IJPRS-TEP-91-007
8 April 1991

(adnexitis, highmoritis etc.), appearance of recurring
suppurative skin ailments, furunculosis, herpes rashes,
oral and vaginal aphthae, and angular khiyelity [transla-
tion unknown] in the course of this time. Four patients
suffered shingles, which occurred twice in one patient. A
number of patients noted feverish states dissimilar from
ordinary colds, not accompanied by catarrhal'manifes-
tations, and disappearing on their own after 1-2 weeks.
Seven patients noted insignificant weight loss.

The most frequent finding of objective examinations was
enlargement of lymph nodes by more than | cm. Lymph
nodes were usually of moderately dense consistency,
they were free of surrounding tissue, and they were not
painful. Usually, groups of two or three lymph nodes
were enlarged. Enlargement of axillary, posterior and
anterior cervical and inguinal lymph nodes was regis-
tered most frequently, while subclavian and ulnar nodes
were detected more rarely. Although lymph node
enlargement was detected in 83 percent of the patients,
only half of them could be said to have generalized
persistent lymphadenopathy corresponding to the. cri-
teria of the American Centers for Disease Control
(enlargement of more than two lymph nodes in more
than two groups, not counting inguinal, and for not less
than 3 months). It should be noted that the expressive-
ness of lymphadenopathy varied significantly in patients
over a long period of observation.

The manifestation of HIV infection second in frequency
following lymphadenopathy was changes on the part of
the skin and mucous membranes, revealed in 20 percent
of the subjects. These were usually fungal afflictions of
the nails and skin, seborrheic dermatitis, suppurative
rashes on the skin, herpes simplex of the lips, oral
aphthae, and infections in the corners of the mouth.
Molluscum contagiosum, herpes rashes on sex organs,
hairy leukoplakia of the tongue, aphthous stomatitis,
furunculosis, focal hair loss, chancriform pyoderma and
pyoderma vegetans, shingles and Kaposi’s sarcoma were
encountered more rarely.

Recurrent respiratory infections, often complicated by
pneumonia, were frequently noted among patients with
skin afflictions in the course of the observations. Roent-
genography usually revealed focal and, more rarely,
infiltrative and intestinal changes, and in two cases the
pleura was drawn into the inflammatory process. Most
cases of pneumonia yielded to ordinary antibiotic
therapy, indicating that these cases were banal in nature.

Pathology on the part of organs of the gastrointestinal
tract and kidneys was encountered significantly more
rarely among adult’ patients. Gross neurological symp-
toms were revealed as a rule only in patients in the
terminal stage, and as a manifestation of developing
encephalitis and meningoencephalitis. In this case the
weak expressiveness of such symptoms did not usually
correspond to the pronounced afflictions of the brain
and its membranes which were revealed by autopsy. In

SOVIET UNION 17

this connection we reached the conclusion that diag-
nostic lumbar puncture is required on such patients,
even in the absence of meningeal symptoms.

Patients admitted for observation may be divided in
general into two groups. One of them contained patients
with lymphadenopathy and “without symptoms,” while
the other contained persons who had clinical manifesta-
tions of decompensated immune deficiency (secondary
afflictions of the skin, mucous membranes and internal
organs) in addition to (or in the absence of) lymphade-
nopathy. The first group was larger, containing 72 per-
cent of all patients. Despite the absence of clinical
manifestations of immune deficiency, a large number of
their immunological indicators were altered. Lymphocy-
tosis was noted in 16 percent of the patients, and
lymphopenia was noted in 18 percent. Almost two-thirds
of the patients had a reduced blood concentration of
T4-lymphocyte-hélpers and almost half. exhibited a
decrease in the helper-suppressor coefficient below 1.
Elevation of IgG was revealed in 74 percent of the
patients, and elevation of IgA was noted in 35 percent.
Dermal allergic reactivity was reduced in most patients.
These changes were even more pronounced in the second
group of patients.

Dynamic observation over a period of 1.5 years revealed
a decrease in the total quantity of lymphocytes in blood
in 59 percent of the patients, a decrease in the absolute
number of T-helpers in 68 percent, and a decrease in the
helper/suppressor coefficient in 71 percent. Symptoms
of secondary afflictions developed in 21 percent of
patients of the first group.

Of interest is the fact that certain aggravating factors
were implicated in each case of a most unfavorable
course of disease in patients.

Classification

We developed a clinical classification of the stages of
HIV infection on the basis of the work experience
accumulated in our clinic and in connection with the
need for maintaining a common approach to evaluating
the state of a patient with this disease.

The clinical classification of HIV infection.
1. The incubation stage.

2. The stage of primary manifestations:

a. acute infection,

b. symptomless infection,

c. generalized lymphadenopathy.

3. The stage of secondary illness:

a. less than 10 percent weight loss, fungal, viral and
bacterial afflictions of the skin and mucous membranes,
shingles, recurrent pharyngitis, sinusitis,



IPRS-TEP-91-007
8 April 1991

Moscow (plus four from Bulgaria) and 30 from Alma-
Ata. The plan is simple—to start a chain reaction of
similar seminars and conferences in the republics,
regions, and cities, in which the participants of this
meeting will become the principal transmitters of infor-
mation. And we must give the organizers of the seminar
their due: in Moscow, the Central Instructor Training
Office of Secondary Medical Education under the USSR
Ministry of Health, and the foreign public health depart-
ment of the Central Order of Lenin Institute for the
Advanced Training of Physicians, and in Alma-Ata the
center for primary medical care collaborating with
WHO. The well organized lesson schedule, the intensity
of the lessons, the diversity of the forms of training and
the synchronous translations, as well as the conditions
themselves and the atmosphere of the working confer-
ence, created a business-like situation.

