control seminar, organised by the Ministry of Health in
Kampala. Representing the WHO Director General,
Lwanga further revealed that on the basis of the 1988
survey, 750,000 Ugandans were HIV positive. It is
estimated that 52,000 people will die this year of AIDS,
making a total of 170,000 adult deaths in Uganda.

Lwanga said that using the HIV prevalence conservative
estimates further indicate that Uganda will have more
than 100,000 new AIDS cases in 1992. As many as
85,000 adults are expected to die of AIDS in the same
year.

Lwanga, a statistician based in Geneva, said that
although the world had in the beginning denied or
underestimated the problem, it was now clear that the
“pandemic is an unprecedented threat to global health.”
He said that HIV and AIDS is today in its early stages in
most countries.

Worse still, he said, the ultimate dimensions of the virus
and the disease are difficult to estimate. Lwanga said
that further spread is inevitable and that the global
situation will worsen before the scourge can be brought
under effective control. [Passage omitted]

In his opening remarks, Prime Minister Dr Samson
Kisekka, said government will liaise and formulate strat-
egies in a bid to boost the renewed campaign against
AIDS.

Citing counselling, change of behaviour and strength-
ening of the existing AIDS contro! projects as some of
the ways to curb spread of AIDS, Dr Kisekka said that on
global level, multi-sectoral approach was a recom-
mended strategy.

Health Minister Zak Kaheru revealed that the disease
was on the increase with reported cases doubling every
six months. “An estimated one million Ugandans
already harbour the AIDS virus and by now there are
nearly 50,000 AIDS patients,” he added.

Kaheru appealed to RCs, churches, Non-Governmental
Organisations and other bodies, to help fight the scourge
which he said was no longer a “purely medical issue.” He
said that economic, social, cultural, behavioural, ethical
and legal ramifications could not be the sole responsi-
bility of the Health Ministry.

He said that the Uganda AIDS Commission had been
established. The commission comprises ministers whose
portfolios are relevant to AIDS control and manage-
ment.

The Commission is to be chaired by the Prime Minister
or any of his deputies. The Commission will have a



SJPRS-TEP-91-002
28 January 1991

October 1990, 157 countries and areas in the world have
reported a total of 298,000 cases of AIDS. And, as
estimated by the WHO, by the same date there could
have been 8 million AIDS virus carriers and 700,000
AIDS patients all over the world.

To us, the most noteworthy fact is that this devil, which
is very hard to guard against, has already stretched its
talons into mainland China. This cannot but arouse.

Our Worries

For the first few years after AIDS began to run rampant
in other parts of the world China, with territory of 9.6
million square km, remained clean and the 1.1 billion
Chinese people were then lucky people.

However, in June 1985, mainland China reported its
first case of AIDS—a male foreigner who was travelling
in China died of AIDS in Beijing. So the history of a
China “free of AIDS” came to an end, marking the
beginning of our worries.

After that, public health departments continued to dis-
cover AIDS- infected persons and AIDS patients among
the people in China. In August 1990, a Beijing medical
doctor died of AIDS and became the first Chinese AIDS
victim.

Medical specialists pointed out that the Chinese people
are now highly vulnerable to AIDS infection and there is
a high possibility of people in China being infected with
AIDS. Venereal disease [VD] and drug addiction consti-
tute severe threats to the country.

In the past few years VD has revived in China and
become the hotbed for AIDS. Statistics show that the
number of Chinese VD patients exceeds 220,000 and
every one of those could be infected with AIDS.

In the border areas of China’s Yunnan Province, close to
the sinister “Golden Triangle” area—the world’s largest
drug producing and marketing center—many people are
drug addicts. Since the discovery of the first case of
AIDS infection among the drug addicts there in late
1988, the number of people infected with AIDS has been
increasing and the situation is becoming increasingly
serious.

Faced with the pressing situation, the Chinese Govern-
ment has begun to take action to fight with AIDS.

Strategies and Measures

China has formulated a series of strategies and policies
to prevent and control the spread of AIDS.

At present, the prevention of AIDS from spreading into
China and the timely discovery of AIDS cases and
AIDS-infected persons is the important strategy which
China practices to prevent and control the spread of
AIDS. In this connection, the following effective mea-
sures have been adopted.

CHINA 2B

—The Ministry of Public Health has already issued two
circulars imposing restrictions on imports of blood
products, which have helped keep the spread of AIDS
through using blood products under effective control.

—In December 1986, the Chinese Government enacted
an ordinance preventing any foreigner infected with
AIDS or VD from entering China. The authorities
concerned shall order any foreigners infected with the
above mentioned diseases to leave the country before
their visas expire.

The control over VD within the country is another
strategy China has adopted against AIDS. In February
1986, the National People’s Congress passed a “‘Law on
Prevention of Infectious Diseases,” which has put AIDS
and VD under legal monitoring and control procedures.
Departments concerned at all levels have consolidated
and improved VD prevention and treatment step by
step, widely publicized the danger from VD and the
knowledge about prevention of these diseases among the
public, and established a nationwide VD epidemic mon-
itoring system.

The struggle against AIDS cannot continue without
scientific monitoring and medical diagnostic and pre-
ventive means. First of all, the constant serological
monitoring and detection of epidemic conditions among
highly vulnerable groups of people is the key to control-
ling AIDS. This task was started in China in 1984. By
1990, almost all provinces, municipalities directly under
the central government, and autonomous regions, had
started their monitoring operations and a monitoring
network had taken shape. China has also developed three
AIDS diagnostic methods, namely, the enzyme linked
immunosorbent assay, the fluorescein immunoassay,
and the protein labelling method [dan bai yin ji fa 5751
4101 0603 6068 3127]. China has also developed on its
own, and is producing, a kind of AIDS diagnostic agent.
Chinese doctors can now diagnose cases of AIDS using
their own methods.

One of the most gratifying developments is that using
Chinese medicines in the treatment of AIDS has proved
effective to a certain extent. The ancient Chinese medi-
cine has been applied to the valuable study in search of
a solution to a modern medical problem.

Let Us Treasure Our Own Health

“Our lives and our world—let us treasure them and help
each other.” This is a slogan against AIDS resounding
across the world.

It is obvious that AIDS is not only a knotty medical
problem but actually a social syndrome. It is one of the
evil consequences of the many long-standing social prob-
lems of modern society. Therefore, to conquer AIDS, we
not only need medical but also social means. In view of
this unique characteristics of AIDS, the WHO has put
forward the above slogan and has taken propaganda and
education as the most efficient means to prevent AIDS
for the time being. In this connection, the WHO decided



SJPRS-TEP-91-002
28 January 1991

and Non-Governmental Organisations attempt to pro-
vide this. It is also important that AIDS patients are not
discriminated or stigmatized.

Certain religious organisations should also stop referring
to AIDS patients as sinners because this is not true.
AIDS patient requires assistance and compassion and
are entitled to their full human rights. In counselling and
support I must express special thanks to the local
Ugandan TASO (the AIDS Support Organisation) for the
very good work it is doing.

Icall on other Ugandans to form similar organisations in
other parts of the country to assist in counselling and
support of our HIV infected people.

The accommodation and capacity of our health units are
limited. The increasing number of AIDS patients in
serious conditions requiring hospitalisation cannot
therefore be catered for by our hospitals. In the future
many AIDS patients will have to be cared for at their
homes. This will require the assistance of the family, the
community and health workers of the nearest health
centres.

Uganda must join the World in the search for a cure or
vaccine against AIDS. Because of our weak economy,
there are certain aspects of research that we are capable
of doing and other areas which are simply out of reach.

In the past, our emphasis was placed on operational
research aimed at increasing, and evaluating the strate-
gies of AIDS control and only limited work was done on
finding a cure of vaccine for AIDS.

However collaboration with international and foreign
organisations and universities is being strengthened to
develop drug trials and vaccines.

As our laboratory facilities at our Virus Research Insti-
tute, Mulago Hospital and elsewhere become rehabili-
tated research activity will be increased.

There are many drugs/extracts on the world market
which have claimed activity against HIV Virus in vitro.
Most of these compounds are not at a stage of normal
administration to patients. Some are in such early stages
that nobody knows the effect of the drugs on the virus or
the body.

However, for the compounds that have been tried else-
where in the World such as AZT and KEMRON, the
Ministry of Health in collaboration with Makerere Uni-
versity will carry out proper drug trials particularly at
Mulago. On the basis of the results we get, the public will
be regularly advised.

I should like to warn the public against desperate and
indiscriminate trials of any drugs without medical super-
vision. There are many dangerous drugs being sold to
patients of AIDS to take advantage of their predicament.
My advice is that AIDS patients should seek the assis-
tance of trained medical doctors for advice. Multi-
sectoral approach to AIDS: As the President has already

SUB-SAHARAN AFRICA 19

announced, the Government has decided to handle the
problem of AIDS by a multi-sectoral approach, In other
worlds the entire society is to handle the problem rather
than leave it only to the Ministry of health.

Problems of AIDS prevention, health education, welfare
of orphans and all AIDS related problems should be
handled by all leaders and Government departments.
Government has established a ministerial AIDS com-
mission [word indistinct] by the Prime Minister and
serviced by a coordinating secretariat in the Prime
Minister’s office.

Coordination through this multi-sectoral Commission
will facilitate the involvement of the entire population in
the fight against AIDS and the management of conse-
quences of AIDS.

The theme of this year’s World AIDS Day is “Women
and AIDS”. The choice of the theme is appropriate and
timely. Women occupy a special position in society.
With regard to AIDS, women are particularly important
in controlling the epidemic, for the following reasons:

Firstly, Women as parents and managers of homes, are
in a strong position to influence change of behaviour by
members of the family.

Secondly, Women bear all the children and they partic-
ularly need protection against this disease in order to
protect the children being born.

Thirdly, Women play a big role in caring for the sick
including AIDS patients. They also act as Birth Atten-
dants, in cases involving AIDS.

Lastly, Women are more susceptible than men to social
exploitation. Unfaithful husbands have been going out
and bringing home HIV infection to the innocent wives
who are not free to refuse sex to their irresponsible
husbands.

Traditionally, women tend to be socially disadvantaged.
For example, in many of our communities a widow may
be forced by relatives to marry the deceased husband’s
relatives. The problem is that the deceased husband’s
relatives may already be infected with AIDS, or the
widow may be infected.

In some societies, when a daughter dies they send a sister
or another female relative to marry an already infected
widower. These traditions need to be reviewed to protect
society.

Children below the age of 5 years reported with AIDS are
about 10 percent of the total number of AIDS patients.
Since more than 1 million Ugandans are already infected
with AIDS we can expect a large number of children
below 5 years to develop AIDS in future.

Itis clear from our reports that children between the ages
of 5 and 14 years are still free from AIDS. These children
must be protected from infection with HIV.



32 NEAR EAST & SOUTH ASIA

ISRAEL

Drop in Number of New AIDS Cases Recorded

TA0401111291 Tel Aviv "AL HAMISHMAR in Hebrew
4 Jan 91 p 15

[Excerpts] [passage omitted] During the first nine
months of 1990, 15 new AIDS cases were discovered,
and by the end of the year another five are expected.
That is good news, because the figure is lower than the
previous two years. The current trend contradicts fore-
casts which spoke about an increase in the number of
new patients. [passage omitted]

The number of AIDS virus carriers in comparison to the
number of afflicted people has grown tenfold in recent
years and is now estimated at some 2,000, but the
percentage of AIDS carriers in Israel is one of the lowest
in the world: 0.001 percent.

Since 1986, when blood testing was introduced, there
have been no AIDS patients among hemophiliacs. Of
some 200,000 tested blood units, 25 AIDS-infected cases
have been discovered.

Now the bad news: Not all the AIDS victims are regis-
tered and their real number is much higher than the
official figures. Up to a month ago, 137 AIDS patients
were registered in Israel, of whom 130 are men. [passage
omitted] Eighty of the patients, 76 men and four women,
died. It is estimated that for each person carrying the
virus there is another whose condition is unknown.
There are 539 virus carriers in Israel, of whom 80
percent will contract the disease during the next 12 years,

Some 33 percent of the AIDS patients are homosexuals,
some 15 percent are drug addicts, 22 percent are hemo-
Philiacs who contacted the disease from infected blood
transfusions before 1986, 10 percent are defined as
“others,” and another 20 percent were said to be
“unknown.” The difference between the last two groups
is unclear. [passage omitted]

SPRS-TEP-91-002
28 January 1991

JORDAN
Health Ministry Official: Forty Five Cases of
AIDS ad my

JN2412090490 Amman JORDAN TIMES in English
24 Dec 90 p3

[Text] Amman—Jordan has 45 cases of AIDS or AIDS
carriers, 80 percent of whom are male, according to a
senior official at the Ministry of Health.

“The ministry keeps tight control over the spread of the
disease by banning imports of all types of bloods and
examining all blood stored at the blood bank to ensure
that it is free of the AIDS virus,” said Dr Hani Shammut,
head of the Department of Communicable Diseases and
chairman of a national committee for combating the
killer disease AIDS.

Since the mid-1980s the blood bank in Jordan has
banned import of blood and hospitals have been relying
on locally donated blood for operations, ministry offi-
cials said.

Last year, the Health Ministry said there were 25 AIDS
victims.

Shammut made the statement at the opening of a sym-
posium organised by the ministry’s Primary Health Care
Department to spread awareness of the disease’s
impacts.

Addressing the symposium, Dr Ma’mun Ma’abrah,
director of the department said that primary health care
constituted the backbone of the ministry’s health ser-
vices and entails spreading awareness of contagious
diseases.

Jordan along with other countries of the world observed
World AIDS Day 1990 on Dec. 1. The concerned author-
ities together with the United Nations Educational Sci-
entific and Cultural Organisation (UNESCO) organised
a day-long programme of discussions with specialists
informing the public about the dangers of AIDS.

A Ministry of Education official told the meetings that
about 33 percent of the school graduates could be
exposed to the disease because they travel abroad for
studies.

UNESCO said that the World AIDS day was part of a
global effort to meet the challenge of AIDS and noted
that nearly 500,000 people around the world were
expected to develop the disease between 1990 and 1991.



14 SUB-SAHARAN AFRICA

population growth and other relevant factors, the sce-
nario is not necessarily as shocking as some ‘doomsday’
reports have made out.

Metropolitan Life actuary Peter Doyle recently
described as “unrealistic” some predictions that 50
Percent of the adult population will be infected with the
AIDS virus by the year 2000. In terms of his model, the
highest figure is 20 percent of the total urban and rural
black population by the year 2000, reaching 27 percent
by 2005.

Two-edged Sword

The effects of the disease on population growth were
likely to be two-fold. As HIV education made an impact,
there would be a natural decrease in birth rates. This
would be exacerbated by infant mortality.

The value of Mr Doyle’s model is its ability to evaluate
different scenarios and AIDS prevention strategies. It
plots the rate of HIV infection, assuming that mean-
ingful changes in sex habits come about by 1995, or by
2000—or not at all.

If such a change can be effected by 1995, the predicted
number of infections 10 years on would be cut by about
a third, the model concludes.

Although this model is more palatable than the worst
case scenarios, economists are still nervous about the
impact of AIDS on labour.

According to Edward Osborn of Nedbank’s Economic
Unit, black unskilled workers in urban areas will be the
most severely affected by the disease, and a shortage of
unskilled labour will result.

He thinks it is “absurd” that the Urban Foundation
projected a national population of 60-million with a
black metropolitan population of 23-million by the year
2012.

“If AIDS is taken into account, the population will
Probably be in the order of 40-million,” he says.

Labour Losses

In his manual, Facing AIDS, Andre Spier predicts that at
least four out of 10 workers will be affected by AIDS
within the next seven to 10 years.

Between five and 10-million would be infected with HIV
in the year 2000—and one-million lives could be lost in
the 1990s, mostly in the economic sector.

The toll by 2020 could reach 25-million, reducing the
predicted population from 80-million to 55-million.

Mr Spier does, however, concede that AIDS may not
have made much of a difference to the population
growth by the year 2000 and that it would be 2010 and
later before the disease gouged the population growth.

JPRS-TEP-91-002
28 January 1991

More pessimistic experts warn that AIDS will spread
dramatically within months if it is not controlled.

Alan Whiteside, an economist in Natal, predicts that
four-million will die of AIDS and about 12-million be
infected by the year 2000. Potchefstroom University’s
Tiep Viljoen estimates that more than 100,000 blacks in
the 5 to 64 age group are already infected with the virus
and that between 150 and 200 more are infected every 24
hours.

Ironically, against this backdrop, the government
recently warned of an increase in unemployment
through an ever-increasing population.

Growth Rate

President F.W. de Klerk said the population was growing
at 2 percent a year, while the available labour force was
increasing at almost 3 percent a year. The current
economic growth rate of 1.5 percent would have to rise
to about 5 percent to accommodate new job-seekers, he
warned,

Stellenbosch University’s Institute for Futures Research
has predicted South Africa’s black population alone at
47-million by the year 2010.

To forecast how the AIDS epidemic will affect future
population is a problem with no easy answers, according
to Andrew Wilson, a researcher at the AIDS Centre in
Johannesburg.

“The general feeling is that AIDS will impact on the
population growth, but whether the disease will eventu-
ally send it into a decline is not known.”