But perhaps the seminar owes its success to a greater
degree to associates of the WHO Secretariat and its
temporary advisors attending the seminar as guests.
They were accurate and competent, and what is espe-
cially important, they were extremely well-wishing, and
tolerant of different opinions. The smiles and humor did
nothing to weaken the impression of the seriousness and
vital importance of the topic under discussion. On the
contrary they only intensified the effect. Because their
number was so small, I can name each of them. I already
mentioned Sandra Anderson, who invariably came to
the rescue of the “team” when the participants asked
especially difficult questions. There was Elizabeth Stussi,
the director of WHO's regional program for nursing
affairs from Copenhagen, who listened to the opinions of
Soviet associates with such great attention and concen-
tration that it seemed as if she had come to do the
learning rather than the teaching. Elizabeth is a nurse
with a higher nursing education. The three textbooks I
mentioned earlier were introduced to the students by
WHO advisors Ursa Andersen (Copenhagen), Tomas
Sni (London) and Agneta Lorensen (Copenhagen). Their
communications were informative and lively. One of the
students described her impressions as follows: “Never
did I think that AIDS and everything associated with it
could be discussed so easily, naturally and personally.”
Yelena Yegorenkova, an associate of WHO's regional
bureau, assisted the specialists.

The calmness and merit with which such a menacing and
terrifying subject was discussed at the seminar were
instructive. Nurses, who represent the largest detach-
ment of public health workers, are called upon to assim-
ilate not only the knowledge of AIDS, but also the spirit
of charity and tolerance, to provide psychological sup-
port to HIV carriers and AIDS patients, so that they
would not feel themselves to be alone and forgotten in
the face of the terrible disease. In the absence of vaccines
and effective resources for treating AIDS, the training of
personnel acquires key significance.

But in the meantime the level of nurse training is
especially low, noted Mikhail Narkevich, chief of the
Main Epidemiological Administration of the USSR

SOVIET UNION i"

Ministry of Health. It’s no secret to anyone that our
country was the first to discover the internal hospital
pathway of infection transmission. Blind destiny
selected Elista, Rostov, Volgograd and Stavropol for
this, but other cities might have been involved just as
well. As the speakers noted, the problem is not limited
just to a shortage of disposable syringes and systems. We
are often let down by the scarcity of elementary consci-
entiousness, of strict order. The recommendations con-
tained in interviews of WHO associates in the video tape
“The World Unites for the Fight Against AIDS,” and in
the training materials presuppose discipline, conscien-
tiousness and responsibility to the patient as indispen-
sible prerequisites.

A survey conducted in one of the meetings produced
extremely interesting results. Students were asked if any
of them had dealt with HIV-positive patients. Eight out
of 25 did (four in a hospital and as many under outpa-
tient conditions). How many had seen AIDS patients?
Only three, and only one at home. Specialists admit that
the figures are typical of a country with a relatively low
incidence of HIV infection. This is why theoretical
knowledge dominates over practical experience.

But even here, special cases do arise. WHO associates
participating in a roundtable discussion were asked
about the probability of a mother being infected by a
nursing child. The question stumped them at first—
another danger is usually encountered, where a mother
infected with the virus can infect her child. Our dramatic
experience of infection of children in hospitals (it was
repeated in transfusions of microdoses of blood in
Romania) perplexed the notable specialists.

But let’s not be pessimistic. As of today there are 559
persons infected with HIV in the country. Scientists who
made their prognosis 2 years ago predicted a different
figure—!,625. Moreover the analysis was duplicated by
two different groups of specialists. But the figure never
became a reality—To our good fortune. Possibly because
AIDS statistics are no longer a closed subject. Maybe
because the country is uniting its efforts to fight this
terrible disease. One thought was expressed several times
at the WHO seminar: Together, we are strong against any
misfortune.

Decentralization of AIDS Control Criticized

91WE0243C Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 6

[Letter to the Editor by A. Oshayev, I. Labazanov, T.
K.-S. Inarkiyeva, N. Aleroyeva, T. Bartuli, A.
Mukhtarova, M. Kukuliyeva and L. Muzayeva: “Was All
of That Work Really for Nothing?”]

[Text] In September of this year the RSFSR Ministry of
Health published Order No 167 transferring staff epide-
miologists and their assistants and a number of functions
having to do with the AIDS problem from the AIDS
prevention and control centers to oblast, kray and



JPRS-TEP-91-007
8 April 1991

Karateyeva: We have developed a special program for
educating the population of our country. It pursues
humane goals—giving each person knowledge about
AIDS, providing warnings of the impending disaster,
and explaining the preventive measures. A person pos-
sessing such information is entitled to choose what is
most acceptable to herself—to subject herself to the risk
of infection or not, to protect herself, her child and those
close to her from the possibility of falling ill, or not doing
so. Owing to the program, people will receive much of
the information they need, for example about the fact
that each person has the right to sterile instruments,
personal protective resources and disposable syringes in
the hospital. All of this is very important for preventive
purposes, but sometimes the people don’t know these
simple truths, and they themselves allow medical
workers to be careless.

At the same time we believe that the medical workers
themselves, almost 60 percent of whom are women,
require special protection today. They have now become
one of the groups at risk of AIDS infection, and they are
the least protected category. Given our disorganization
and the impossibility of adequately sterilizing instru-
ments, they can be infected very simply, but no one
essentially bears any responsibility for this. This is why it
is important to make medical personnel aware that they
have a primary right to protection. And we are obligated
to provide this protection to them.

We have all kinds of funds, associations and public
organizations providing the necessary support. The pro-
gram which we are trying to implement was approved by
the USSR Ministry of Health, and it is financed by the
state, which makes our work easier in many ways, and
helps us to implement the program not in words, and not
on the basis of enthusiasm alone, but realistically.

Zaytseva: What do you feel are the most important
aspects of this program ini the present stage?

Karateyeva: Educating all categories of the population in
matters of general and sexual culture. Its principles must
be mastered first of all by those who teach people and the
growing generation. These include educators, physicians
and cultural officials. We ourselves often find that many
representatives of these professional groups are unable to
transmit The Word, the knowledge, to those whom they
teach and introduce to life, while in their deeds and
actions they serve as antimodels. We need to not only
increase their responsibility but also make each one of
them aware of their role in propaganda and in education,
especially among the young. In order that their words
would not be inconsistent with their deeds, we have
much to do. We need to create a foundation, a basis for
practical work. The consultation departments of poly-
clinics, the “Family and Marriage” counseling offices
and other subdivisions, in which people could receive
good advice, knowledge and the necessary assistance
without embarrassment, without fear, could be of assis-
tance. There is a great deal of fear of AIDS today, and the
psychological climate needs to be improved.

SOVIET UNION 21

Zaytseva: What has your center already done specifically
to help propagandists locally?

Karateyeva: We are conducting all kinds of functions
among the young—meetings, shows, evening entertain-
ments. We have published several video clips on the
subject “Young People and AIDS,” which clearly
describe the disease agents, the pathways of their trans-

ission and the methods of infection. We are now
working on another video on a woman’s faithfulness.
This is a very urgent topic today, inasmuch as the weaker
sex may become a rather dependable barrier against the
spread of the “terrible plague.” Moreover we have pub-
lished many pamphlets, booklets and posters. The
“Advice to Travelers” will soon be coming out. I think
that this will help those who are indiscriminate in their
relations during short vacations. Regional AIDS preven-
tion and control centers have been established locally.

+ They have taken on the task of diagnosing, treating and

preventing the disease, they are coordinating this work,
and they are providing specific assistance within their
territories. Our health centers—the former palaces of
public health education—are also contributing to this
effort to the extent possible (it is just recently that they
have begun performing their new functions, after all).
Many of them possess the necessary materials and video
cassettes.

Zaytseva: Natalya Borisovna, can you say that you are
satisfied with the results of the activity, and that you now
possess all of the possibilities for effective propaganda?

Karateyeva: Of course not. We still have many unsolved
problems, many mistakes. We are only at the beginning
of our road, you see, and we are seeking and discovering
our possibilities. And as you know, the possibilities of
public health are presently limited. Everyone needs
money now, and we don’t have all that much. This is why
we are fighting to see that the ministries, departments
and enterprises would view assistance to all who are
fighting against AIDS as a social contribution, as their
duty to the society and its citizens.

And recently. we have been purchasing disposable
syringes, and receiving them as donations. But how long
can this go on? Quite understandably, under competitive
conditions it is by far simpler to offer a gift than to share
the secret of one’s production operation. I feel that we
need to purchase the technology for producing those
same syringes, and start their production quickly. Let’s
manufacture good condoms ourselves, rather than
importing them from abroad. If a woman is ready to
protect herself, we are obligated to place reliable
weapons in her hands. And can’t our government pro-
vide a tax exemption to organizations that make a
contribution to the effort to prevent AIDS? Imagine how
substantial their contribution could become.

We dream about building boarding hotels for patients
suffering this terrible disease, of finding ways to assist



2 SUB-SAHARAN AFRICA

Prostitutes constitute the primary source of infection for
the spread of the HIV-virus. Over 50 percent of the
prostitutes in the cities are HIV-positive. Their clients
seldom use condoms.

The hardest hit are those male workers who live without
their families in so-called male hostels, as well as the
soldiers of the armies of the various countries.

All countries have their own AIDS-programs but they are
ineffective, lack resources and are doomed to failure.

Medicine men have a considerable negative influence.
They are trusted by the uneducated.

Half of all newborns are considered to be HIV-positive.

Those religious organizations that do not accept family
planning contribute, by their dogmatic attitude, to the
spread of the HIV-virus.

The report maintains that the statistics situation in
South Africa is confused and controversial. There is
agreement, however, that—so far—the situation is not as
serious as in the countries surrounding South Africa. Still
it is serious.

The percentage of persons testing HIV-positive in 1990
varied, according to these various sources, from 0.9
percent of male blood donors to 7 percent of those who
went to a clinic for venereal diseases in Johannesburg.