The effect of AIDS would be felt stronger over a period
of time and would mainly attack the reproductive
groups. AIDS would also indirectly affect the population
growth in that thousands of babies born to pregnant
women who have the disease would not live.

African AIDS Specialists Arrive

91WE0142B Cape Town THE ARGUS in English
29 Nov 90 p 25

[Article by Esann van Rensburg]

[Text] The first group of AIDS specialists from African
countries to visit South Africa has arrived.

The group, which is in South Africa at the invitation of
the Medical Research Council (MRC), wants to find out
more about South Africa’s research programmes and
assess the extent of AIDS in Southern Africa,

The eight scientists from French-speaking countries are
members of Opals, an international non-government
organisation which aims to provide medical information
on AIDS to health authorities, the media and all Opals
members in Africa.



6 SUB-SAHARAN AFRICA

JPRS-TEP-91-002
28 January 1991

Table 10. Summary of AIDS Prevention Questions
(number of respondents = 1,153) (Continued)

Question ‘Women (%) Men (%)
use of condoms 5 6
other 9 13
don’t know 32 30
c.“Do you know of AIDS-preventing birth control method?”

Yes l 18 I 26
“Have you heard of condoms?”

Yes l 23 | 43
"What should an infected person do to avoid spreading AIDS?”

abstain from sex 31 31
isolate themselves 26 33
use condoms 5 9
other 19 7
don't know 19 10

5) “What should a carrier of the AIDS virus do?”

Nearly one-third of respondents believe that those
infected with HIV or afflicted with AIDS should abstain
from sexual relations. A slightly lower percentage
believes that these individuals should isolate themselves,

which more categorically implies sexual abstinence and
belies a much broader fear of contamination. The
“other” category encompasses such responses as to
abstain from donating blood or sharing needles.... These
opinions differ appreciably according to age. (See Table
11)

Table 11. “What should an HIV-positive person do?”
{number of respondents = 1,153 in percentages)

Age Group 15-24 25-34 35+
Abstain from Sex 35 30 26
Isolate themselves 27 31 35
Use condoms 4 6 8
Other, don’t know 34 33 31

6) “Can AIDS be avoided by modifying one’s behav-
ior?”

Of those who had heard of AIDS, 23 percent responded
in the affirmative; 29 percent responded in the negative;
and 45 percent did not know. Affirmative responses vary
significantly with a number of variables. (See Table 12.)

Table 12. Belief in AIDS Prevention through Behavioral
Change as a Function of Age, Education, and Literacy

Table 12. Belief in AIDS Prevention through Behavioral
Change as a Function of Age, Education, and Literacy
(number of respondents = 1,153) (Continued)

Category Yes (%)
Higher 30
Reading Level
None 14
With difficulty 24
With ease 27

(number of respondents = 1,153)
Category Yes (%)
‘Age Group
15-24 18
25-34 24
35+ 28
Education
None 16
Primary 22
Secondary 27

Confidence in the possibility of avoiding AIDS through
behavioral change increases with age, education, and
reading ability. In contrast, the responses do not vary
significantly with religion, marital status, length of resi-
dency in an urban area, or occupation.

When asked “‘How?” 50 percent of women and 57
percent of men said “by not frequenting prostitutes;” 28
percent of women and 18 percent of men said “by
avoiding sexual relations with strangers;” 20 percent



JPRS-TEP-91-002
28 January 1991

BRAZIL

Profile of AIDS Changes in Sao Paulo

91WE0113A Sao Paulo O ESTADO DE SAO PAULO
in Portuguese 30 Nov 90 p 14

[Text] For the first time since the first case of AIDS was
reported in Sao Paulo 10 years ago, the percentage of

LATIN AMERICA 29

those infected through heterosexual relations or intrave-
nous drug use is higher than that for victims in the
homosexual and bisexual groups. In 1989, the latter two
groups together accounted for 45.6 percent of the cases,
while the first two groups accounted for 38.4 percent. As
of this month, drug addicts and heterosexuals already
account for 43.5 percent of the new cases reported in
1990, while 42.6 percent are homosexuals and bisexuals.

New Profile of AIDS Cases in Sao Paulo

Forms of Transmission
Year Homosexual Bisexual Heterosexual Intravenous Drug Others* Total
1980 0 1 0 0 i) 1
1982 3 3 0 0 0 6
1983 13 6 1 1 1 22
1984 52 21 2 Cy) 4 79
1985 159 68 i 7 24 269
1986 274 114 27 32 St 498
1987 554 390 97 209 208 1,258
1988 780 287 174 $22 360 2,123
1989 891 337 278 7155 427 2,688
1990 652 244 216 688 299 2,099

1990 data as of 31 October

* Hemophilia, blood transfusions, through mother, other unknown causes

Source: Center for Epidemiological Vigilance, Sao Paulo State Secretariat of Health

The final 1990 accounting of the World Health Organi-
zation reveals that 60 percent of the infection worldwide
is through heterosexual contact. This is already the
predominant form of transmission in developing coun-
tries, according to the WHO report which will be
released officially today in Washington, correspondent
Moises Rabinovici reports. In the industrialized coun-
tries, heterosexual infection is increasing more slowly, at
a constant rate. The projection for the year 2000 indi-
cates that heterosexual relations will be responsible for
75 to 80 percent of all cases, which implies a dramatic
increase in AIDS among women.

“We have to be aware that women are going to bear an
increasingly heavy burden as the pandemic proceeds in
the next century,” said Hiroshi Nakajima, director gen-
eral of the WHO. According to the WHO report, 3
million women already carry the AIDS virus, worldwide.
In Brazil, 1,293 are already presenting symptoms. Given
this picture, the WHO decided to dedicate International
AIDS Day to the women. On that day, at 1645 hours
(Brazilian time), radio and television stations in the
United States will observe a minute of silence . At the
same moment, the lights will be turned off in public
buildings in the large American cities.

“Up until three or four years ago, the ratio of AIDS
carriers was one female to 12 males,” said Mexican

Fernando Zacarias, the principal AIDS adviser of the
Pan-American Health Organization. “Now the ratio is
one to six,” he added. In Sao Paulo, the ratio has gone
from one female to 47 males, in 1985, to one woman to
seven males today. The organization estimates that
within five years an equal number of men and women
will be infected.

The WHO warns that 2 million women will die of AIDS
during the 1990s—most of them in Africa—and that
600,000 will be suffering from AIDS in 1992. In the
sub-Saharan region, one of every 40 women is carrying
the virus today. The proportion is one in 500 in Latin
America and one in 700 women in the United States.
The WHO report identifies a new problem with the
spread of AIDS among women: knowledge of the clinical
course of the disease is incomplete, because most of the
studies have been conducted among males, the predom-
inant victims at the start of the pandemic.

Zacarias said that the WHO does not participate in the
debate over whether pregnant women infected with the
AIDS virus have the right to an abortion, as advocated
this week by Jose Aristodemo Pinotti, Sao Paulo State
secretary of health. “To our mind, the important thing is
that women be informed, before and after they become
pregnant, of the risks of transmitting AIDS to their
children,” Zacarias said. The WHO estimates that about



26 EAST ASIA

This is similar to trends in cities like New York and
Edinburgh.

There are an estimated 1.1 to 1.3 million intravenous
drug users in the United States and some 500,000 in
Western Europe.‘

This compares with estimates of 100,000 to 200,000 in
Thailand (with the bulk in Bangkok), though all numbers
are difficult to confirm.

AIDS spreads quickly through addict communities due
to the sharing of contaminated needles, and much of the
prevention work around the world has focused on how to
change this habit by using individual syringes or steril-
izing them before use.

Dr. Khachit Chupanya of the Bangkok Metropolitan
Administration said the rate of spread has stabilized
because of the city’s extensive outreach programme,
which includes 17 detoxification clinics and counselling
for patients.

The 2,000-odd addicts who come in for voluntary treat-
ment each day are provided with bleach powder and a
vial to mix it with water, condoms, and advice on safe
sex.

Some European countries offer clean needles in
exchange for contaminated ones—800,000 given out
each year in Holland, and about four million annually in
Britain.

While this has helped to reduce needle-sharing in these
countries, Dr. Gerry Stimson of the London-based
Centre for Research on Drugs and Health Behaviour
warned that syringe distribution might be unworkable in
countries where there are large addict populations and
limited resources. In such cases, bleach may be an
effective and cheaper alternative.

He and other speakers stressed that drug users can
change risky behaviour if programmes are well designed.

The BMA also has a policy of giving high doses of
methadone—an addictive drug taken orally to replace
injected heroin—indefinitely to AIDS infected people
who attend city clinics.

This has been made possible though a special arrange-
ment with the Ministry of Public Health, whose regula-
tions permit only short-term regimes of methadone in
45-day de-oxification cycles—gradually increasing the
dosage and then reducing it to zero after a month and a
half—in order to “cure” addicts completely.

“But you must remember that heroin addiction is a
natural chronic relapsing disease, so if you only give
45-day treatment, some people will just start using
needles again after they leave. This is who we give HIV
people methadone,” said Khachit.

JPRS-TEP-91-002
28 January 1991

In New York and other cities with big addict communi-
ties, HIV is spreading fast from infected drug users to
non-users.

Wichai said Bangkok addicts tend to inject more con-
centrated doses of heroin than their Western counter-
parts, which may serve to depress sexual activity.

He said addicts in the city use about 250 milligrammes
of heroin of about 60 to 80 percent purity each day,
which compares to smaller doses of ten percent purity in
the United States.

“This may have implications for their sexual behavious
because most of them are stoned a lot of the time with
such high doses,” Wichai said.

Several international speakers, however, said the notion
that Western addicts have no sex life is a misconception.
They expressed concern about the spread of AIDS from
drug users to their sex partners and, in the case of
women, to their unborn children.

Two Million AIDS Carriers by Year 2000
Predicted

BK2212024590 Bangkok BANGKOK POST in English
22 Dec 90 p 2

[Text] At least two million people in Thailand will be
infected with AIDS by the year 2000 if the acceleration
rate of the killer virus is not slowed in the next four years,
Mechai Wirawaithaya, secretary-general of the Popula-
tion and Community Development Association, said
yesterday.

He has called for the temporary shutdown of Thailand’s
massive sex industry as one way of stemming the tide of
the deadly virus.

He also says Thai men who regularly frequent brothels
need to change their ways to stop the spread of the killer
bug.

The warning came on the final day of the International
Congress on AIDS being held in Bangkok.

The conference ended with calls for a greater sense of
urgency on the part of the government concerning the
problem.

Mr. Mechai estimated that at least one million Thais
could be saved by the end of this decade if the AIDS
epidemic’s annual rate of increase is slowed down by
1992,

The projections are based on an estimate of 150,000
current HIV carriers.

This figure is still conservative and could be doubled to
be realistic, he said.

The worst scenario is that there will be as many as six
million by 2000, if the rate of increase does not level off
until 1996, according to the anti-AIDS activist.



SJPRS-TEP-91-002
28 January 1991

Spontaneously, 13 percent of women and 17 percent of
men were able to name correctly several modes of AIDS
transmission. This percentage increases with schooling.
(See Table 3.)

Table 3. Education and Ability To Name Correctly
Several Modes of AIDS Transmission
(number of respondents = 1,138)

SUB-SAHARAN AFRICA 3

Among those who cited perinatal transmission (774), 36
percent of women and 45 percent of men knew that
transmission occurred during pregnancy or birth. Breast-
feeding was cited by 27 percent as a means of transmis-
sion and the remaining percentage cited daily contacts
between mother and child during feeding and bathing.

2) “Is it possible to be cured of AIDS?”
Sixty percent of those questioned said that it is not

Education Number of Respon- Percent possible to be cured of AIDS. Paradoxically, a greater
dents proportion of intellectuals having a university level
None 286 6 education believe that it is possible to be cured of AIDS.
P, 355 1 (See Table 4.) This is probably due to the fact that
mmary intellectuals have access to foreign radio and magazines
Secondary 433 20 that have carried frequent reports of miraculous medi-
Higher 64 43 cations. Those who have access solely to national sources
more frequently stated that AIDS is incurable.
Table 4. “Is AIDS Curable?”
(number of respondents = 1,138 in percent)
Education Yes No Don't know
None 24 56 20
Primary 25 59 16
Secondary 26 64 10
Higher 38 54 8

Those who said that AIDS is curable (324) were asked to
explain how it is cured. Medical treatment was cited by
80 percent; 9 percent cited traditional remedies; and 3
percent cited prayer. Among those who said that AIDS is
incurable (868), some stated that they would prefer to
commit suicide if they contracted the infection.

3) Average Index of Awareness.

An overall index of AIDS awareness was drawn up on
the basis of correct responses to the seven questions
discussed above. One point is given for each correct
response and no points are given for incorrect responses.
The index therefore ranges from 0 to 7. For the sample as
a whole (1,991), the average index value is 1.5. The
median index is 1.0. (See Table 5.)

Respondents’ scores vary significantly in relation to their
sex, age, education, religion, and access to several
sources of information.

They do not vary whether the respondent’s information
sources are subject to verification (radio, television,
newspapers) or not subject to verification (friends,
neighbors, relatives). (See Table 6.) Length of residency
in an urban area does not have a bearing on the degree of
AIDS awareness.

An index value of 0 represents no knowledge of AIDS.
Values of 1 and 2 indicate a weak knowledge. Knowledge
is fair at 3 and 4, and good to excellent starting at a value
of 5.

Table 6. Average AIDS Awareness Index for Different
ariables
(number of respondents = 1,991)

Table 5. Frequency Distribution of Awareness Index Category ‘Average Index
(number of respondents = 1,991) Gender

Index % of Sample Women Ll
0 46.0 Men 2.0
1 9.0 Age Group

2 14,3 15-24 17
3 14,7 25-34 7
4 9.6 35+ 12
5 45 Education

6 1.6 None 0.6
7 0.3 Primary 1.8



2 SUB-SAHARAN AFRICA

SJPRS-TEP-91-002
28 January 1991

Table 1. Awareness of AIDS.
(number of respondents = 1,991)

Table 2. “What is the world’s most serious disease?
(in percentages)

Respondents ¥es (%) No (%)
Gender
Men 1 29
Women 49 St
Age Group
15-24 70 30
25-34 63 37
35+ 47 53
Education
None 33 67
Primary 76 24
Secondary 96 4
Higher 97 3
Religion
Christian 81 19
Animist 1 29
Muslim 44 56
City
Abeche 26 74
Bongor 73 27
Moundou 82 18
Ndjamena 53 47
Sarh 2B 22

2) “In your opinion, what is the most serious disease in
the world today?”

AIDS was spontaneously cited by 28 percent of those
questioned. Appreciable differences appear in relation to
sex, age, education, religion, and marital status. (See
Table 2.) The fact that single people cited AIDS as the
most serious disease more often than did married people
is related to age. Single people are, in fact, considerably
younger than married people.

Length of residency in an urban area does not have a
significant bearing on responses.

Those who did not mention AIDS cited malaria and
the seven diseases targeted by the Expanded Vaccina-
tion Program (EVP): tuberculosis, whooping cough,
diphtheria, tetanus, poliomyelitis, measles, and yellow
fever. Others, still mindful of the drought and the war
they suffered, cited famine. Finally, other respondents
cited cancer, meningitis, and diarrhea.

Respondents Cited AIDS Did Not Cite
AIDS
Gender
Men 7 83
Women 39 61
Age Group
15-24 35 65
25-34 29 11
35+ 20 80
Education
None 9 1
Primary 28 Rn
Secondary 39 61
Higher 70 30
Marital Status
Single 44 56
Divorced, separated 15 85
Married or with partner 22 8
City
Abeche 12 88
Bongor 35 65
Moundou 33 67
Ndjamena 24 76
Sarh 39 61

II. Knowledge of How AIDS Is Transmitted

The analyses that follow involve only those respondents
who had heard of AIDS (1,192), or 60 percent of the total
sample.

1) Modes of Transmission.

Sexual contact was cited by 74 percent of women and by
81 percent of men as a means by which AIDS is
transmitted. Transmission from mother to child is
known to 68 percent of women and to 72 percent of men.
Transmission via blood is known to 6 percent of women
and 10 percent of men. Injections were cited by only 1
percent of respondents.

Other means were cited by 19 percent of women and 9
percent of men. For the most part, these other means
related to everyday contact but also to exchanges of
greetings, mosquito bites, public toilets, dust, etc.
Several said that they had never seen an AIDS victim
and therefore found it difficult to know how the disease
is transmitted without knowing its symptoms.



IJPRS-TEP-91-002
28 January 1991

Research Project

The group was particularly interested in the MRC’s
recent AIDS research project that assessed the knowl-
edge, attitudes and awareness of schoolchildren in Cape
Town. It was keen to obtain the questionnaires used in
this survey, a statement from the MRC said.

The president of the MRC, Dr. Philip van Heerden, said
the arrival of the group represented a milestone in South
Africa’s medical history. He hoped similar visits would
take place regularly in the future.

“AIDS, along with many other infectious diseases,
respects no borders, so we need to talk to our neighbours
to learn about disease trends and set up appropriate
monitoring systems to help curb epidemics.”