According to law, all foreign mine workers are now being
tested. Miners who test HIV-positive become an extra
large economic problem, since the mining industry (gold,
diamonds, platinum, coal, etc.) still constitutes the
driving force in South Africa’s economy.

A Dramatic AIDS Calculation for Zimbabwe
Suppositions:

1. The number of inhabitants in December 1990 is 8 million.

2. The net population increase (born minus dead), excl. dead from
AIDS, is 3 percent annually.

3. The number of HIV-positive in December 1990 is 20 percent (of
total population).

4. Another 5 percentage points of HIV-positive will be added each
year for four more years.

5. Of those who test HIV-positive, all will die as follows: 10 percent
the first year, 10 percent the second, and so on until 100 percent are
dead after 10 years.

Given these suppositions, the population figure develops as follows (all
figures in units of 1,000).

December Population Next year's Minus
population
increase (3
percent)
1990 8,000 + 240 :
1991 8,240 + 247 ~ 160
1992 8,327 + 250 = 200
1993 8,337 + 251 = 240

JPRS-TEP-91-007

8 April 1991
1994 8,388 + 252 = 280
1995 8,360 +251 = 320
1996 8,291 + 249 - 320
1997 8,220 + 247 = 320
1998 8,147 + 244 = 320
1999 8,071 + 242 = 320
2000 7,993 + 240 - 320
2001 7,913 + 237 - 160
2002 7,990 ete...
ANGOLA

Blood Treatment Lab Installed in Cunene
Province

91P40190A Luanda JORNAL DE ANGOLA
in Portuguese 20 Feb 91 p'3

[Excerpt] A blood treatment and analysis laboratory was
set up two months ago in Cunene Province. The instal-
lation and equipment was financed by the European
Economic Community. The amount of financing was
not divulged.

The laboratory is being used at the Lubango central
hospital where blood transfusion tests are being carried
out, according to the director of the EEC program, Dr.
Adriana Prokopepp.

Three laboratories will be set up in the country this
year—in Namibe, Bie, and Moxico—under the frame-
work of the Angolan anti-AIDS campaign. They are
patterned after other projects being carried out in
Malanje, Huambo, Cabinda, Zaire, and Benguela Prov-
inces under the auspices of Doctors Without Borders.
Alongside these projects, a specialized team of Doctors
Without Borders is carrying out public health assistance
programs and furnishing basic health care to hospital
patients. Adriana Prokopepp revealed that, nevertheless,
as of 30 September 1990, 191 AIDS cases had been
detected in Angola. These include men, women, and
children, as well as diagnosed and notified cases. It is
assumed that many more cases exist, unknown to local
health authorities.

The doctor added that, in most cases, people infected
with AIDS are unaware that they are carrying the dis-
ease, and when it is in the first phase they seem healthy,
work normally, and go on to transmit the virus to other
people. However, it is recommended that discrimination
not be practiced against AIDS patients since they need
special treatment from doctors and their assistants.
[passage omitted]



18 SOVIET UNION

b. over 10 percent weight loss, unexplainable diarrhea or
fever lasting more than 1 month, hairy leukoplakia,
pulmonary tuberculosis, recurrent or persistent viral,
bacterial, fungal and protozoic afflictions of internal
Organs, recurrent or disseminated shingles, localized
Kaposi’s sarcoma;

¢. generalized bacterial, viral, fungal, protozoic and
Parasitic diseases, pneumocytic pneumonia, esophageal
candidosis, nonpulmonary tuberculosis, atypical myco-
bacteriosis, cachexia, disseminated Kaposi’s sarcoma,
and afflictions of the central nervous system of various
etiology.

4. The terminal stage.

Incubation stage—from the moment of infection to the
appearance of a body reaction taking the form of clinical
manifestations of “acute infection” and/or antibody
production. Duration is usually from 3 weeks to 3
months, but it may stretch out to 1 year as well. Diag-
nosis is possible in this stage on the basis of epidemio-
logical analysis and detection of viruses or their frag-
ments. The stage of primary manifestations—existing
clinical and laboratory symptoms are associated exclu-
sively with HIV infection itself, and not with secondary
diseases developing on the background of immune defi-
ciency. Acute infection is noted in approximately 70
percent of infected patients in the first 3 months after
infection, and it may be accompanied by phenomena of
pharyngitis, fever and lymphadenopathy, enlargement of
the liver and spleen, bowel movement disorders, nonper-
sistent and diverse skin rashes, and aseptic meningitis.
The symptoms usually disappear after 2-3 weeks. Natu-
rally, disease is not usually diagnosed in this stage; all the
more so because HIV antibodies may not appear until
the second or third week after the beginning of clinical
manifestations. Our observations showed that such
patients are usually diagnosed as having infectious
mononucleosis, adenoviral infection, measles, rubella,
viral infections of the ears and nose, and so on.

Patient Management Tactics

Establishing a diagnosis of HIV infection is an extremely
serious step. The diagnosis may be made on the basis of
an analysis of epidemiological, clinical and laboratory
data. It is impermissible to make the diagnosis only on
the basis of the results of tests run on blood sent to the
laboratory. We have observed several cases of mistaken
diagnosis resulting from technical errors made in ship-
ping blood to be tested.

After the diagnosis of HIV infection is confirmed, the
patient is given an examination with the purpose of
establishing the stage of disease and determining the
approaches to its subsequent management. Patients in
the stage of primary manifestations are released in the
absence of laboratory signs of immune deficiency, with
the recommendation that they return for a repeat exam-
ination in 6 months. When the concentration of T4-
lymphocytes is low, a repeat examination 3 months later
is recommended. We believe that a persistent decline in

JPRS-TEP-91-007
8 April 1991

indicators of immune status or presence of secondary
illnesses is an indication for prescribing specific azidot-
hymidine treatment.

In our opinion the notion that therapeutic assistance to
patients with HIV infection is totally unpromising is
mistaken. Therapy can be expected to have an impact if
it is carried out by well trained specialists who are well
equipped with diagnostic and therapeutic resources, and
if it follows a consistent plan. In no cases should HIV-
infected patients be viewed as objects of experimenta-
tion with doubtful and new therapeutic drugs. ~

The main rules are: creating a favorable psychological
situation for the patient; promptly diagnosing and
treating background illnesses; maintaining careful outpa-
tient observation and promptly initiating specific
therapy and treatment of opportunistic diseases.

On the whole, a study of the clinical pattern of HIV-
infected Soviet citizens showed that it cannot be reduced
to just AIDS, since AIDS patients are only an insignifi-
cant fraction of infected individuals, many of whom
require medical care in earlier stages.

Well organized medical care of HIV-infected patients,
maintained under medical secrecy, is the most important
factor of epidemic control measures. If the HIV-infected
patient is not sure that he will receive assistance and that
his diagnosis would be kept secret, he will try to receive
treatment without informing doctors about his illness.
Uncautious actions by medical personnel in relation to
HIV-infected patients may provoke suicide attempts and
asocial behavior.

Dnepropetrovsk Official Estimates 30-40 Cities at
is

91WE0243G Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 pp 10-11

[Article by special correspondent Marina Kushnareva:
“At the Outskirts of the City”]

[Text] According to official statistics there are no HIV-
infected persons or AIDS patients in Dnepropetrovsk. It
is true, however, that 80 persons out of 30,000 tested in
the last 3 years were initially suspected of having a
positive reaction.

And although the suspicion was not confirmed by sub-
sequent tests, Dnepropetrovsk AIDS Prevention and
Control Center director B. M. Estrin is certain that
unrevealed HIV-infected persons are present in the city.
In general, he feels that there are some 30-40 so-called
cities at risk in the country, in which unidentified virus
carriers do not even suspect their misfortune. In his
opinion Dnepropetrovsk is one such potential city at
tisk.

On what grounds are the suppositions of this epidemiol-
ogist with 30 years of experience based?



24 WEST EUROPE

FRANCE

AIDS Patients Eligible for Life Insurance

91WE0241A Paris LES ECHOS in French
1 Mar 91 p 12

[Article by Jean-Michel Bezat: “AIDS: Companies Agree
To Insure Seropositive Individuals”"—first paragraph is
LES ECHOS introduction]

[Text] Under pressure from the government, insurance
companies are deciding that the 100,000 to 200,000
French who are seropositive can be insured—provided
that they pay an additional premium, and that contract
lengths and guaranteed benefits are capped.

The Jolivet report entitled “Insurance and AIDS” will
not remain a dead letter. Yesterday, two weeks after [it]
was turned into the government, Pierre Beregovoy and
Claude Evin called on insurance companies to imple-
ment the chief recommendations of the task force (phy-
sicians, insurers, high-ranking bureaucrats) led by Benoit
Jolivet, the former insurance director in the Ministry of
the Economy.

In a joint communique, the ministers of finance and
social affairs have announced that insurers will soon
bring out life insurance contracts for persons infected
with the AIDS virus. The move is an industry first, since
insurance companies had thus far considered seroposi-
tive individuals—numbering from 100,000 to 200,000,
according to the most serious estimates—an “uninsur-
able risk.” On the other hand, those ill with AIDS! will
continue to be excluded from insurance coverage.

The Jolivet report, which was approved by the insurance
representatives, stipulates that the contracts will be
drawn up “according to the framework established for
so-called ‘aggravated’ risks.” Indeed, insurance compa-
nies are establishing three conditions: the duration of the
contract must not exceed 10 years, the amount of the
guaranteed benefit cannot exceed | million French
francs [Fr], and an additional premium will be charged
to those insured under these plans. In addition, compa-
nies reserve the right to “regularly update the sur-
charges” in accordance with changes in epidemiological
data (morbidity, mortality, new treatments.)

This means that, to purchase housing, a seropositive
individual would borrow at an 18 to 19 percent rate
(compared to about 10 percent for a borrower in good
health) because of the additional cost of his insurance.
Pierre Beregovoy and Claude Evin believe that the
“current additional premium is too high” and would like
to see “progress made.”

In addition, the task force reached a decision on the
guidelines for drafting questionnaires sent to contract
applicants, and its members agreed that “no question
concerning the intimate nature of [the applicant’s} pri-
vate life, and in particular sexual life, can be included in

JPRS-TEP-91-007
8 April 1991

the questionnaires.” The government adopted that rec-
ommendation as well. But it went further by announcing
that it was preparing a bill designed to sanction compa-
nies that disregarded that rule.