Ideal Opportunity

He said that because AIDS had reached South Africa
later than the rest of Africa, it was an ideal opportunity
to learn from countries which had dealt with the killer
disease for several years.

“This is the first group to take up our offer of sharing
knowledge and we hope that this initiative will gain
momentum in the years to come so that, on the medical
scene, Africa can be united in combating disease,” Dr.
van Heerden said.

HIV Cases Increasing Among TB Patients

91WE0142C Cape Town THE ARGUS in English
29 Nov 90 p 25

[Text] Durban—The incidence of HIV infection among
tuberculosis patients at Durban hospitals has escalated
to four percent—double that of last year.

Dr. Isobel Windsor, head of virology at King Edward
Hospital (which does all the AIDS confirmatory testing
in Natal), said: “People who have latent tuberculosis and
are HIV positive now actually get the symptoms of TB
which is why we are also seeing more TB cases presenting
at hospitals than before.”

Blind Testing

The incidence in this group of people is merely a
reflection of how AIDS is escalating, she said. There are
no accurate figures to show the infection among Sexually
Transmitted Disease Clinic patients, ante-natal clinics or
the general population.

A while ago it was stated that about two percent of the
sexually active population was HIV positive and that
infection in patients attending STD clinics was about
three percent.

This kind of survey will no longer be done by the
provincial laboratory and updated figures are not avail-
able for various reasons.

SUB-SAHARAN AFRICA 15

“We were doing blind testing (randomly testing patients
without knowing their names and without their permis-
sion) and getting a good idea of what was happening in
the community, but from a public health point of view
we decided that HIV sufferers should (after they have
given their informed consent) rather be identified and
then counselled if they are HIV positive.”

Owing to a manpower shortage and restricted finances it
is, according to Dr Windsor, not feasible to do both blind
and informed HIV testing.

“It is a well documented fact that when HIV testing with
informed consent is started there are many people who
refuse the test and our figures (doing it the public health
route) are no longer reflective of what is happening,” she
said.

Scared Off

Dr. Windsor said many people were scared off by
publicity, for example young black girls, whose high rate
of infectivity has been highlighted in the Press.

Her laboratory is responsible for all the confirmatory
AIDS testing in the Natal/Kwazulu region. It is also still
not fully computerised, which makes the gathering of
reliable data almost impossible.

An initial AIDS test called an Elisa (taken by a general
practitioner and sent to a private pathologist for
example) costs about R40.

Medical Association Welcomes AIDS Education
Program

MB2012093990 Johannesburg Domestic Service

in English 0900 GMT 20 Dec 90

[Text] The Medical Research Council has welcomed the
announcement by the Department of National Health
and Population Development that AIDS education pro-
grams will be introduced in South African schools next
year.

The coordinator of the council’s AIDS community based
program, Dr. Malcolm Steinberg, said a recent study
conducted at four high schools in Cape Town had
indicated that pupils did not know much about how to
prevent AIDS.

Doctor Details Northern Transvaal Donor HIV
Figures

MB2012114890 Johannesburg SAPA in English
1106 GMT 20 Dec 90

[Text] Pretoria Dec 20 SAPA—Twenty northern Trans-
vaal blood donors were found to be be HIV-positive
between January and September this year, the South
African Institute of Medical Research [SAIMR]
revealed.



JPRS-TEP-91-002
28 January 1991

Table 9. Recourse to Informal Sources of Information
About AIDS and Education
(number of respondents = 1,144)

Education Percent
None 35
Primary 24
Secondary 10
Higher 2

The role of oral communications and conversations is
clearly much more important among those who have had
no schooling.

II. AIDS Prevention
1) “What does AIDS mean to you?”

For this question, respondents were given several
responses to choose from: an inevitability, an unavoid-
able risk, or a sexually transmitted disease. Forty-one
percent characterized AIDS as a sexually transmitted
disease.

“An inevitability” was the response selected by 31 per-
cent and “‘an unavoidable risk” the response selected by
14 percent. Eight percent gave other responses, such as
AIDS is a myth, a disease of women, or a European
disease, and 6 percent had no opinion (1,153).

Those who believe that AIDS is an unavoidable risk
explain their response by the fact that they feel incapable
of modifying their own behavior or their partner’s
behavior. They are thus aware of the fact that AIDS can
be avoided by behavioral change (see paragraph 6 of this
section), but feel incapable of protecting themselves.
Women tend to hold this belief more often than men.
From this there emerges a mutually held sense of the
other’s responsibility with respect to transmission of the
infection. Each believes that it is difficult for the other to
modify his or her behavior.

2) Awareness of Family Planning.

Among respondents having heard of AIDS, 31 percent
were unaware of methods of birth control or of spacing
births. The rhythm method is known to 30 percent and

SUB-SAHARAN AFRICA 5

27 percent are aware of the modern methods of contra-
ception, among them the condom that was spontane-
ously cited by 6 percent of respondents (1,153). The
other methods mentioned by 12 percent of respondents
involve traditional practices: The will of God should not
be disobeyed. “Nature has its own way of spacing
births.” “A mere spell can prevent a woman from
conceiving.”

3) Knowledge of a Family Planning Method Used in
AIDS Prevention.

When asked whether it is possible to avoid AIDS by
using a family planning method, 23 percent responded in
the affirmative; 29 percent said it was not possible; and
48 percent did not know. Among the 23 percent
responding affirmatively (240), 16 percent had never
attended school and 30 percent had received a university
education, men more often than women (1,043).

4) “Have you ever heard of condoms?”

This question received an affirmative response from 23
percent of the women and 43 percent of the men who
had heard of AIDS (1,169). Some respondents knew of
condoms but refused to answer this question because
their partner’s presence during the interview made them
uncomfortable. Among the respondents who had heard
of condoms (410), 57 percent (equal numbers of men and
women) knew where to obtain them.

Awareness of the condom and of its role in preventing
AIDS does not vary according to religion, length of
residency in an urban area, or marital status. In other
words, single persons are no more aware of the use of
condoms than are married persons.

In contrast, awareness of condoms rises steadily with
education, moving from 26 percent at the primary level,
to 43 percent at the secondary level, and to 73 percent at
the university level. Individuals who have not attended
school are just as aware of condoms as are those with a
primary education (25 and 26 percent respectively).

This awareness rises steadily with age: 27 percent of
those between the ages of 15 and 24 are aware of the
condom as compared with 44 percent of those 35 and
older.

Table 10. Summary of AIDS Prevention Questions
(number of respondents = 1,153)

Question I

Women (%) |

Men (%)

a.“What does AIDS mean to you?”

an inevitability

32

30

an unavoidable risk

15

13

a sexually transmitted disease

35

45

don’t know

18

12

b.“Are you aware of birth control?”

thythm method

31

31

modern contraceptives

23

20



IJPRS-TEP-91-002
28 January 1991

people information in the hope that they will eventually
change their sexual behaviour.

On the use of condoms, Namara said they should not
replace morality and discipline. “Condoms are 90 per-
cent effective in family planning as a contraceptive and
not 100 percent in preventing AIDS.” He therefore said
they do not advocate for condoms as a principle, but
only in limited circumstances.

According to Namara, University students are the
highest risk group now in the country, that is why ACP
supplied them with condoms. This is also re-enforced by
the belief that university students can use and dispose of
them correctly.

The AIDS Surveillance Report, second quarter, 1990,
shows that by June a total of 17,422 cases had been
reported to ACP. Of these 15,724 (90.25 percent) were
adults and 1,698 (9.75 percent) were children. Today
every district has reported at least a clinical AIDS case.

Kapchorwa district has the minimum number of cases
with 7, while Kampala and Masaka have the highest with
4,657 and 3,043 respectively. All the clinical AIDS cases
reported to ACP are from Kampala and Masaka with
26.73 percent and 17.47 percent respectively.

Of the 1,511 adult cases recorded as having acquired
AIDS through sex, 7,494 (49.59 percent) were male and
7,617 (50.41 percent) were female. A total of 1,698
paediatric cases aged 11 years and below have been
reported to ACP and 1,454 babies aged 2 years and
below have been reported.

According to the report, by June 1990, Mulago, Kitovu
and Lacor hospitals had the highest number of reported
cases with 2,893; 2,098 and 1,253 cases respectively.
Aviation medicals, Lugazi, Mbarara Moslem Supreme
Council and UTRO hospitals reported one case each.

The report shows that Kampala district reported the
highest number of cases, 4,657, followed by Masaka
district 3,043, whereas Bundibugyo, Kapchorwa and
Kalangala districts reported the lowest cases with 9, 7
and 9 cases respectively. Twenty one AIDS cases of
Ugandans abroad were reported to ACP.

During a recent seminar on the multi-sectoral approach
to AIDS for civil servants, S.K. Lwanga, a Ugandan
statician working with WHO Geneva, revealed that by
the end of this year, 60,000 AIDS cases are expected. By
1992, 100,000 more cases will come up and 85,000
adults are expected to die of AIDS.

In the same seminar, participants observed that of late
there is an increasing number of people in their fifties
and sixties falling victims to AIDS. A number of senior
government officials have died of AIDS and many more
are expected to follow.

Recently WEEKLY TOPIC reported that the rate of
infection is increasing in schools and institutions of
higher learning. It was learnt from Nakasero Blood Bank

SUB-SAHARAN AFRICA 2

that of the 721 units of blood received from students,
105 were infected with HIV, rising from 2.4 percent to
7.4 percent this year.

Women face an increasing risk of being infected, and
they constitute 41 percent of the reported cases in
Uganda. This was attributed to their subordination and
child bearing role in society.

But Dr. Namara doesn’t agree with this. According to
him, in Uganda men and women face the same risk of
AIDS. “Infection rate for men is just like that for
women,” he said. He also dismissed speculations that
men die faster than women. “In Africa, with our condi-
tions, the average incubation period for AIDS is seven
years for all people,” he said.

Namara said there won’t be a cure or vaccine for AIDS in
the near future. He however said that arrangements are in
the final stages to test KEMRON in Uganda. “If found
effective, it will be supplied to the people,” he said.

ZIMBABWE

Health Minister Discusses Tuberculosis, AIDS

MB2812200090 Johannesburg SAPA in English
1845 GMT 28 Dec 90

[Text] Norton Dec 28, SAPA—HIV related tuberculosis
is the commonest cause of hospitalisation in most dis-
trict hospitals, Zimbabwe Health Minister Timothy
Stamps, said on Friday [28 December], the ZIANA news
agency reports.

After visiting Chegutu District Hospital and Norton
Rural Council Hospital, Dr. Stamps said there was a 50
percent increase in the total amount of tuberculosis
treating drugs since 1988.

“There is more urgency for family planning programmes to
be stepped up to reduce the number of dependents, because
the providers are going to die from AIDS,” he said.

“The burden of health would have to be borne by the
society as a whole, and if the HIV infected people die
their children would suffer because their providers
would have died.”

The minister said he expected deaths from AIDS to go
up in the future and even if there were no new infections
from the virus, there were a lot of infected people who
were doomed to die.

“The severity of AIDS will be revealed soon, and all who
did not believe that the disease is a killer will believe
when there is a death in their own family,” Dr. Stamps.

He said almost everyone in the country knew about
AIDS and the second stage was up to the individual to
take precautions in avoiding the disease.

Dr. Stamps said he was pleased to hear that there were
signs that there could be a vaccine for HIV but “that is a
long way off’, and if it materialised it could not be
helpful to those already infected.



PRS-TEP-9 1-002
8 JANUARY 1991
Foreign
Broapcast
INFORMATION
Service

PRS Report—

Epidemiology

AIDS

19980506 113

REPRODUCED BY

U.S. DEPARTMENT OF COMMERCE

NATIONAL TECHNICAL INFORMATION SERVICE
SPRINGFIELD, VA. 22161

DTIC QUALITY INSPECTED S



44 WEST EUROPE

The real figure is thought to be much higher, however,
and AIDS workers estimate the numbers with HIV is
triple the official level of 1,000.

There are 425 male drug users who are HIV positive and
136 females. There are 174 AIDS victims and 75 people
have now died from the disease, November Department
of Health figures show.

Seventy-five babies are HIV positive with 141 gay-
bisexual men and 112 haemopheliacs affected.

NORWAY

Health Service Releases Year to Date AIDS
Figures

91WE0118A Oslo AFTENPOSTEN in Norwegian
27 Nov 90 p 3

[Article by Kare M. Hansen: “Thirty-Nine AIDS Cases
This Year”—first paragraph is AFTENPOSTEN intro-
duction]

[Text] Health authorities have recorded 39 new AIDS
cases in Norway so far this year. The number of homo-
sexuals recently infected with the HIV virus is cause for
concern.

So far this year 87 new HIV-positive people have been
registered in the country as a whole. Senior executive
officer Oivind Nilsen of the National Institute of Public
Health (SIFF) says that a total of approximately 50 AIDS
cases will probably be reported this year. The majority of
them are homosexuals in the Oslo area. The health
authorities know of six children who have been infected
by their HIV-positive mothers in recent years. One of the
children has developed AIDS.

“After five years of working with HIV and AIDS we have
completed the most serious emergency response. And we
believe we can state that the epidemic will not be as
extensive as many feared. But we continue to record
newly-infected people from all backgrounds and the
situation among homosexuals is alarming. There are also
many cases of new infections among heterosexuals. But
there is surprisingly little new infection among drug
abusers now,” Nilsen says.

As 1990 draws to a close SIFF statistics show that 371
homosexuals have been recorded as infected with the
HIV virus. Of these 127 have developed AIDS. At the
same time 306 HIV-positive drug abusers have been
recorded. Only 16 of them have developed AIDS.

“The explanation for this development is that as a group
drug abusers were infected later than homosexuals. It is
also a fact that many drug abusers die from other causes
before they develop AIDS,” says Oivind Nilsen.

The health authorities has made an intensive effort to get
various groups to submit to HIV testing. This year

SJPRS-TEP-91-002
28 January 1991

almost 300,000 HIV tests will be carried out in Norway.
Most of these are so-called clinical patient tests.

Sexual intercourse is still the most common source of
infection. But contrary to the dire predictions health
authorities have not recorded a single reliable case of
HIV infection from a prostitute so far. The reason may
be a more widespread use of condoms. Many clients of
prostitutes get tested.

As of this date Norway has registered a total of 184 AIDS
cases, Of these 125 have died. At present there are 955
names on the list of Norwegians who tested positive for
HIV.

Dr. Jan Kristoffersen of the Directorate of Public Health
says that through their information activity health ser-
vices have succeeded in limiting the epidemic consider-
ably. “People now know what HIV and AIDS are. The
goal should be to maintain this knowledge and concen-
trate our efforts on sexuality among high-risk groups and
young people,” Kristoffersen says.

The Directorate of Public Health is now working with a
long-range plan against HIV and AIDS. It outlines the
anticipated development over the next few years and
points out possible angles of attack in the effort to
combat the problem. However the directorate sees no
reason to sound the alarm.

This Saturday is International AIDS Day. Related events
are scheduled in several places in Norway. This year’s
theme is women’s sexuality in the context of HIV and
AIDS.

SWITZERLAND

Public Health Service Releases AIDS Figures

91WE0101B Geneva JOURNAL DE GENEVE
in French 31 Oct 90 p 2

[Text] Berne—During the first nine months of 1990, 278
people died of AIDS in Switzerland. According to the
latest publication from the Federal Public Health Office
(OFSP) published Tuesday, that brought the total
number of deaths from AIDS to 873 at the end of
September. Moreover, 340 new cases of the disease were
declared between January and September of 1990.

Forty-one percent of the new AIDS cases are drug
addicts (140 cases), 40 percent homosexual or bisexual
men (135 cases), 13 percent heterosexual men and
women (43 cases), 2 percent children under the age of 15
(8 cases), 1 percent blood transfusion recipients (5 cases),
and | percent hemophiliacs (4 cases). Five cases were
considered “of undetermined cause.”

1990 thus seems to-confirm last year’s trend: For the last
two years, drug addicts have made up the largest group of
new patients.



JPRS-TEP-91-002

8 SUB-SAHARAN AFRICA 28 January 1991
Table 15. Perception of Personal Risk as a Function of AIDS Awareness
(number of respondents = 1,1.

Awareness Index (0 to 7)

Perceived Risk 0 1 2 3 45 6-7

None 19 25 32 27 31 26

Slight 7 10 12 13 13 23

Some, very high 29 39 37 45 45 49

As shown in Table 16, 31 percent of men and women
believe that individuals infected with HIV should prac-
tice total abstinence from sexual relations. This propor-
tion varies almost not at all in relation to education.
Similarly, slightly less than one-third of those questioned
think that HIV-positive individuals should be placed in
isolation. Other opinions relate to other modes of trans-

mission: to avoid donating blood, to avoid receiving
injections, to avoid everyday contacts with other indi-
viduals. The use of condoms is recommended by 3
percent of respondents not having attended school, 5
percent of those who have completed the primary level,
9 percent of those at the secondary level, and 20 percent
of those at the university level.