On the other hand, the government did not follow to the
letter the Jolivet report, which favored authorizing com-
panies to run serological tests before signing any insur-
ance contract. Certainly those tests to detect AIDS will
be authorized, but for a guaranteed benefit exceeding
Frt million. Below that amount, they will be “absolutely
banned,” the government communique specifies.

Finally, as the Jolivet report recommended, the govern-
ment has decided to create a “monitoring group”
(administration, insurers, reinsurers, physicians, patient
aid associations) that will regularly provide the profes-
sion with the latest data on AIDS (number of people
infected, therapeutic progress). Individuals believing
themselves to have been discriminated against by their
insurer can refer their case to this group.

The FFSA, GEMA, and Groupama have in practice
subscribed to all these reforms. But their decision is less
an expression of philanthropic generosity than of an
analysis of the evolution of AIDS prevalence, morbidity,
and mortality. Indeed, the Jolivet report emphasizes that
“50 percent of those infected develop AIDS in the 10
years following their infection,” but that “a significant
and growing proportion of them will live over 10 years,
sometimes 15 or 20 years, before reaching the AIDS
stage.”

As for the life expectancy of patients (two years on the
average), it has climbed steadily since 1981 thanks to
improved treatment. With 10 years of experience behind
them, the task force’s experts thus concluded that the
situation of seropositive individuals was gradually
approaching that of persons afflicted with other serious
pathologies.

Footnotes

1. Experts estimate that France will have 21,000 AIDS
cases (cumulative total since the start of the epidemic) at
the end of 1991.

GREECE

No Behavioral Changes in AIDS Carriers

91WE0221A Athens ELEVTHEROTIPIA
in Greek 28 Jan 91 p 22

[Excerpt] A great percentage of persons suffering from
AIDS, even after having been diagnosed as having the
disease, refuse to change their sexual behavior thus
putting in serious danger not only themselves but their
sexual partners.

This was shown in a survey whose results were presented
at the Second All-Greek Congress on AIDS and Sexually
Transmitted Diseases.



20 SOVIET UNION

But while the equipment issue is beginning to be
resolved to some extent, things are still unclear about
establishing an independent AIDS Prevention and Con-
trol Center.

Where is space on which to build such a center to be
found in built-up Dnepropetrovsk?

If you seek, it turns out, you may find. As an example we
saw several new modern buildings in the city on the
verge of accepting tenants, but not medical personnel,
unfortunately. Near the fabulous new building of the
Palace of Political Education, erection of yet another
building for precisely the same needs is reaching its
conclusion. And the future building of the Kirovskiy
Rayon Party Committee, photographed by the MED-
ITSINSKAYA GAZETA photographer, was quite unex-
pectedly reclassified as a frozen facility.

When the “real estate war” began, several public health
institutions suffering poor conditions immediately
began making claims on this building.

B. M. Estrin also decided to make a bid for this building.
He addressed his arguments on why the city’s AIDS
Prevention and Control Center should occupy this
building, in writing, to V. V. Tolyan, the city executive
committee’s deputy chairman.

However, according to City Public Health Department
Deputy Director L. N. Reshetnyakh the dispute is not
currently resolvable. The building had been mothballed,
and its future ownership cannot be determined at the
moment.

Thus it turns out that we can’t hope for complete
independence for Dnepropetrovsk’s AIDS Control
Center in the immediate future.

As I left Estrin (whose office, by the way, is located in the
city public health department temporarily), he received a
phone call from his associate in Krivoy Rog. A virus
carrier—a school-age child—was discovered there.

It is only 800 kilometers by rail from Krivoy Rog to
Dnepropetrovsk...

Photographs [not reproduced]: Presence of HIV in blood
is determined with an AKITs-01 immunoenzymatic col-
orimetric analyzer; the city’s AIDS Prevention and Con-
trol Center could be housed in this building.

Anti-AIDS Campaign for Youth

91WE0243H Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 10

[Interview with Candidate of Medical Sciences Natalya
Borisovna Karatayeva, All-Union Scientific Research
Center for Preventive Medicine of the USSR Ministry of
Health, by V. Zaytseva: “In the Beginning Was the
Word...”]

JPRS-TEP-91-007
8 April 1991

[Text] So it is written in the ancient text. In fact, it is
through the word that we perceive 60 percent of all
information. And consider how many times each of us
has. been persuaded how much more effectively treat-
ment proceeds when the doctor explains the cause of
your illness simply and comprehensibly during your
visit, and provides good advice on prevention.

Never has medical propaganda been so active, so persis-
tent, as in the fight against AIDS. It doesn’t even make
sense to ask the question ““Why?”—everyone under-
stands that the disease is deadly and incurable, and
therefore especially dangerous. The sole possibility of
protecting ourselves from it is active prevention, which
involves propaganda as well.

Today’s interview is with Candidate of Medical Sciences
Natalya Borisovna Karatayeva, director of the labora-
tory of child and adolescent hygienic education of the
All-Union Scientific Research Center for Preventive
Medicine of the USSR Ministry of Health.

Zaytseva: Natalya Borisovna, why have women become
an object of special attention this year? Does solution of
such a complex problem really depend upon the ordinary
female worker?