Table 16. Sympathy and Fear Toward AIDS Victims

Questions/Responses Educational Level

None Primary Secondary Higher
a.“What should an HIV-carrier do to avoid transmitting the infection?”
Sexual abstinence 31 28 35 29
Isolation, quarantine 28 32 30 28
Use of condoms 3 5 9 20
Other 18 21 7 14
Don’t know 20 14 9 9
b.“Where should AIDS victims be cared for?”
Hospital 9 74 1 70
Should be eliminated 8 12 10 2
Isolation i 12 18 27
Don't know 2 2 1 1
c.“What measures should be taken by the state against AIDS?”
Vaccinate the population 23 31 20 2
Test the population 15 23 29 13
Fight prostitution 17 10 18 19
Educate the population WW 12 12 32
Eliminate AIDS victims 4 3 0
Distribute condoms 1 0 1 5
Fight homosexuality 0 0 1 0
Other 22 18 14 29
Don’t know 7 3 2 0
d.“Who should be responsible for an AIDS victim?”
Responses Women Men
Family 5h 44
State 26 38
Family and state ul 10
Volunteer groups 1 1
Other 6 5
Don’t know 5 2



JPRS-TEP-91-002
28 January 1991

gave other responses such as avoiding blood transfusions
and injections as well as by avoiding contact with HIV-
infected individuals.

This reveals that the respondents emphasized partner
selection and the avoidance of strangers or individuals
with multiple partners in the prevention of AIDS
through sexual behavior.

IV. The Perceived Threat of AIDS
1) AIDS as a Public Health Threat.

The large majority of respondents (84 percent) believe
that AIDS represents not only a danger but a very serious
danger to Chad. (See Table 13.) This concept is vague. Is
AIDS a danger perceived as a distant threat or as the
presence of an imminent catastrophe? Other studies will
be necessary in order to arrive at a more precise defini-
tion of the danger that AIDS represents.

Table 13. Perceived Imminence of Threat of AIDS
‘Summary,
(number of respondents = 1,153)

SUB-SAHARAN AFRICA 7

Table 13. Perceived Imminence of Threat of AIDS
jummary)
(number of Eespondents = 1,153)

(Continue
Question [ Percent
b.""What are the risks you will contract AIDS?”
None 28
Slight 12
Some, very great 41
Don’t know 19

c.“Who runs the greatest risk of contracting AIDS?”

Prostitutes 57
Homosexuals 14
Single persons 5
Others 16
Don’t know 8
d.“Would you be willing to take an AIDS test?”

Yes | 94

€."Would you be willing to be informed of the results?”
Yes | 93
£"Would you agree to let your family know the results?”
Yes l 89

2) “What is your own risk of contracting AIDS?”

‘Question l Percent
a.“What danger does AIDS pose to health in your country?” Of those who had heard of AIDS, 41 percent believe they
None 7 run either some risk or a very great risk of contracting

the infection or the illness. An average of 40 percent
A danger 18 think that their risk of contracting AIDS is slight or nil.
Serious danger 66 The perception of little or no risk rises with education,
Don't k 7) reaching 65 percent among universityeducated respon-

enon dents. (See Table 14.)
Table 14, Perceived Risk of AIDS by Educational Level
(in percent)
Educational Level

Perceived Risk ‘None Primary ‘Secondary Higher
None 24 25 31 48
Slight 19 12 13 17
Some, very high 40 43 44 22
Don't know 17 20 12 13

Among respondents with a university education, 48
percent believe they run no risk of catching AIDS; 22
percent believe to the contrary that they run a high risk.

Generally speaking, the sense of being safe from AIDS
rises with education while the sense of risk diminishes.

A better awareness of the ways in which the HIV
infection is transmitted leads to a bipolarization of
attitudes as is evident in Table 15.



40 SOVIET UNION

century,” although it may help to identify infected
persons in a more timely fashion.

Of particular concern to us is a completely defenseless
risk group—namely, children born to mothers who are
HIV-carriers. Unfortunately, their number is also
steadily increasing. In order to reduce that number, the
republic should undertake the broadest possible testing
for AIDS among pregnant women. There are as many as
2.5 million such women in the Ukraine.

And here there is a new urgency with regard to the
problem of diagnostic systems and equipment.

Mayboroda: Tell us about that in greater detail.

Frolov: We have already talked about the need for some
correction factor in our statistical data on AIDS. In large
measure, that necessity is associated with the poor
quality of the test systems that we use. To get better
testing accuracy, we must purchase imported diagnostic
equipment from, say, Finland. A good test-system widely
approved throughout the world and made by one of the
Finnish firms (with whom, incidentally, we have already
conducted negotiations) for 10 million tests per year will
cost us 16 million foreign currency rubles. Included in
that cost is equipment for 550 diagnostic laboratories.

Moreover, the Finns have agreed to set up coproduction
of such high-performance, promising test systems in the
Ukraine to be based, for example, at our Kiev Scientific-
Research Institute of Epidemiology and Infectious Dis-
eases imeni L. Gromashevskiy. It is quite feasible that
Production of those systems can be started up in one
year, and after 1.5-2 years we should be able to provide
them for the Ukraine and then go on to the national
market.

When we set up that kind of production, then we shall
have to spend about 700,000 foreign currency rubles per
year for the purchase of the synthetic polypeptides that
constitute the basic diagnostic component.

Mayboroda: Does that mean that all that is needed is the
completion of negotiations?

Frolov: Alas, the rub is foreign currency. Only our
republic government can allocate such currency. As yet,
it has provided virtually no financing for the battle
against AIDS; at least, it has not allocated even a single
kopeck for scientific research in that area.

And time is working against us. HIV is no joking matter.
Measures must be taken without delay. That’s why I
would like our Ukrainian deputies to discuss the
problem at the next session of the Supreme Soviet.

Mayboroda: Arkadiy Fedorovich, everyone is constantly
talking about the problem of disposable syringes. What is
the situation in the republic with regard to the solution of
that problem?

Frolov: Not one of the union republics has solved that
problem. And it shouldn’t seem strange, but even now

JPRS-TEP-91-002
28 January 1991

it’s not a cause for great distress. The fact of the matter
is that while we are just now “waking up,” many of the
developed countries, including America, that set up the
production of disposable syringes and blood transfusion
systems in a timely fashion are now facing the virtually
insoluble problem of what to do with them after they
have been used. Should they be stored, or buried in the
ground? Both those alternatives are uneconomical.
Moreover, as the number of such plastic, non-reusable
“waste products” increases, their ecological harm
becomes a problem to be reckoned with.

Therefore, in those same developed countries the battle
against AIDS is not steering a course aimed at disposable
instrumentation, but rather at the high-quality steriliza-
tion of all medical equipment (everything from house-
hold equipment to barber tools, for example). And that’s
the course we should be steering.

Mayboroda: In a recent interview given by General
Director of the World Health Organization Hirosi Naka-
zima, he reported to journalists that research is under
way in the development of more than 30 types of
“anti-AIDS” vaccines for the purpose of preventing the
spread of HIV. However, he noted, one cannot yet say
with confidence just when an effective and safe agent
against AIDS will be developed. How would you, Ark-
adiy Fedorovich, comment on that report?

Frolov: If one takes a purely scientific approach to a
solution of the problem, then, in light of the considerable
mutability of the virus, such vaccines would have to be
developed very often. Moreover, their development will
require large economic outlays. Because of the reasons
already mentioned, their effectiveness would be short-
lived. The vaccination of all risk groups, plus all or
almost all citizens (as, for example, in flu epidemics), is
practically impossible. Maybe we could vaccinate infants
who were born of mothers who are HIV-carriers.

For today, and apparently for the foreseeable future,
prevention and the development of various curative
agents must be the principal methods of battling AIDS.

HIV-Positive Foreigner Deported
91WE0132B Moscow TRUD in Russian 1 Dec 90 p 1

[Article by Ye. Ukhov, Yoshkar-Ola, Mari ASSR: “AIDS
Carrier Deported”; first paragraph is source introduc-
tion]

[Text] Yoshkar-Ola—A foreign specialist who had been
working under contract in Volzhsk of Mari ASSR has
been forced to leave the Soviet Union against his will.

An HIV-carrier has been identified in the city! He turned
out to be a foreign citizen who was working at a local
enterprise. The suspicions of physicians, which arose
during a preventive medical examination, were con-
firmed by the regional center for AIDS control (in
Nizhniy Novgorod) and the head institute in Moscow, to
which samples had been sent for analysis.



28 EAST ASIA

The government here takes the problem of AIDS seri-
ously and has said it must prepare itself for the inevi-
table.

Drug abuse is also dealt with, though resources are
limited, and the government run a drug rehabilitation
centre in Hanoi.

Observers, however, have mixed views on the impact of
AIDS in Vietnam.

JPRS-TEP-91-002
28 January 1991

“It’s not a big problem in Vietnam for the future because
there are not many homosexuals, prostitution is not that
big and drug- taking is ... Mostly smoking,” one observer
said,

But another seasoned observer slammed this view,
pointing out that there were reportedly some 50,000
prostitutes in Ho Chi Minh City and 30,000 in Hanoi.

“More and more you see these ladies in (Hanoi dance)
clubs ... Then you have to be careful,” one resident here
said.



JPRS-TEP-91-002
28 January 1991

AIDS Figures Stabilize in 1990

LD0701110191 Bern International Service in English
1000 GMT 7 Jan 91

[Text] The number of people in Switzerland infected
with the AIDS virus who subsequently develop the
disease has stabilized for the first time. Figures released
by the Federal Office of Public Health in Bern show that

WEST EUROPE 45

the number of reported cases for 1990 was around 450,
about the same as in the previous year. The number of
people infected with the virus in 1990 was also lower
than the previous year. A spokesman for the Office of
Public health said the stabilization of the figures, fol-
lowing several years of progresively higher figures, was
the result of greater public willingness to take measures
to prevent infection.



JPRS-TEP-91-002
28 January 1991

About 24,000 people have been tested HIV positive and
the latest government estimate puts the number of HIV
carriers between 50,000 and 100,000.

Mr. Mechai said AIDS would have a significant impact
on the Thai economy.

Earnings of people who would die from AIDS complica-
tions would amount to US $5 billion by the end of the
decade if the epidemic peaks in 1992 and US $8 billion
if it peaks in 1994, he said.

Calling for a temporary closure of the sex industry as a
measure to curb the spread of AIDS, he said the Gov-
ernment should move as quick as possible on this matter.

“The sooner we peak, the worse the problem is. [no end
quote marks as published]

Pointing out that AIDS is not just the Government’s
problem, he urged all segments of society to fight the
virus.

But the Prime Minister must play a leading role in the
campaign, he said. He also urged sympathy be accorded
to HIV carriers and AIDS patients.

The public must “learn to live with AIDS” in a humane
manner, he said.

He said the sexual behaviour of Thai males, who like to
frequent brothels, needed to be changed as the virus had
been increasingly contracted through heterosexual inter-
course. Despite differences on estimates of HIV carriers,
AIDS experts at the conference agreed that the rate of the
increase was unlikely to be slowed before 1996.

Communicable Disease Control Director-General
Theera Ramasuta said he expected the increase would be
stabilised in 1996.

Dr. Wichan Witthayasai of Chiang Mai University said
the spread was unlikely to reach a plateau by 1994,

It could probably take at least 10 years to peak because
sexual behaviour was difficult to change.

VIETNAM

First AIDS Case in Ho Chi Minh City

BK1001003491 Hong Kong AFP in English 1128 GMT
10 Jan 91

[Article by Leo Dobbs]

[Text] Hanoi, Jan 9 (AFP)—A southern Vietnamese
woman has become the country’s first known carrier of
the Human Immunodeficiency Virus (HIV) that can lead
to AIDS and it seems likely she spread the infection
before being diagnosed.

The 30-year-old woman from Ho Chi Minh City was
tested by the International Organization for Migration

EAST ASIA 27

(IOM) early December while trying to emigrate to Aus-
tralia, an informed source said.

He added that her case had been handed over to the
Ministry of Health and the results had been confirmed
but the ministry had kept quiet about the issue.

“This is not official but they (the ministry) know,” he
said.

“This is the first seropositive of HIV,” in Vietnam, the
source said of the virus that can lead to Acquired
Immune Deficiency Syndrome (AIDS)—an incurable
disease that destroys the body’s immune system.

The source said the lady most likely caught the disease
from an old lover—a Vietnamese exile who returned to
Ho Chi Minh City from his home in West Germany in
1988 and spent a month with the woman.

“She seems to have been a happy lady who had a
Vietnamese boyfriend coming from West Germany,” he
said, adding: “it seems she has been with many people
since.”

“We don’t know how many more (cases) will be coming
out,” he said.

Vietnam has steadfastly maintained it is AIDS-free but
has set up AIDS combat teams in major cities in the past
three years.

Ho Chi Minh City, known as Saigon before 1975, is the
most liberated city in Vietnam and prostitutes are easily
available to locals and the growing number of foreign
visitors.

But southern newspapers have reported that 80 percent
of the prostitutes in the city are drug addicts—regarded
as a high risk group for AIDS.

The source said the woman had been planning to emi-
grate to Australia, where she has a brother, when she was
tested by the independent IOM.

The IOM tests blood samples of Vietnamese planning to
leave for new homes in the West.

A confidential government document, addressed for the
attention of Prime Minister Do Muoi, Vice Premier Vo
Van Kiet and Vice Premier Nguyen Khanh and the
Vietnam Communist Party Secretariat, said the single
lady was tested on December 7.

“The risk of AIDS in Vietnam is very high ... Contami-
nation from the virus in the Vietnamese community is
worrying because, according to international statistics
when you discover one case of AIDS there are probably
100 more cases,” the document said.

Her test was sent to Bangkok for analysis which proved
positive and a further test by the Ministry of Health also
proved positive, the source said.

The whereabouts of the woman was not known.



4 SUB-SAHARAN AFRICA

SJPRS-TEP-91-002
28 January 1991

Table 6, Average AIDS Awareness Index for Different
ariables
(number of respondents = 1,991) (Continued)

Table 6. Average AIDS Awareness Index for Different
‘ariables
(number of respondents = 1,991) (Continued)

Category Average Index Category ‘Average Index
Secondary 28 Sources of Information
Higher 36 Formal 14
Literacy Informal 16
Iliterate 0.6 Various 3.0
Read with difficulty 18 One profile emerges readily: The person who has some
Read with ease 27 knowledge of AIDS (an index value greater than 2) is not
Religion more than 35 years of age; is more often a man than a
- woman; is more often Christian than Muslim; reads with
Christian 22 ease, having studied at the secondary or higher level; and
mMuslim Ll has access to or seeks out several sources of written or
mAnimist 18 oral information.
4)Information Sources.
The respondents had heard of AIDS through various
channels of information. These are listed in Table 7.
Table 7. Sources of Information about AIDS as a Function of Educational Level
(number or respondents = 1,144 in percent)
Educational Level
Source None Primary Secondary Higher Total
Radio and TV alone 41 45 59 80 $1
Newspapers 1 3 10 8 6
Neighbors, relatives, 35 24 10 2 20
friends
Health-care workers 2 2 1 1 9
Radio, TV, and other 21 26 20 9 21

Note: Each respondent was allowed more than one response.

Although information sources vary according to level of

education, what is immediately striking is the consider-
able importance of radio with its increasing audience,
cited here merely for the record. The role played by
neighbors, relatives, and friends is considerable for those

who have had little or no schooling. Health-care workers
play only a very minor role. Newspapers and magazines
are a sole source of information for only 10 percent of
those with a secondary or higher level of education.

Table 8. Sources of Information About AIDS as a Function of Gender
(number or respondents = 1,144)

‘Source Women Men
Radio and TV alone 37 61
Newspapers 5 6
Neighbors, relatives, friends 32 12
Health-care workers 2 1
Radio, TV, and other 24 20

Women have less access than men to radio and TV, but
on the other hand, women rely much more on conversa-
tions for information.

The sources of information about AIDS were divided
into two types: formal sources, i.e., subject to checks for

accuracy (radio, TV, newspapers, or magazines), and
informal sources, i.e., not subject to checks for accuracy
(friends, neighbors, family). Access to these two types of
sources clearly varies significantly according to educa-
tion.



18 SUB-SAHARAN AFRICA

secretariat which will monitor and coordinate all AIDS
related activities in the country. [Passage omitted]

Museveni Addresses AIDS Rallies

91WE0141 Kampala THE STAR in English
20 Nov 90 pp 1,7

[Excerpt] President Yoweri Museveni has called on the
people of Uganda and those of Rakai District in partic-
ular to assume an enhanced responsibility to counteract
the spread of the AIDS disease.

Speaking at public rallies at Kyotera and Mutukula in
Rakai District, President Museveni said that AIDS has
reached alarming proportion in the country necessitating
all the people to be serious with preventive methods. He
particularly advised the youth to guard against con-
tracting the disease through undisciplined sex.

Museveni said that AIDS is very easy to avoid because
the channels through which it is spread are well known.
He further warned that AIDS has no known cure as of
now. He advised young people intending to get married
to first undergo an AIDS test.

Museveni said that the government is going to launch a
multi-sectoral approach to the problem of AIDS with a
secretariat in the Prime Minister’s Office. He said that
AIDS cannot be left in the hands of the Ministry of
Health since there are other social implications caused
by AIDS such as orphans, who can be tackled on a wider
scale by the Office of the Prime Minister.

Earlier, the President addressed members of Rakai
Resistance Council and opinion leaders. He told them
that the spread of AIDS had been mainly fuelled by
cultural degeneration and poor health services. He urged
them to be open and serious to their children so as to halt
the spread of AIDS. President Museveni disclosed that
the government of Belgium has provided seven million
USS. dollars to cater for orphans and that other interna-
tional donors are promising assistance.

Health Minister Reviews Progress Against AIDS

91WE0141C Kampala THE STAR in English
4 Dec 90 pp 3, 5,6

[First paragraph is introduction]

[Text] Last Saturday, 1 December 1990 was World AIDS
Day. To mark the occasion, the Minister of Health Mr.
Zack Kaheru addressed the nation and called upon
Ugandans to “mark the Day as a way of strengthening
our struggle against AIDS.” The following is the full
address.

December 1, 1990 the world observed “WORLD AIDS
DAY.” On this day, Uganda and the rest of the world
renewed our resolve to control the AIDS epidemic. The
day gave us an opportunity to expand and strengthen the
world wide effort to stop the spread of AIDS. World

JPRS-TEP-91-002
28 January 1991

AIDS Day brings messages of hope, compassion, soli-
darity and understanding about AIDS everywhere in the
world,

For one week Uganda has been marking the problem of
AIDS by talking about the problem and 1 December was
the climax of our activities. Each district was expected to
mark the day and the national ceremony took place in
Kampala at Kololo airstrip. The day opened with pro-
cessions in various towns and centres ending in public
rallies which were added [word indistinct] by leaders.

Since 1986 the NRM government has responded to the
challenge of the epidemic by establishing an AIDS con-
trol programme in the Ministry of Health to provide
technical leadership in the control of AIDS and HIV
infection. Although the disease is still spreading, some
gains have since been achieved.

This was established and continues to monitor the inci-
dence and distribution of the disease. The findings are
published in quarterly review reports. In future, this
service will be strengthened by including the develop-
ment of better methods of data collection. The Ministry
is creating a database on AIDS information.

We can only stop or control the spread of AIDS mainly
by a change of sexual behaviour. Before there can be
Positive change of behaviour, people need to be provided
with information about the disease and its transmission.
After the awareness, people would be mobilised for
change of behaviour.

In the last year, health education campaign to inform the
public on the modes of transmission and ways of
avoiding infection was intensified. This raised awareness
of the relevant simple facts about AIDS to a level of up
to 60 percent. In the coming year these education mea-
sures of particular importance in the fight against the
disease will be further intensified. The AIDS control
Programme has a four pronged Health Education Pro-
gramme.

(a) The School Health Project, which is mainly executed
with the assistance of the Ministry of Education is aimed
at raising the awareness of the problem of AIDS and to
encourage discussions of AIDS by our youth with a view
to effecting change of behaviour. We intend to increase
the use of more audio-visual shows such as films and
drama and to encourage more pear discussions. Here I
should like to appeal to headmasters and teachers to
intensify their effort.

(b) The Health Education network for the districts. This
network sustains and augments routine health education
activities in districts with special emphasis to control of
AIDS.

(c) The District AIDS Mobilisation programme, where
districts are specially mobilised from the top level to the
level of RC | in a period of three weeks.

AIDS patients are entitled to treatment and counselling
to ensure that they live positive lives, Ministry of Health



SJPRS-TEP-91-002
28 January 1991 SOVIET UNION

35

Table 1. Clinical Stages of AIDS*

Stage

Points

1. Asymptomatic

A. Persistent generalized lymphadenopathy

IL. Early signs of disease (at least one)

A. A weight loss of less than 10%

B. Minor changes of skin and mucous membranes

1, Seborrheic dermatitis

2. Folliculitis

3. Pruritis

4. Psoriasis

5. Fungal infection of the nails

6, Recurrent ulcers in the mouth cavity

a) Angular cheilosis

7. Necrotic gingivitis

C. Shingles for 5 years (in persons under 50)

D. Recurrent upper respiratory tract infections

IH. “Intermediate” signs (at least one; i.e., the stage of “full-blown” disease)

1, Progressive weight loss (more than 10%)

Diarrhea of unclear origin (for more than 1 month)

Oral candidiasis

Leukoplakia

Pulmonary tuberculosis (in the recent past)

Peripheral neuropathy

Localized form of Kaposi's sarcoma

elalalelalelr

Disseminated shingles

9, Severe recurrent bacterial infections (pneumonia, pyomyositis, bacterial sinusitis)

IV. Late signs of disease (at least one)

1, Pneumonia evoked by Pneumocystis carinii

2. Toxoplasmosis

3. Cryptococcosis

4, Isosporosis

5. Strongyloidiasis

6. Cytomegalovirus infection

7. Herpes simplex

8. Progressive multifocal leukoencephalopathy

9, Histoplasmosis

10, Esophageal candidiasis

11, Atypical mycobacteriosis

12, Salmonellar septicemia

13, Extrapulmonary tuberculosis

14, Lymphoma

15. Disseminated Kaposi's sarcoma

16. Cachexia

17, HIV-induced encephalopathy (disturbances of the central nervous system,

dementia)



36 SOVIET UNION

It should be noted, however, that that classification is
not very well suited for use in many developing (prima-
tily African) countries, where laboratory capabilities are
quite limited, which makes it impossible to establish the
accurate diagnosis of opportunistic infection or tumors
that the classification requires. Moreover, clinical man-
ifestations of AIDS in developing countries differ con-
siderably from those described in North America and
Europe. In addition, in the opinion of a number of
authors,’ there are other flaws in the classification,
including the following: (1) the absence of early nonspe-
cific manifestations of HIV infection, as a result of which
some cases of disease remain undiagnosed; and (2) the
possible presence of not one, but several signs of disease
in the individual, which, however, does not influence the
prognosis (according to the classification).

Although we agree with the remarks presented above, we
would like to express some of our own thoughts about
certain items of the classification that appear rather
debatable to us. From our point of view, the following
may be named among the shortcomings of the classifi-
cation:

1. No mention is made of pronounced weakness as one
of the main signs of the disease. The same is also true for
fever and night sweats.

2. The correctness of introducing diseases such as sebor-
theic dermatitis, folliculitis, pruritis, psoriasis, etc. (stage
Il, items B 1-4), into the classification as diagnostic
criteria of AIDS is doubtful, since it unquestionably
leads to hyperdiagnosis.

3. Many things are unclear in the description of stage IV
of the disease. In particular, calling strongyloidiasis,
herpes simplex, and extrapulmonary tuberculosis signs
of the late stage of AIDS seems a mistake to us. In
general, that system of pathology grouping is a clinical
system rather than a laboratory system. For example, it
makes a clinical distinction between “progressive multi-
focal leukoencephalopathy” (stage IV, item 8) and
“HIV-induced encephalopathy” (stage IV, item 17). The
former is more of an anatomical concept, whereas the
latter is functional—i.e., what we have here are two
hard-to-compare diagnoses.

4. There is no logic, completeness, or concreteness to the
proposed classification; it is often unclear as to what the
AIDS diagnosis is based on. For example, section IV,
item 1, includes pneumonia induced by Pneumocystis
carinii, which, as we know, is a frequent marker of AIDS
in adults, But the authors of the classification give it 4
points, just as they do strongyloidiasis and herpes, for
example.

5. “Recurrent upper respiratory tract infection” is placed
in stage II D, as one of the possible early signs of AIDS;
whereas “‘severe recurrent bacterial infection (pneumo-
nia, etc.)” is placed in stage III, item 9. Here again, the
grounds for the distinction are unclear. How and by what
criteria is the severity of the individual’s state assessed?
That is, after all, quite a variable characteristic.

JPRS-TEP-91-002
28 January 1991

6. Pyomyositis and bacterial sinusitis are named among
other signs of disease in stage III, item 9. As we know,
pyomyositis is a rather rare disease, while bacterial
sinusitis is an extremely nonspecific marker for AIDS,
since it is encountered rather often in persons not
infected with HIV.

7. The expression “Pulmonary tuberculosis in the recent
past” (stage III, item 5) requires explanation. What does
“in the recent past” mean? Why not in the present?

8. In our opinion, the expression “minor changes of the
skin and mucous membranes” (stage II B) requires
clarification. What signifies “minor”? Should pruritis
(itching), which causes hardly any skin reaction, be place
in the same section with profound tissue alterations such
as psoriasis, mycosis, and especially necrotic gingivitis?

9. On the whole, the proposed division of signs of disease
into “early” and “late” appears unconvincing, indistinct
and inconsistent to us, and the classification itself seems
cumbersome and too detailed.

Recently, WHO proposed a simplified system, presented
below (Table 2), for using a point count to identify
individuals with AIDS.”

Table 2. System for [dentifying. AIDS by Point Count
(WHO, 1988)

Disease Symptom Points
1. Persistent generalized lymphaden- 0
opathy

2. (a) Changes in skin and mucous 1
membranes

2. (b) Weight loss 1
2. (¢) Pronounced fatiguability 1
3. Viral infection (herpes simplex) 2
4, Diarrhea lasting longer than 1 4
month

5. Fever lasting longer than | month 4
6. More than 10% weight loss for 4

longer than 1 month
7. Pulmonary tuberculosis

5

8. Recurrent bacterial infections 5
9. (a) Leukoplakia Ss
5

8

9. (b) Stomatitis, oral thrush

10. Delimited Kaposi's sarcoma

11, Cachexia 12
12, HIV-induced encephalopathy 12
13. Lymphoma 12
14, Opportunistic infections 12

According to that system, when the point count is 0-3,
the probability of AIDS is low; at 4-11, AIDS is more
probable; and at 12 points or more, AIDS is highly
probable.



24 CHINA

to name | December World AIDS Day as of 1988, with
a view to reminding all governments and peoples in the
world of the ubiquitous threat of AIDS.

Propaganda and education on hygiene among the public,
especially among the highly vulnerable groups of people,
and also young people, is part of China’s successful
experience in the struggle to prevent AIDS,

In the past few years, the departments concerned have
tried unremittingly to convey a message to the public
through the mass media: treasuring one’s own health is
the most effective weapon against AIDS.

Now that the idea of treasuring one’s own health has
struck root in the hearts of the people, some people who
were indiscreet in their conduct have begun to behave
themselves. The propaganda and education efforts have
proved to us that the spread of AIDS can be checked and
good conduct can keep everyone immune to AIDS.

First Chinese AIDS Victims
91WE0131 Moscow IZVESTIYA in Russian 8 Dec 90
ps

[Article by Yu. Savenkov, under the rubric “Around the
World”: “First AIDS Victims in China”]

[Text] Beijing—The Chinese government has for the first
time officially announced the death of two citizens of the
PRC who were carriers of the AIDS virus. As noted by
Deputy Director of the Health Ministry Epidemiology
Administration Dai Chzhichen, both persons had an
infection associated with that severe disease.

One of the victims, a resident of Beijing, became infected
through sexual contact. The other, from the southern
province of Yunnan, was a drug addict and was infected
by the virus as a result of intravenous injections. Inci-
dentally, the sharp increase in the number of AIDS virus
carriers among the Chinese is, in fact, associated with the
Yunnan province, in whose western regions, which
border Burma, illegal opium and heroin trade is carried
on. A cause of infection is the group use of non-sterile
syringes. (Since 1985, a total of 446 AIDS carriers have
been detected in China. Of that number, 68 were for-
eigners. Of the 378 Chinese AIDS carriers, 368 live in
the province of Yunnan),

In recent months, the government has intensified its
monitoring of the spread of AIDS. A new law for the
prevention of infectious diseases gives health officials, in
particular, the right to test for AIDS all Chinese citizens
who are potential candidates for infection with that
dangerous virus and to isolate AIDS victims. Among
those being tested are hotel employees and guides—in
short, those who come into contact with foreigners. The
law gives health officials the right to test any citizen of
the PRC for AIDS, but many medical experts believe
that to be excessive. Virus carriers are isolated promptly

SJPRS-TEP-91-002
28 January 1991

and are not allowed to go to work or school. Foreigners
are immediately expelled from the country (there have
been quite a few such cases). In short, China in its efforts
is emphasizing the erection of a barrier to the spread of
the disease, as opposed to universal testing of the popu-
lation. However, certain experts believe that traditional
morals, which forbid casual sex, have slackened in recent
years, which has resulted in the appearance of diseases
such as gonorrhea. Those experts are insisting on
broader testing of the population.

Recently, China has been actively involved in coopera-
tion with the World Health Organization (WHO). In
November, a joint team of Chinese and international
experts will begin work in the border regions of the
Yunnan province. The WHO representative in Beijing,
Bill Kin, said that they will assist Chinese medical
personnel to establish AIDS testing techniques and to
learn methods for determining the groups of the popu-
lation at highest risk.

As early as the mid-1980s, before there were any signs
that AIDS was a threat in China, specialists of traditional
medicine were already searching through the rich collec-
tion of herbs for those that might be helpful in curing
persons afflicted with that dangerous virus. Recently, a
group of specialists from the Beijing Company of Tradi-
tional Chinese Medicine held a press conference to
demonstrate a new agent called TACH (the first letters of
the long English name “Treatment of AIDS with Chinese
herbs”), But when reporters asked Chzhao Chzhilyan,
the general manager of the company, to explain exactly
how the medicine overcomes the disease, he termed the
method a “secret.” Have any control experiments been
conducted? The response was negative, although Chzhao
did admit that some of the ingredients had been taken by
patients from the United States and Africa. The medi-
cine is based on 33 formulas consisting of 200 herbs.
Chzhao named only a few of them: honeysuckle, wild
chrysanthemum, Chinese violet, seaweed. The series
consists of colored capsules: the yellow capsules “elimi-
nate the symptoms and improve health,” the green ones
“arrest the development of the disease,” the red capsules
“strengthen vital energy and regulate the body’s immune
system,” and the white capsules “protect against random
infection.” The medication is now being offered to
purchasers at the ongoing traditional exhibit of export
commodities of Guanchzhoy.

Thus, in China there is now concern about the spread of
AIDS, and plans have been made to make use of certain
advantages to fight the peril. In the view of experts, those
advantages include the fact that, in the first place, the
virus appeared here later than in many countries. In the
second place, the overwhelming majority of virus car-
tiers are concentrated within narrow confines—in the
west, in the Yunnan province. Finally, attempts are
being made to develop an antidote in formulas of tradi-
tional medicine that have more than once proven their
potential.



JPRS-TEP-91-002
28 January 1991 3 AIDS

SOVIET UNION

Alma-Ata Woman Found HIV-Positive After Lengthy Testing

[Vladimir Ardayev: Moscow IZVESTIYA, 28 tug 90].
AIDS Screening in Uzbekistan /1. Artemenko; Moscow PRATDA, 4 Sep 90]
Aralsk Plague Quarantine Lifted, AIDS Case Discovered

[V. Ardayer; Moscow IZVESTIY. 1, 27 Sep 90]. 33
Clinical Classification of AIDS

/¥u. Galkin, Y. Nilson, et al: KLINICHESKAYA MEDITSINA, Vol 68 No 10, Oct 90]... 34
Government Assistance for Children With AIDS

{Moscow PRAVT NYY VESTNIK, Oct 90} 38
Ukrainian AIDS Official Comments /. /. Mrolov Interview; KRAINY, 24 Oct 90). 39
HIV-Positive Foreigner Deported /¥e. Ukhov; Moscow TRUD, 1 Dec 90] 40
AIDS in Buryat Republic /S. Trofimov; Moscow TRUD, 2 Dec 90]. 4l

AIDS Measures in Ukraine
ILS. Nekrasova Interview; Moscow KOMSOMOLSKOYE

WEST EUROPE
CANADA

AMY A, 2 Dee 90]

Montreal Study Links AIDS With Poor Women
[Andrew Nikiforuk; THE TORONTO STAR, 1 Nov 90]...

DENMARK

Growing AIDS Risk Among Hetcrosexuals  /Copenhagen BERLINGSKE TIDENDE, 27 Nov 90). 43

IRELAND
Health Department Reports AIDS Statistics /Dublin IRISH INDEPENDENT, 30 Nov 90] 43
NORWAY
Health Service Releases Year to Date AIDS Figures
[Kare M. Hansen; Oslo AFTENPOSTEN, 27 Nov 90f 44

SWITZERLAND

Public Health Service Releases AIDS Figures /Geneva JOURNAL DE GENE
AIDS Figures Stabilize in 1990 /Bern International Service, 7 Jan 91]



JPRS-TEP-91-002
28 January 1991

CANADA

Montreal Study Links AIDS With Poor Women

91WE0105 Toronto THE TORONTO STAR in English
1 Nov 90 p A4

[Article by Andrew Nikiforuk}

[Text] The Canadian AIDS epidemic has a new face.
Once solely associated with affluent gay men, acquired
immune deficiency syndrome is now more likely to
appear in heterosexual women of childbearing age living
in poverty, a Montreal study says.

The overall risk of infection with the human immuno-
deficiency virus (HIV) among women of childbearing
age is now a startling 6.1 per 10,000 live births, or one
woman in 1,638, says the study, published today in the
Journal of the Canadian Medical Association.

That’s twice the rate recently found in a similar Ontario
survey. The Montreal study is based on 42 confirmed
findings of HIV antibodies among 68,808 anonymous
blood samples taken from newborns in Quebec in 1989.
(HIV antibodies in children indicate HIV infection in
mothers.)