Karateyeva: The answer to this question is both simple
and complex. A woman plays a dual role: as a person
exposed to an enormous danger of AIDS infection, and
concurrently as a force capable of protecting herself and
others from the menacing misfortune. In our society, the
role of women is continually growing, and their social
functions are widening. Today they are not only house-
wives but also workers. More and more of our women
are executives, politicians and active participants of
public organizations and mass movements. Their
strength in society is enormous. They have shown that
they can effectively influence adoption of important
government decisions, and shape public opinion. By
attracting their attention to the problem, we in a sense
ensure a certain amount of success in the associated
propaganda effort.

No less serious is the fact that the incidence of AIDS is

‘growing among women. By compelling them to think

about the problem, we can achieve more, and fight the
evil more successfully. Who but a woman can under-
stand and recognize more deeply what the disease holds
for her, her progeny and the entire future?

The World Health Organization requested that we make
the channels of the mass media, the church and munic-
ipal bodies available for education purposes. By working
among women and with the help of women, WHO
believes, we can force them to realize that the future of
the world and the planet is now in their hands.

Zaytseva: Considering that you play a role in propaganda
work, please tell us how your work is organized, what
plans and programs for fighting AIDS the country might
possess, and how specifically they are being imple-
mented.



JPRS-TEP-91-007
8 April 1991

transmission of HIV through homosexual and hetero-
sexual contacts from men to women and from women to
men, transmission by the transfusion of the blood of an
infected donor, in parenteral interventions carried out
with instruments contaminated by the blood of HIV-
infected persons, from mother to nursing child, and for
the first time in the world, from a child to its mother
were discovered through epidemiological investigation.

A graphical example of the effectiveness of combining
epidemiological surveillance with epidemiological inves-
tigation is the discovery and confinement of the hospital
focus in the Kalmyk ASSR. The epidemiological inves-
tigation we undertook in relation to two cases of HIV
infection among patients revealed in the city of Elista
and sent to our clinic for examination and treatment
made it possible to reveal the hospital focus of HIV
infection existing there due to violation of the rules of
sterilizing medical instruments. Elimination of the flaws
in the epidemiological conditions of the hospitals
averted further progress of the outbreak. The epidemio-
logical investigation conducted in connection with this
case made it possible to reveal hospital foci in children’s
hospitals of Volgograd, Rostov, Rostov Oblast and
Stavropol.

Anonymous voluntary testing for HIV antibodies com-
bined with anonymous survey, begun in 1987, proved
itself not only as an effective method of revealing the
sources of HIV infection, but also as a method of
assessing the activity of transmission factors and the
influence of social conditions on the spread of HIV. The
rate at which cases of HIV infection were revealed by
anonymous testing was rather high (1 case out of 500-
1,000 subjects). It was with the help of seropositive
persons revealed by anonymous testing that their sexual
partners were brought into the epidemiological investi-
gation, and that the fact of penetration of HIV into the
milieu of homosexual men in the USSR was established
in particular.

Epidemiological investigation of each revealed case of
HIV infection made it possible to also establish the
significance of certain HIV transmission factors oper-
ating in the USSR. The absence of cases of infection
among 118,000 having only various sorts of personal or
work-related contacts with HIV-infected persons once
again confirmed the wrongfulness of suggestions that
HIV might be transmitted through fecal-oral contact, by
airborne droplets or through casual contact.

It was established that in 1988-1989 transmission of
infection in the USSR occurred most often through
parenteral interventions in medical hospitals, carried out
with instruments that had not been sterilized. This was
responsible for 56.9 percent of the cases. However, all of
these cases were associated primarily with one major
outbreak in the city of Elista, and with formation of
secondary foci in the cities of Volgograd, Rostov, Sha-
khty and Stavropol. Infection of children usually
occurred as a result of reuse of an unsterilized syringe to
administer medicines into subclavian’ veins through a

SOVIET UNION 15

catheter, but it also sometimes occurred with intramus-
cular injections using the same syringe but a different
needle. A survey of medical workers of several cities,
including Moscow, revealed that this is a rather wide-
spread practice, and it is not viewed by them as one
creating the threat of infection of a patient. But special
attention should be turned to this fact, including in the
training of medical personnel.

The focus of HIV infection resulting from the use of
contaminated instruments existed in Elista hospitals for
8 months. The virus was transmitted from child to child,
and when the children were moved, it was carried from
hospital to hospital, including to other cities. Formation
of secondary foci there once again confirmed that what
happened in Elista is not unique, and that obviously the
situation may recur in any corner of the country. It
should be noted that besides violations of. epidemiolog-
ical conditions, the excessive parenteral load imposed on
patients, typical of the USSR, also had an effect on the
outbreaks.

While hospital outbreaks may be responsible for sharp
rises in morbidity in certain periods of time, the con-
stancy of the virus’s circulation and continual growth of
morbidity are the result primarily of sexual transmis-
sion—30.8 percent of the cases. In this case only 40.4
percent of the cases of sexual transmission were associ-
ated with homosexual behavior, which makes HIV infec-
tions in the USSR significantly different from the USA
and Western Europe, where homosexual transmission
dominates, and on the other hand from countries of
Africa and the Caribbean Basin, where transmission of
HIV through the heterosexual population is responsible
for the absolute majority of cases.