When the same data was correlated with place of resi-
dence via postal codes, it showed the kind of dramatic
association between poverty and HIV infection that has
been repeatedly noted in U.S. cities, the Caribbean and
Africa.

As a consequence, the risk of HIV infection climbed as
high as 46.4 per 10,000 live births, or one woman in 216,
in Montreal-island neighborhoods where incomes are 20
percent or more below the norm. (In contrast, the rate of
infection in Metro is one in 1,976 women.)

“We’re seeing the first evidence that AIDS could become
an important problem,” said Dr Catherine Hankins, the
Teport’s main author and an epidemiologist at Mont-
real’s General Hospital.

“We have the same rate as San Francisco and a fifth the
rate of New York. It’s the highest rate of infection in
Canada.”

Hankins said no more than one-third of the infected
women come from Haiti or Africa. In fact, the majority
of those infected are white Montrealers who are either
intravenous drug users, or their sexual partners.

DENMARK

Growing AIDS Risk Among Heterosexuals

91WE0121A Copenhagen BERLINGSKE TIDENDE
in Danish 27 Nov 90 pI9

[Unattributed article: “Growing AIDS Risk Among Het-
erosexuals’’—first paragraph is BERLINGSKE
TIDENDE introduction]

WEST EUROPE 4B

[Text] A study of Copenhagen figures show that the HIV
virus is spreading among heterosexuals.

The HIV virus is spreading more and more within the
heterosexual part of the population. Whereas earlier,
women got the HIV virus because they were needle users
or had blood transfusions with contaminated blood,
intercourse with men is becoming the more frequent
cause for women becoming infected with the HIV virus,
which leads to the incurable AIDS disease.

UGESKRIFT FOR LAEGER [Physicians Weekly]
released a study made between the years 1985 to 1988 at
three hospitals in Copenhagen. In this period, IIS women
were found to be HIV positive. Every third woman was
infected through intercourse with an infected man.

In the early part of this period, only 14 percent were
infected through heterosexual contact, whereas by 1988,
it was true for 73 percent of those diagnosed as infected.

Approximately 5000 people in Denmark are estimated
to be infected with HIV. Indications are that between 10
and 15 percent of these are women. At the end of
October, 690 had developed the AIDS illness. Of these,
44 were women, 19 of which had acquired the disease
after sexual contact with a man.

A European study of the risk of HIV infection passing
from man to woman, as yet not completed, currently
shows that the number of encounters, earlier sexual
diseases in the woman, and the health of the man, among
other things, have significance for the risk of infection.

A pregnant HIV-infected woman has a risk between 25
and 50 percent of passing the infection to her child. At
the current time, there have been a total of eight children
with AIDS reported in Denmark. Two were born of a
substance abuser while six of them have mothers who
were infected by intercourse with a male partner.

The first Danish women was reported to have AIDS in
1985; in 1988, the first woman with AIDS infected by a
man was reported.

On a global level, heterosexual contact is the most
frequent mode of infection, but in the USA and Europe,
most cases of AIDS in the past were found among men
who had intercourse with other men, and among needle
users. Women appear destined to form an ever growing
portion of the infected, and more and more of them are
becoming infected through men.

IRELAND

Health Department Reports AIDS Statistics

91WE0153 Dublin IRISH INDEPENDENT in English
30 Nov 90 p8

[Text] The numbers of heterosexual people who are HIV
positive continue to grow with the latest official figures
showing 83 infections.



JPRS-TEP-91-002
28 January 1991

The “carrier” was deported from the country along with
his spouse. But the uproar has not quieted down. The
fact of the matter is that there has been a report in the
republic’s press that the carrier is suspected of having
had intimate relations with individuals whose number is
expressed as a three-digit figure! Oh, those provincial
morals...

AIDS in Buryat Republic
91WE0132A Moscow TRUD in Russian 2 Dec 90 p 1

[Article by S. Trofimov, Ulan-Ude: “AIDS in Buryat-
iya”; first paragraph is source introduction]

[Text] Ulan-Ude—It was literally just yesterday when
most inhabitants of Buryatiya looked upon the spread of
AIDS in our country as some kind of abstract idea.
Today, that opinion has changed.

The reason for that change is the official communique
broadly disseminated in the republic that inhabitants of
the Buryat capital city have become infected by the virus
of this terrible disease.

Director of the Ulan-Ude City Health Department M.
Khaltayev commented on this sad news at the request of
a TASS correspondent:

“In fact, specialists of the republic center for AIDS
control have registered two patients who have become
infected by the acquired immune deficiency syndrome
virus.”

How did the AIDS virus get into Buryatiya? It was
brought in from abroad. Both patients had been working
fairly recently in one of the southern foreign countries.
That is where the infection occurred. The patients are
currently under the observation of specialists and are
receiving appropriate treatment.

AIDS Measures in Ukraine

91WE0132C Moscow KOMSOMOLSKOYE ZNAMYA
in Russian 2 Dec 90 p 15

[Interview with Kiev Deputy Chief State Health Physi-
cian Lyubov Sergeyevna Nekrasova by R. Povar: “AIDS
Is on the Rise, But...”; first two paragraphs are source
introduction]

[Text] Over the last three years, AIDS has become a
major health problem in all the countries of the world
because of its rapid proliferation and high mortality rate.
Forecasts are becoming increasingly alarming.

For example, according to WHO estimates, there are at
least six million persons infected with HIV throughout
the world, and approximately two million of them are
women. According to estimates, the number of AIDS.
cases among women by the year 1992 will be 350,000,
which is three times greater than the figure at the end of
the 1980s. It is therefore no accident that the theme of
the World Day for the control of that dread disease on 1

SOVIET UNION 41

December 1990 was “Women and AIDS.” Our corre-
spondent asked Kiev’s Deputy Chief State Health Phy-
sician Lyubov Sergeyevna Nekrasova to comment once
again on the plague of the 20th century.

Nekrasova: This terrible disease is spreading quite rap-
idly, and by the end of this year [1990], more than 1,600
persons will be infected by the AIDS virus in our
country. In 1991, that figure will be 6,200, and according
to scientific predictions, 50 million persons will have
been infected by the year 2006. In the Ukraine, 219
persons have been identified as HIV-infected—that’s
159 foreigners and 60 citizens of the USSR. Four people
have come down with the disease, and three of them
have died. The most unfavorable epidemiological situa-
tion exists in the Odessa and Donets oblasts and in Kiev.

Povar: Lyubov Sergeyevna, I would like to know how
many AIDS patients there are in the republic’s capital?

Nekrasova: Fifty-five virus carriers have been identified.
Ten of them are Kievans. However, the real dimension
of the epidemic may be considerably greater that what is
now known to the medical profession.

Povar: What should be done to arrest the spread of this
dangerous disease?

Nekrasova: It is essential that we consolidate and coor-
dinate the efforts of various state and public organiza-
tions. We have now worked out a draft for a National
Program for the Prevention and Control of AIDS. We
must utilize all possible methods to control this insidious
disease. For example, in accordance with current legis-
lation, all foreign citizens who are suffering from AIDS
or are virus carriers are subject to deportation. However,
the unsatisfactory manner in which foreign students are
being examined is conducive to an epidemic of trouble.
Take, for example, our own city. Of the 5,668 foreign
students studying in Kiev, 2,835 have not been tested for
HIV. On a number of occasions, the city medical epide-
miological station has dispatched information to the
UkSSR Ministry of Higher and Secondary Specialized
Education, but there has been no follow-up with appro-
priate action.

The testing of juveniles for the virus would not be such a
bad idea. Their behavior has been a matter of concern to
teachers, medical personnel, and the militia. After all, no
small segment of the youth believe that unrestrained
sexual relations is normal. However, this disease doesn’t
give advocates of “free love” any chance whatsoever for
recovery. That is borne out by the facts. After all, most of
the infected and AIDS-afflicted Soviet citizens are indi-
viduals with promiscuous sex lives.

Health-education work plays a major role in the struggle
against AIDS. Knowledge itself about the disease alone is
believed to have reduced the growth of the disease in
America. If at one time in the United States the number
of afflicted individuals doubled every six months, it now
takes 14 months to double.



JPRS-TEP-91-002
28 January 1991

“The minister of health at the time only confirmed the
functions of the team already in existence,” Prof. Ode-
houri recalled. However, today he has declined the call of
all those who want him to give conferences or conduct
awareness campaigns. Indeed, he is no longer a member
of the committee.

In fact, in the wake of the 16 October 1989 cabinet
reshuffle and the appointment of Prof. Alain Ekra as
health minister, the CNLS experienced major upheavals.
“With the greatest secrecy, notably as far as the press was
concerned,” as the daily, FRATERNITE MATIN,
pointed out, a new coordinator, Dr. Nda Konan, a
63-year old retired medical doctor who had not been
working for three years, was appointed. This was a
choice that stunned most of the committee’s associates.

“The old man,” as they nicknamed Dr. Nda Konan,
obviously does not know anything about the AIDS
problem. Several members of the committee even
thought of resigning. “I dissuaded them,” Prof. Ode-
houri recalled. Prof. Odehouri preferred to resign after
they wanted to make him play an honorary role—as
“figurehead,” he said, within the committee. Health
Minister Alain Ekra is chairman, while a scientific
committee chaired by Prof. Leopold Manlan Kassi, dean
of the Faculty of Medicine, is working hand in hand with
the committee. The former team, which was somehow
demobilized, does not understand why “people wanted,
by all means,” to change “‘a team that was winning,” as
FRATERNITE MATIN stressed. Certainly, the coun-
try’s money suppliers wanted a full-time coordinator,
but according to an associate of the CNLS, the minister’s
insistence on keeping a team that had proved its worth
would have been enough to make the money suppliers
give in.

The importance of the funds of the country’s interna-
tional donors—$2 million for 1990—perhaps prompted
the Health Ministry to exercise tighter control on CNLS
activities. It also appears that the WHO permanent
representative in Ivory Coast, Dr. Pierre Masumbuko, at
the beginning wanted “to control the committee and use
its funds for other things,” as FRATERNITE MATIN
pointed out. He wanted to acquire computers to equip
the WHO offices.

“However the EEC did not give any money to Ivory
Coast to finance WHO,” Prof. Odehouri said ironically.
He thought it was possible that the WHO representative
played a role in his dismissal as chairman of the com-
mission. (Dr. Masumbuko refused to talk to us to con-
firm this feeling.)

Finally, the avowed membership of Prof. Odehouri to an
opposition party, the Ivorian Popular Front of historian
Laurent Gbagbo, and his active participation in the
strike by doctors last spring also played a part in his
dismissal. “They have won the battle, but I am not sure
that the AIDS project has won also,” he said today. This
is exactly the question one should ask. At a time when

SUB-SAHARAN AFRICA u

the spread of the terrible disease should call for mobi-
lizing all talents, one can only regret the interference of
other considerations. [passage omitted]

The donors, who are expected to make an assessment
before granting more funds for the CNLS at the begin-
ning of next year, will [words indistinct] rightness of the
committee’s choices. However, on 22 June, the joint
monitoring committee of the National Comittee for the
Fight Against AIDS comprising all three donors to the
fund, the WHO, and health authorities, did not find their
assessment satisfactory. As FRATERNITE MATIN put
it in its 5 July issue: “The activities accomplished are
unfortunately not commensurate with the talents and
means in Ivory Coast.”

Will the committee pull itself together and organize wide
media campaigns that the people rightfully expect from
it? “These days, everyone only thinks about elections.
Who has time for AIDS?,” Prof. Odehouri Koudou
remarked. The fact remains that when the election fever
has gone and Ivory Coast has time for its health, the
shock will be very violent: the spreading of the virus has
not slowed down.

MAURITIUS

Educational AIDS Hot Line Established

91WE0114A Port Louis WEEK-END in French
18 Nov 90 p 10

[Article entitled: “Mauritians Still Not Knowledgable
About AIDS”; words within slantlines published in
English]

[Text] Mauritians still know little about AIDS, particu-
larly the ways in which the dread disease is transmitted.
Such was the observation of Pastor David White, presi-
dent of the “Friendship Aid” association, after taking
the first calls to a hot line initiated last 5 November.

In fact, as of 5 November, any one wanting additional
information on AIDS can call 424-1114 on Mondays and
Fridays between 1700 and 1900: All calls are strictly
confidential.

“Friendship Aid,” an association bringing together pro-
fessionals from various sectors, includes among others,
Dr. Clement Chan Kam, coordinator of the National
Anti-AIDS Program; and Michele Etienne, a radio per-
sonality; who are there to take calls on those two days.

According to Pastor White, the public “response” to the
start of this advice program has been extremely positive
and has proved to be a success. It has become apparent
that Mauritians are looking for more information about
the ways the illness is transmitted. But they also wonder
about the sexual practices to be adopted to avoid infec-
tion through sexual relations.

“Our message concerning sexual relations is clear: It is
imperative that any one involved in /”’Casual Sex‘/



IJPRS-TEP-91-002
28 January 1991

The first of its kind, the study aimed to collect informa-
tion to help plan appropriate—and urgently needed—
educational interventions in schools. It was motivated
by pupils’ concern about the disease—reflected ina
barrage of questions put to visiting school nurses.

“The kids picked things up from radio and TV and kept
on asking us what AIDS was all about,” said Zodwa
Mbulawa, one of a team of 15 nurses employed by the
Cape Provincial Administration to visit black schools in
the region.

The sample was 377 pupils, ranging in age from 13 to 26
years, at four Cape Town schools run by the Department
of Education and Training (DET).

Almost all knew of the disease, said researcher Cathy
Mathews, but did not perceive themselves to be at risk.
“While many pupils associated AIDS with death, the
belief that there is, or potentially is, a cure for AIDS has
been found to be a barrier to effective education.”

Most knew it was infectious, but there was confusion
about how it was transmitted: although sex was the most
common means mentioned, casual contact (shaking
hands, using the same utensils) was mentioned in almost
half the responses, while none mentioned intravenous
drug use and only one cited transmission from mother to
child.

And among those who cited sex as the prime means of
transmission, this was often associated with “bad
people”, “promiscuous people”, prostitutes, whites, or
people from other countries. According to Mathews, this
was a form of denial which leads to blaming others.

More than half the pupils were unaware that an affected
person could appear to be perfectly healthy, and a full 69
percent did not know that AIDS cannot be cured.

Of those who believed AIDS was curable, almost 70
percent put their faith in doctors and nurses, and just
over 32 percent in traditional healers.

Responses also reflected fear of being stigmatized: “That
would worry me my whole life because I would be
separated from other people and it would be the end of
the world”.

But almost 15 percent were unconcerned about getting
AIDS, saying they were not yet sexually active, they had
only one or a few partners, or they believed their sexual
behavior was safe.

Of the 64 percent who thought AIDS could be prevented,
80 percent cited condoms as preventing its spread. But
over 19 percent of those who said condoms protected
also said, in a later question, that they did not know what
a condom was.

Only a small number (11.4 percent) of the 75.4 percent
of pupils who said they had had sexual intercourse, had

SUB-SAHARAN AFRICA 13

ever used a condom. Of those who had had sex and who
also believed condoms protected against AIDS, only 15.4
percent had used them.

Less than 40 percent said they would use a condom in
the future. Most of these were boys, and many said they
did not know what a condom was: “Condom, I know its
look, what beats me is how to use it and when”.

Reasons offered by those who did not plan on using
condoms in future included: “I don’t enjoy it and the
taste is not there” and “When you use a condom it
means you don’t like him and you don’t trust each
other”. many girls did not believe the decision to use
condoms was theirs.

Other methods of prevention suggested by pupils were
not necessarily protective: “Behave and be honest to
each other” and “Don’t have sex with other nations”
were among the strategies mentioned.

Almost all the pupils (96.2 percent) wanted AIDS infor-
mation at school, video being the most popular choice of
medium.

According to Mathews, the study indicates that preven-
tion programmes at schools is a matter of urgency.

Experts: Conflicting Views on AIDS Threat

91WE0142A Cape Town THE ARGUS in English
29 Nov 90 p 25

[Report by Helen Grange; first paragraph THE ARGUS
comment]

[Text] The spread of the AIDS epidemic, studied in
isolation, is indeed ominous. However, examined in the
light of other factors, the spectre acquires a slightly, less
threatening pose.

The government recently expressed fear over the spiral-
ling population growth, warning that this would lead to
increased unemployment.

At the same time, AIDS experts warned economists to
prepare for a severe shrinking of the labour pool in the
future as the killer AIDS epidemic spreads.

These two issues, the population boom and AIDS, and
are often highlighted separately in dramatically ominous
reports. But when they are juxtaposed a different picture
emerges.

Experts in both fields agree that AIDS will have little
effect on the population growth rate in the short term.
However, they contradict each other on AIDS and pop-
ulation figures in the medium to long term.

Projected statistics of future AIDS deaths and infections
are varied, ranging from relatively moderate to alarm-
ingly high, But according to authorities who have looked
at the effects of the virus against the backdrop of



JPRS-TEP-91-002
28 January 1991 2 AIDS

Uganda

SH VISION,

AIDS Cases Double Every 6 Months /Hellen Mukiibi; Kampala THE 2 Nov 90] .. 17

Museveni Addresses AIDS Rallies /Kampala THE STAR, 20 Nov 90} 18
Health Minister Reviews Progress Against AIDS /Aamnpala THE STAR, 4 Dec 90). 18
“Exccutive’ Clinic for AIDS Testing Opened /Kampala WEEKLY TOPIC, 7 Dec 90]. 20
ACP Head Reports on Lack of Public Response

[Sensasi Benjamin; Kampala WEEKLY TOPIC, 7 Dec 90]... 20

ZIMBABWE

Health Minister Discusses Tuberculosis, AIDS Johannesburg SAP.A, 28 Dee 90]

CHINA

AIDS Seminar Held in Beijing /Fan You: Beijing GUANGMING RIBAO, 29 Nov 90].
HIV Cases Detected in Yunnan /Zhu Baoxia; CHINA DAILY, 29 Nov 90]
Fight Against AIDS /Zhu Li; Beijing JING CANK.AO, 1 Dee 90]

First Chinese AIDS Victims /Y'u. Savenkor; Moscow IZVESTIYA, 8 Dee 90}

eeererey
BOOS

EAST ASIA
THAILAND

Estimated 10 Percent of Men in North HIV-Positive
{Ann Danaiya Usher and Martha Ross; Bangkok THE NATION, 18 Dee 90]

AIDS Prevalence Among Bangkok Drug Addicts Viewed
/-lnn Danaiya Usher; Bangkok THE NATIO: 0) Dec YOf

Two Million AIDS Carriers by Year 2000 Predicted [Bang
VIETNAM

First AIDS Case in Ho Chi Minh City /Leo Dobhs; Hong Kong AFP. 10 Jan 91] 27

LATIN AMERICA

BRAZIL

Profile of AIDS Changes in Sao Paulo /Sao Paulo O ESTADO DE SAO PAULO, 30 Nov DO, eevee 29
CUBA

Interferon Treatment for AIDS Yields “Satisfactory” Results [Havana GRANMLA, 22 Nov 90... 30

Guantanamo Province Records 17 AIDS Cases in 1990
[Jose Mejias; Havana Radio Rebelde Network, 10 Jan YI]...
Vice Minister Discusses AIDS Program /Iavana Tele Rebelde Network, 11 Jan 91}

DOMINICAN REPUBLIC

AIDS Cases From 1983 to 1990

[Santo Domingo Radio-Television Dominicana Radio Network, 20 Dec 90] 31
NEAR EAST & SOUTH ASIA
ISRAEL
Drop in Number of New AIDS Cases Recorded /Tel Aviv AL HAMISIALAR, 4 Jan 91]... 32
JORDAN
Health Ministry Official: Forty Five Cases of AIDS /:tnuman JORDAN TIA. 24 Dee 90). 32



34 SOVIET UNION

this region. One hundred sixty-five persons who had
been in contact with D. were revealed. A special com-
mission was created, emergency measures to prevent the
spread of the “plague of the 20th century” were imple-
mented, and a decision was made to create a special
center, for which the necessary assets were allocated.

All of these facts are more the rule than chance occur-
rences. The ecological situation in the Aral zone is such
that rather favorable conditions have been created here
for epidemics of the most dangerous diseases. And what
we need is not only to “put out the fires” but also
implement fundamental measures to provide assistance
to people living today in this ecological disaster zone.

UDC 616.98:578.828.6]-092:6 12.017. 1]-008.6

Clinical Classification of AIDS

91WE0092 Moscow KLINICHESKAYA MEDITSINA
in Russian Vol 68 No 10, Oct 90 pp 99-102 (Manuscript
received 15 Mar 90)

[Article by Yu. N. Galkin, physician at the USSR
Embassy in Denmark (Copenhagen); Y.O. Nilson,
doctor of medicine, director, department of infectious
diseases and AIDS at Vidovr Hospital (Copenhagen,
Denmark); T. Erikssen, physician, department of infec-
tious diseases and AIDS at Vidovr Hospital; and B.L.
Bychenko, professor, doctor of medical sciences,
regional advisor of the WHO European Regional Bureau
(Copenhagen): “On the Clinical Classification of
Acquired Immune Deficiency Syndrome”]

[Text] As we know, one of the most menacing diseases of
the 20th century—HIV infection and its final stage,
acquired immune deficiency syndrome (AIDS)—have
assumed the nature of a real pandemic that has envel-
oped almost all countries of the world and has affected
many spheres of human vital activities—social, eco-
nomic, political, etc. In light of the extremely polymor-
phic nature of the clinical picture of the disease, many
authors are trying to develop a general model of its basic
clinical signs, which would make it possible to avoid the
terrible consequences of both hyperdiagnosis and unde-
tected cases of AIDS (as occurred, for example, with the
first Soviet patient, Olga G., who died of AIDS in 1988).

In 1985, Haverkos et al. proposed a system for the
clinical classification of AIDS that divided patients into
seven groups, according to the severity of their condi-
tion. Group | contained patients with an asymptomatic
disease course, while group 7 contained patients with

JPRS-TEP-91-002
28 January 1991

“full-blown” AIDS. In that same year, Blattner et al.!
proposed a similar classification. Later, various classifi-
cations of the symptoms of HIV infection were
developed.? In 1986, the American Centers for Disease
Control (CDC, Atlanta, United States) proposed a vari-
ation of the classification.® It was based on dividing
HIV-infected individuals into four groups, according to
stage of the disease’s development and presence (or
absence) of specific signs and symptoms—from acute
HIV infection to various secondary diseases brought
about by the action of the virus upon the human body.
However, the proposed classification turned out to be
highly arbitrary, and it did not become widely used,
because of its many flaws.

In another classification that has been employed since
1987 at the recommendation of the CDC and was
revised by WHO?, all AIDS patients were divided into
three groups: (1) individuals in whom laboratory tests for
the virus have not been conducted; (2) individuals in
whom the disease diagnosis is confirmed by laboratory
data; (3) individuals who test negative for AIDS (for
presence of the virus). That classification took into
account the presence in the individuals of any of 11
so-called indicator diseases that are considered to be
rather reliable criteria of AIDS, including six related to
diseases typical of AIDS.* The classification widened the
boundaries of the definition of AIDS by including in that
concept, for the first time, severe and even fatal syn-
dromes such as encephalopathy and the “emaciation
syndrome,” which afflict a considerable number of HIV-
infected individuals; that doubtlessly helped increase the
number of recorded cases of disease. However, that
classification is not free of substantial flaws. Specifically,
as with previous classifications, it fails to take into
account certain acute and asymptomatic illnesses—for
example, cases of persistent generalized lymphadenop-
athy in which diseases belonging to the AIDS “‘indica-
tor” group are absent, and constitutional and neurolog-
ical diseases that are less severe than HIV-induced
encephalopathy and the emaciation syndrome. It should
also be noted that the criteria for HIV-related encephal-
opathy and the emaciation syndrome are very complex,
and there is some doubt as to whether those criteria were
taken into account in all reported cases. Moreover,
according to that classification, diseases serving as AIDS
indicators must have a clear diagnosis, which is not
always possible. Based on all that, the World Health
Organization in 1987 developed and recommended a
new classification of the clinical stages of AIDS, pre-
sented below in Table | (the classification was last
revised in July 1989).



2 CHINA

AIDS Seminar Held in Beijing

HK2412020890 Beijing GUANGMING RIBAO
in Chinese 29 Nov 90 p 1

[Report by correspondent Fan You (5400 0642): “At
Seminar on ‘Women and AIDS,’ Experts Suggest Wide
Publicity for Knowledge About AIDS Prevention”)

[Text] Beijing, 28 Nov (GUANGMING RIBAO)—The
first of December each year is devoted to promoting
worldwide propaganda on control of AIDS and the
theme of this year’s “World AIDS Day” is “Women and
AIDS.”

This reporter has learned some worrying figures today
from a “Women and AIDS” experts seminar sponsored
by the Global Venereal Diseases Foundation: By 31
October this year, the number of verified AIDS patients
in the world exceeded 298,000; the number of people
infected with AIDS reached about 8 million, of whom
are women. Facts show that 25 to 40 percent of newborn
babies whose mothers are AIDS virus carriers are
infected with AIDS and most will die before the age of
ve.

As estimated by WHO, by 1992 there will be about
200,000 new female AIDS patients and, at the same
time, some 200,000 AIDS- infected babies will have been
born. About 3 million women and children will die from
AIDS in the 1990’s, thus the death rate for children
under the age of six will rise to 30 percent. In conse-
quence, the world’s orphan population will increase by
several million. Therefore, paying great attention to
AIDS control and preventing the spread of AIDS have
become pressing tasks which brook no delay.

During the seminar, the experts unanimously agreed that
for the moment the first policy for the protection of
women and children against AIDS is the wide publicity
of knowledge on AIDS prevention—propaganda and
education in this regard should be carried out down to
every household and every organization with female
members. Wang Aixia, a professor in dermatology from
Beijing’s Xiehe Hospital, noted that it is necessary to
teach the public to correctly view the danger and
spreading channels of AIDS and not to discriminate
against AIDS patients and those infected with AIDS. She
also called on the vast number of medical workers to set
an example in this effort.

Present at today’s seminar were Chen Muhua; Fei Xiao-

tong; Chen Minzhang, minister of public health; Zhang

Liping, director of the health division of the General

Logistics Department of the People Liberation Army;

and Dr. Keehan [1015 1869], WHO representative in
ina.

HIV Cases Detected in Yunnan

91WE0146A Beijing CHINA DAILY in English
29 Nov 90 p 3 -

[Article by Zhu Baoxia]

[Text] Two sexually-transmitted HIV cases have been
detected in Yunnan Province.

JPRS-TEP-91-002
28 January 1991

Both cases are women and they became infected by their
husbands who had been exposed to the virus by com-
munal use of contaminated syringes for intraveneous
injection, CHINA DAILY learned yesterday in Beijing
at a conference to mark the World AIDS Day that falls
on Saturday.

Apart from these two women, the majority of the 378
Chinese HIV carriers are male drug addicts in Yunnan
Province, an official from the Ministry of Public Health
said.

Some senior medical experts participating in the meeting
called for increased education on AIDS control to pro-
tect the health of women as well as children.

And they suggest that State departments such as the
All-China Women’s Federation and the Ministry of
Public Security should work together in the education
campaign.

An investigation among drug addicts in Yunnan
revealed that only 30 percent of them are aware that they
could contract AIDS.

As well as medical experts, some State officials such as
Chen Muhua, chairman of the All-China Women’s Fed-
eration and Chen Minzhang, Minister of Public Health
also attended the discussion. The conference is spon-
sored jointly by the Central Patriotic Health Campaign
Committee, the National Women’s Federation, the
China Petrochemical Corporation and China Global
STD (sexually-transmitted diseases) and the AIDS Foun-
dation.

Qian Xinzhong, chairman of the AIDS Foundation, gave
a report on the situation worldwide.

Statistics from the World Health Organization show that
by mid-1990, at least six million people around the world
had been exposed to HIV, one-third of whom are
women.

And experts estimated that by 1992, about 200,000
women in the world will develop AIDS.

Fight Against AIDS

HK2412040090 Beijing JINGJI CANKAO in Chinese
1 Dec 90 pi

[Article by staff reporter Zhu Li (2612 7787): “Faced
With ‘A Life Taker,—Marking World AIDS Day”]

[Text] Today (1 December) is designated by the WHO as
World AIDS Day.

Since the discovery of the first case of AIDS in the
United States in 1981, AIDS as a “life taker” has been
running rampant in the world for nearly 10 years.
Nowadays it remains a constant threat against the lives
of healthy people. Incomplete statistics show that by late



Epidemiology
AIDS

JPRS-TEP-91-002 CONTENTS 28 January 1991
[This EPIDEMIOLOGY report contains only material on AIDS. Other epidemiology topics will be covered in a later
issuc.]
SUB-SAHARAN AFRICA

CAMEROON

New Cases of AIDS Detected /Dakar PANA, 9 Jan 91]
CHAD

Government Conducts AIDS Awareness Poll
{Merci Danyod: Ndjamena REVUE SCIENTIFIQUE DU TCHAD Vol I No If

GHANA
Seventy-cight AIDS Cases in North in Three Years /tccra Domestic Service, 26 Dec 90]. 10
IVORY COAST .
Paper Reports Authorities Playing Down AIDS Threat
[Catherine Morand; Paris AFRICA INTERNATIONAL, Nov 90]... 10
MAURITIUS
Educational AIDS Hot Line Established /Port Louis WEEK-END, 18 Nov 90]... It
SEYCHELLES
Events for World AIDS Day Discussed /Iictoria SEYCHELLES NATION, 30 Nov 90] 12
Women’s Role in Battle Against AIDS /Tictoria SEYCUELL NATION, 9 Dec 90]... 12
SOUTH AFRICA
Black Students Reveal Perceptions of AIDS
[Gaye Davis; Johannesburg THE WEEKLY MAIL, 16-22 Nov 90]. .... 12
Experts: Conflicting Views on AIDS Threat //elen Grange; THE ARGUS, 29 Nov 90] 13
African AIDS Specialists Arrive /Esann van Rensburg: THE ARGUS, 29 Nov 90] 14
HIV Cases Increasing Among TB Patients /Cape Town THE ARGUS, 29 Nov 90) 15
Medical Association Welcomes AIDS Education Program
[Johanneshurg Domestic Service, 20 Dee 90]... 15
Doctor Details Northern Transvaal Donor HIV Figures /Johannesburg § 20 Dee 90] 15
Government Reports 613 AIDS Cases for 1982-90 /Johanneshurg SAP, 7 Jan 91]. 16
“Alarming Growth’ in Pediatric AIDS Cases /Johanneshurg SABC TV 1 Network, 14 Jan 91] 16
SWAZILAND
Medical Official Notes 18 AIDS Deaths Since 1987 /Afhahane Domestic Service, 9 Jan 91]... 16
TANZANIA
Study Says 90 Percent of Citizens Aware of AIDS /Nairohi KNA, 7 Jan 91] 16



30 LATIN AMERICA

30 percent of the children born to HIV-positive women
could be infected before, during, or immediately after
delivery. A total of 10 million children will have been
born with AIDS by the year 2000.

CUBA

Interferon Treatment for AIDS Yields
“Satisfactory” Results

91P40075a Havana GRANMA in Spanish 22 Nov 90
pl

[Text] Clinical studies in which carriers of the AIDS
virus were treated with leucocytic and recombinant
alpha-interferon and transfer factor have yielded satis-
factory results in Cuba.

This treatment which prevents or delays the develop-
ment of AIDS began to be used four years ago on more
than 200 patients at the Santiago de las Vegas sanato-
rium. In cases where the illness did develop, its onset was
reportedly delayed by an average of three years.

According to Pedro Lopez Saura, investigator at the
Center for Biological Studies, these results were pre-
sented at the annual meeting of the International Society
for Interferon Studies held last week in San Francisco,
USA.

The results were well received and were considered
important, according to the scientist. He stressed that
investigations continue.

Specialists from the Santiago de las Vegas sanatorium
and the Advanced Institute of Medical Sciences in
Havana also participated in the studies.

Dr. Rodolfo Rodriguez, national director of Epidemi-
ology of the Ministry of Public Health, said that these
results will allow treatment to be extended to other
patients on the island.

Thus far, 508 persons have been found to be infected
with the AIDS virus; of these, 69 have developed the
illness and 39 have died.

Guantanamo Province Records 17 AIDS Cases in
FL1001195091 Havana Radio Rebelde Network
in Spanish 1255 GMT 10 Jan 91

[Report by Jose Mejias from Guantanamo Province]

[Excerpts] AIDS patients are being treated at the hospital
located in southern Guantanamo City. All this is part of
a national program which seeks for AIDS victims to have
a better relationship with their relatives and friends, to
improve psychotherapy techniques, and to offer special-
ized medical treatment on hospital equipment. [passage
omitted]

JPRS-TEP-91-002
28 January 1991

Guantanamo Province recorded a total of 17 AIDS cases
by the end of 1990. All these patients, who were being
treated in Havana, have now been transferred to the
hospital located in southern Guantanamo City.

Speaking about the work on AIDS control and preven-
tion throughout Guantanamo Province, Dr. Hector
Terry, Cuban public health vice minister, told this radio
station the following:

(Begin Hector Terry recording] Guantanamo has carried
out a good research work. It was the first to carry out
research work in the mountain region. As you know, the
Guantanamo mountain region was one of the first to
benefit from the family doctor program. In keeping with
inherent characteristics of Guantanamo Province, the
family doctor program allowed Guantanamo Province to
carry out a massive research on the new leprosy program.
The blood samples obtained in the leprosy program were
also used [for AIDS tests]. This was done to save
resources because routine procedure calls for the assess-
ment of the situation of the AIDS population. [end
recording]

I reassert that AIDS patients are already being treated at
the hospital which has been set up for this purpose in the
southern Guantanamo City. By the end of 1990, 17
AIDS cases were reported in Guantanamo Province .

Vice Minister Discusses AIDS Program

FL1101192591 Havana Tele Rebelde Network
in Spanish 1347 GMT 11 Jan 91

[“Text” of interview with Dr. Hector Terry, Cuban
public health vice minister, by journalist Rosa Maria
Fernandez; place and date not given—recorded]

[{Excerpt] Fernandez: This is the sixth AIDS treatment
center that has opened in Cuba. In addition to being an
important event, what impact does it have on health
education?

Terry: I would say that the opening of an AIDS hospital
in Guantanamo Province will make the people more
aware [of the issue]. It is our intention to open similar
centers throughout the country so that each province
may treat its own AIDS patients. When treatment cen-
ters are located far away, as has been the case of the units
in Havana, people tend to forget that this is a very real
problem. They forget this problem which, although it
may go unnoticed, still exists. Therefore, I believe that
the opening of an installation of this nature in Guan-
tanamo should make everyone ponder on and be better
acquainted with the issue. This will also allow the people
to periodically carry out activities, similar to those being
currently carried out in other hospitals throughout the
country, in which AIDS patients participate, to halt the
spread of the disease and to make everyone focus on this
issue, particularly youths who are more exposed to
contracting this disease.



JPRS-TEP-91-002
28 January 1991

Government Assistance for Children With AIDS

91WE0030C Moscow PRAVITELSTVENNYY
VESTNIK in Russian No 41, Oct 90 p 7

[Article: “The State Will Help”]

[Text] The fate of people infected with AIDS is doubly
serious—unfortunately the disease is incurable, and vic-
tims often feel themselves to be outcast. A decree of the
USSR Council of Ministers “On Measures to Ensure the
Social Protection of Persons Infected With Human
Immune-Deficiency Virus or of AIDS Patients” should
change the situation.

A decision was made to establish state assistance equal to
the minimum wage for children up to 16 years old
suffering AIDS or HIV infection. The decree also fore-
sees that one of the parents will retain his status of
working continuously in one job if either of them quits
work to care for the youngster. And temporary disability
assistance will be paid until the child reaches 16 years of
age.

The USSR State Committee for Public Education was
instructed to work jointly with the governments of the
union and autonomous republics to organize special
general secondary school and vocational-technical
training programs for children and juveniles in clinics
and rehabilitation centers and at home.

The USSR Ministry of Health was asked to organize
provision of medicines for outpatient care free of charge,
while the governments of the union and autonomous
republics were asked to organize a procedure by which to
compensate for expenses associated with free travel of
patients and carriers to their place of treatment.

Ukrainian AIDS Official Comments

91WE0132D Kiev PRAVDA UKRAINY in Russian
24 Oct 90 p 3

[Interview with Professor Arkadiy Fedorovich Frolov,
chief infectious disease specialist of the UkSSR Ministry
of Health and head of the Ukrainian Center for Control-
ling the Spread of AIDS and the Prevention of AIDS, by
T. Mayboroda: “AIDS—There Are No Grounds for
Optimism”; first paragraph is source introduction]

[Text] “AIDS: There are no grounds for optimism.” So
speaks Professor A. F. Frolov, chief infectious disease
specialist of the UkSSR Ministry of Health and head of
the Ukrainian Center for Controlling the Spread of AIDS
and the Prevention of AIDS.

Mayboroda: Arkadiy Fedorovich, as is known, AIDS has
now become the No. 1 problem for the World Health
Organization (WHO) and the UN, having pushed cancer
and cardiovascular diseases into second place.
According to the forecasts of scientists, the number of
HIV-infected persons in our country might reach 1,625
persons this year, 6,200 in 1991, 24,000 in 1992, and
1-1.5 million persons by the year 2000. By 1996 we

SOVIET UNION 39

might have the same level of morbidity as in the United
States, which the Americans themselves have labelled a
national catastrophy.

One year ago, we published a table indicating the distri-
bution of HIV-positive citizens (carriers) of our republic
by oblast. How do those statistics look today?

Frolov: We probably should look at the overall situation
of how the Ukraine compares with the other union
republics in that regard. It is second after the RSFSR on
this sad list. Right behind us is Belorussia, which has
almost four times fewer HIV-infected persons than we
do.

To date, we have identified a total of 214 HIV-carriers in
the republic, of whom 156 persons are foreign citizens
and 58 are citizens of the USSR. On an oblast-by-oblast
basis, the situation in terms of the number of afflicted
Soviet citizens looks like this, as compared with last year:

Oblast, city 1989 1990
Donets 5 8
Transcarpathian 2 4
Kiev - 1
Crimean 1 2
Lvov : 1
Nikolayev 1 1
Odessa 18 18
Sumy 1 2
Kharkov - -
Kherson 1 1
Cherkassy : 1
Chernigov 1 2
City of Kiev 5 10
City of Sevastopol 1 2

As you can see, there is a definite growth trend. One
should keep in mind that, because of selective health
screening and technical flaws in our diagnostic systems
and equipment, some correction factors are needed for
the data. In the opinion of WHO specialists, for each
identified person (AIDS-afflicted or HIV carrier) there
are from 70 to 100 unidentified carriers, i.e., all of the
cited figures should be multiplied by 100.

Mayboroda: Have there been any changes in terms of risk
groups?

Frolov: Yes. It is not without pleasure that I can report
that the probability of the virus being transported in
blood and its preparations has been sharply reduced and,
one might say, virtually reduced to zero. That has been
facilitated by a considerable amount of organizational
work and the painstaking testing of all donors for AIDS.

But, as before, there is still the high risk of becoming
infected by HIV through promiscuous sexual relations.
The draft legislation on legalizing the status of prosti-
tutes and homosexuals, if adopted, will hardly reduce the
number of patients afflicted with this “plague of the 20th



IJPRS-TEP-91-002
28 January 1991

THAILAND

Estimated 10 Percent of Men in North
HIV-Positive

BK1812025190 Bangkok THE NATION in English
18 Dec 90 p A3

[Article by Ann Danaiya Usher and Martha Ross]

[Text] While only 71 cases of full-blown AIDS have been
detected in Thailand so far, one in ten young northern
tural men in some provinces may already be carrying the
fatal disease, according to an April study conducted by a
participant at yesterday’s AIDS congress.

International health experts at the meeting said such vast
discrepencies show the difference between testing for
AIDS patients, and surveying the incidence of the dis-
ease by mass screening of certain groups.

According to the latest Public Health Ministry statitis-
tics, 24,600 people are known to be infected with the
AIDS virus and 71 full-blown cases of the disease have
been identified.

The scientists warned that deciding on optimal combi-
nations of testing can be tricky, particularly in countries
like Thailand where health resources are limited.

On one hand, knowing only the number of patients can
be misleading because it is an under-estimation that
reflects people who became infected up to ten years ago,
but random testing in the wrong places can create false
confidence and waste scarce funds, they said.

A person can become infected with the AIDS virus, HIV,
and show no symptoms for between one and 12 or more
years.

The World Health Organisation estimates that 50,000 to
100,000 Thais are now infected with the virus, while
Michai Wirawaithaya of the Population and Community
Development Association has put the number at
300,000.

But Thawisak Nopkeson of an army hospital in Phitsan-
ulok province thinks these figures could be too low.

He told THE NATION yesterday that in the lower
Northern region 0.5 to one percent of 20 to 24 year-old
male villagers tested are infected with HIV, while three
percent of the same group in “touristic” Northern prov-
inces were carrying the disease.

This marks a doubling of a similar group of men from
the general population tested by Dr. Wichan Witayasai
of the Chiang Mai University Hospital, a year earlier in
the same area.

American epidemiologist Bruce Weniger, who is cur-
rently advising the Thai health ministry, pointed out that
in the United States there are currently about 140,000
AIDS patients.

EAST ASIA 25

But extrapolations of sample testing suggests that one
out of 75 men and one of 700 women of the general
American population are infected with HIV, he said.

The Thai health ministry was praised by several partic-
ipants for three national sentinel surveys that have been
carried out since June 1989, which give a clear picture of
how the disease is spreading.

A Malaysian participant commented that in his country
the public dervies comfort from knowing that all intra-
venous drug users and prisoners are tested.

But Dr. Roger Detels of the University of California, Los
Angeles School of Public Health said this could be
creating “false comfort”

He said that with such directed testing they could be
looking in the wrong place, and giving people the mis-
guided impression that only those groups are affected by
AIDS.

Comparing with Thailand, he noted that the disease has
spread initially from drug users to prostitutes, and then
to their male clients.

Weniger referred to these developments as the first three
“waves” of the disease. The final two, he said, involve
the transmission of the AIDS virus from men to their
wives, and from mothers to their unborn children.

AIDS Prevalence Among Bangkok Drug Addicts
Viewed

BK2012070590 Bangkok THE NATION in English
20 Dec 90 p A2

[Article by Ann Danaiya Usher]

[Text] A combination of free bleach and condom distri-
bution, substitution drugs and counselling may have
stabilized AIDS prevalence among Bangkok’s drug
addicts at around 40 percent, though the disease is
spreading to their lovers and new-born.

While the prevalence has levelled off, the total number of
AIDS- infected addicts is growing steadily as those being
screened in clinics are a constantly changing group.

International key-note speakers during the third day of
the Chulabhorn Research Institute’s AIDS conference
yesterday said the pattern of AIDS spread among Thai
intravenous drug-users is similar to other countries—a
sudden rapid increase followed by a plateau.

Dr. Wichai Posayachinda director of Chulalongkon Uni-
versity’s Institute’ of Health Research said that in
Bangkok this sudden jump occurred over a six to eight
month period during 1988.

Surveys show that in January 1988, 16 percent of addicts
whose blood was screened were infected with AIDS,
while six months later the number had escalated to 42
percent. The figure seems to have remained stable since
then,



SJPRS-TEP-91-002
28 January 1991

2) “Where should AIDS victims be cared for?”

An average of 74 percent of respondents believe that the
hospital is the best place for an AIDS victim to be cared
for, but 14 percent think that AIDS victims must be
placed in isolation and 10 percent think that they should
be eliminated. Isolation is more often recommended by
those who have received a university education. Thus,
nearly one-fourth of respondents express a clear rejec-
tion of AIDS victims.

Among those who feel that AIDS victims should be sent
to the hospital, it is likely that a certain percentage of

SUB-SAHARAN AFRICA 9

them consider this a way of isolating the ailing, meaning
both a form of protection and separation from the
general population.

Those who state that the ailing should be treated in their
homes (1 percent) think that the infected individual is
the victim of his own “misbehavior” and that the illness
is contagious and fatal.

The 5 or 6 percent who chose other responses believe for
the most part that it is futile to care for a person suffering
from an incurable disease.

Isolation and the elimination of AIDS victims are con-
sidered options even by those who have a good know!l-
edge of the disease. (See Table 17.)

Table 17. Isolation and Elimination Responses as a Function of AIDS Awareness

(in percentages)
AIDS Awareness
Index
Response 0 1 2 3 45 6-7
Isolation 9 13 10 18 18 20
Elimination 9 7 10 13 7 14

3) Responsibility for Care.

The vast majority of respondents believe that the state
and/or the family should take responsibility in caring for
those afflicted with AIDS. Nearly half of the respondents
think that the family is responsible for the care of a
family member ill with AIDS, thus expressing support.

4) Should the state adopt measures?

More than 90 percent of those questioned believe that
the state should take measures against the AIDS epi-
demic.

A surprising 28 percent of women and 20 percent of men
believe that it is not only desirable but possible to
vaccinate the population against AIDS. It is likely that
the AIDS test is being mistaken for a vaccine or perhaps
this reflects a desire for future medical protection of the
population.

Eighteen percent of women and 26 percent of men would
like to see the population tested in order to identify those
who are HIV-positive.

Fighting prostitution (by banning it) is specifically city
by 14 and 16 percent of respondents. Eleven and 14
percent are in favor of informing and educating the
public.

The elimination of AIDS cases is proposed as a measure
by 3 percent of respondents and the use of condoms is
proposed by | percent. Some respondents cited a need to
monitor travellers and to close borders.

Generally speaking, the proportion of respondents rec-
ommending isolation and elimination as measures to
adopt with respect to infected and ailing persons rises
with the AIDS awareness index.

Conclusion

Prior to World AIDS Day on 1 December 1988, 53
percent of Ndjamena residents and 26 percent of Abeche
residents knew of the existence of AIDS. After World
AIDS Day, 82 percent of Moundou residents, 73 percent
of Bongor residents, and 78 percent of Sarh residents had
become aware of the existence of AIDS.

This demonstrates the impact of a two-week information
campaign on radio and television for which songs,
posters, and special events were produced. This kind of
operation therefore merits being repeated.

Persons with little or no schooling, the majority of them
women and Muslims, are less knowledgeable of AIDS as
they rely most often on oral communication in conver-
sations and discussions with their relatives, friends, and
neighbors for information about AIDS.

There is a need to step up efforts to make AIDS the
subject of private and public discussions while ensuring
the accuracy of information communicated through such
discussions. An educational slogan on this theme might
be “Let’s get informed and inform those around us about
AIDS.” Sensitizing a population that is difficult to reach
through the media requires closer association and greater
collaboration with the religious communities, non-
governmental organizations, associations, private com-
panies, etc...

More than three-fourths of the urban population having
heard of AIDS cited sexual activity as a way in which the
disease is transmitted; 70 percent cited transmission by
mother to child.

Erroneous beliefs about the transmission of AIDS are at
the root of the fear manifest among numerous Chadians



12 SUB-SAHARAN AFRICA

protect himself or herself. And there is no shame in a
boy, or even a girl, using a condom, which is still a sure
protection against AIDS, in that case,” said the president
of “Friendship Aid.”

Moreover, Pastor White regrets that the members of his
association, who are all volunteers, cannot, for practical
reasons, devote more time to the advice program. None-
theless, that possibility will be examined shortly.

SEYCHELLES

Events for World AIDS Day Discussed

91WE0144 Victoria SEYCHELLES NATION
in English 30 Nov 90 pp 1, 2

[Text] Film shows at the Pirates Arms will highlight the
activities organised in Seychelles to mark World AIDS
Day tomorrow, | December.

Pirates Arms bar and restaurant is one of the most
popular meeting place in Victoria. The shows, to be
projected from mid-morning to afternoon, is part of the
campaign to sensitise the public on the dangers of AIDS
(anti-immune deficiency syndrome).

Leaflets with information on World AIDS Day 1990,
whose theme is “Women and AIDS,” will also be dis-
tributed during the day.

As is the custom each year, a message from Health
Minister Ralph Adam will be broadcast on RTS televi-
sion and radio on Friday evening and Saturday morning,
respectively, and published in Saturday’s SEYCHELLES
WEEKEND NATION.

The Seychelles Nurses Association (NARS) will on
Friday be holding an “educational meeting” on this
year’s World AIDS Day theme at the Schoo! of Health
Studies, Hermitage, as from 1:30 pm.

The chairperson of the information, education and com-
munication sub- committee of the National Task Force
for AIDS (NTFA), Mrs Enid Savy, explained that the
theme should not be interpreted as women being respon-
sible for transmitting the killer disease but rather as
women and their role as educators.

All letters going through Seychelles Post Office on Sat-
urday will be stamped with logo “AIDS, Make it Your
Concern.”

Women’s Role in Battle Against AIDS

91WE0152B Victoria SEYCHELLES NATION
in English 9 Dec 90 pp 1, 2

[Excerpt] Seychelles Health Minister Ralph Adam
repeated yesterday, on World AIDS Day, he had no
doubt that the deadly virus was already in Seychelles and
causing a lot of damage.

JPRS-TEP-91-002
28 January 1991

The Minister again called on the population, particularly
the women, to be responsible in their sexual behaviour.

The theme of this year’s AIDS day is “Women and
AIDS” but Mr. Adam clarified that this did not mean
that the virus was transmitted solely by women, but it
was an occasion to reflect on the sufferings the disease
could bring to them.

“Women can help control AIDS. They have a great role
to play,” Minister Adam said in a nationwide message.

“Don’t let people lie to you that AIDS does not exist in
Seychelles, Do not believe them,” he told the Seychellois
women.

He said the women had a responsibility to protect
themselves, their husbands or partners and naturally
their children.

The risk of Seychellois women catching AIDS is big,
Minister Adam said, adding that this could be the result
of their own behaviour and the conduct of their partners.

“Who can assure you that the men around you do not
already carry the disease?” the Minister asked.

According to the minister the rate of incidence of sexu-
ally transmitted diseases gives a good indication on how
esily AIDS could spread in Seychelles. He said many
women in Seychelles had gonohrrea because they had
relations with several partners.

“One or two consider themselves prostitutes, but others
do not. We also know that women have contracted
gonohrrea not because they have extra relations but
because their partners are involved in other affairs,” the
Minister said. [passage omitted]

SOUTH AFRICA

Black Students Reveal Perceptions of AIDS

91WEO0129A Johannesburg THE WEEKLY MAIL
in English 16-22 Nov 90 p 41

[Article by Gaye Davis]

[Text] Black school pupils are eager to learn about AIDS,
but their perceptions of the disease are more than slightly
skewed.

Black South African high-school pupils do not know
enough about AIDS to prevent them from infection,
although many are sexually active.

They have not yet learnt basic information about AIDS
transmission and prevention strategies, nor even the
simple message that for AIDS, there is no cure.

This is the blunt message conveyed by a landmark survey
of township school pupils’ knowledge, attitudes and
belief about AIDS, carried out recently by researchers in
the Medical Research Council’s Center for Epidemiolog-
ical Research in Southern Africa.