This research showed that the spread of HIV infection in
the USSR may be maintained simply through hetero-
sexual transmission of thé virus, and although it is less
intensive than transmission among homosexual men, it
does elicit greater concern, since the disease is spread
through the general population, and it disperses within
it, creating the false impression that morbidity in the
heterosexual part of the population does not play a
leading role in the epidemiological process. Moreover
fighting HIV infection in the heterosexual milieu, which
has not recognized itself as being at risk of infection, is
especially difficult.

Discovery of cases of the infection’s transmission from a
mother toa nursing child at an unusually high frequency,
and for the first time from the child to the mother,
elicited a broad international response from among
specialists, since it allowed the hypothesis that these
factors are more significant than was thought previously,
and it made it necessary to recommend cessation of
breast feeding as an epidemic control measure when HIV
infection is present iti the child and the mother.

The process of the illness’s spread to previously unaf-
fected territory may be described generally as follows:
First the virus is imported into the néw territory by



IJPRS-TEP-91-007

8 April 1991 CHINA 7

He noted that the medium-term plan for prevention and
control of AIDS, formulated by the ministry and the
World Health Organization last year, has brought
China’s efforts for AIDS control to a new stage.

He said he hoped the international organizations con-
cerned would give more support to the plan.

The conference will end tomorrow.



4 SUB-SAHARAN AFRICA

The AIDS campaign started in Natal with seminars by
the ANC’s health secretariat and will later be “taken into
every house” by the organisation’s branches.

Said Mr. Piliso: “The ANC sees the AIDS issue as
something that needs urgent attention. The education of
the masses is of vital importance.”

Mr. Piliso said the ANC was concerned about the spread
of AIDS and the complacency among South Africans—
particularly the youth.

He said it was alarming that many South Africans
continued to ignore the killer epidemic.

“This is a deadly virus that cannot be ignored. We feel
we have to educate our people about the dangers of the
disease,” Mr. Piliso said.

The ANC’s AIDS campaign comes at a time when the
heterosexual spread of AIDS has reached alarming pro-
portions.

According to the National Health and Population Devel-
opment Department, 446,000 South Africans are
expected to be HIV positive by the end of this year.

By late last year, the number of reported AIDS cases had
increased to 554. The number of deaths was 250—a 45
percent fatality rate.

Of the total number of cases, 422 were men and most
cases (198) occurred in the 20-39 age group.

The department said the virus was taking a heavy toll on
the most economically active age group.

According to the World Health Organisation, about 45
percent of South Africa’s workforce could be HIV-
positive if nothing is done to prevent the spread of the
disease.

At least one HIV-infected baby is born in South Africa
every day.

At Soweto’s Baragwanath Hospital alone, 300 HIV
infected mothers gave birth last year—a three-fold
increase on 1989.

WHO estimates that by 1992 more than four million
children will have been born to infected mothers and an
additional 10-million children will be orphaned as their
parents die of the disease.

The organisation estimates that between eight and 10
million people world-wide are already HIV positive and
about 1.2 million men, women and children have full-
blown AIDS.

Data Shows 693 Recorded AIDS Cases in Country

MB1803122591 Johannesburg THE STAR in English
18 Mar 91 p 6

[Report by Carina la Grange: “AIDS Escalating in SA
[South Africa] as 48 New Cases Noted”]

JPRS-TEP-91-007
8 April 1991

{Text] From the beginning of the year to March 8, 48
new cases of AIDS were reported in South Africa,
according to the Department of National Health and
Population Development, which released the data on
Friday [15 Mar].

This brings the cumulative total of recorded AIDS cases
in South Africa to 693. To date there have been 282
deaths—41 percent of the total recorded cases.

Some 91 of the cases were those of children, the result of
mother-to-child transmission. This year, nine new pae-

" diatric cases were recorded. The information supplied by

the department is based on anonymous data from the SA
{South African] Institute for Medical Research.

The latest figures were released simultaneously at a press
conference together with the findings of the first survey
of a proposed annual survey of HIV incidence among
pregnant women attending ante-natal clinics.

The escalation of AIDS in South Africa can be seen from
the increase in the totals over the following number of
years: 24 cases in 1986, 39 in 1987, 87 in 1988, 172 in
1989 and 291 in 1990.

The department says the fatality rate of 41 percent is
lower than expected and that this was probably the result
of under-reporting.

The department says that from 1982, when the first cases
were reported, to 1989, homosexual/bisexual transmis-
sion accounted for 63 percent of AIDS cases and hetero-
sexual and paediatric cases 28 percent.

The increase in the incidence of heterosexual transmis-
sion is illustrated by the increase in cases in the black
population (where homosexual cases are minimal) from
nil to 333.

The total among whites is now 326, of which 285 cases
are through homosexual transmission. Homosexual/
bisexual cases peaked at 83 in 1989, dropping to 66 in
1990.

In 1990 heterosexual and paediatric transmission was
predominant. The department says the newly released
statistics point to the known fact that women are more at
risk of HIV infection than men.

The department says that in the light of these findings,
women should be regarded as an important group for
educational intervention.

“Women should be encouraged to improve their condi-
tions and status in the light of the fact that they usually
have less power than men, which makes it impossible for
them to insist on safe sex,” it says.



SJPRS-TEP-91-007
8 April 1991

BOTSWANA

District Medical Official Notes AIDS Cases,
Deaths

MB1703055291 Gaborone Domestic Service in English
1910 GMT 16 Mar 91

[Text] The Selebi Phikwe senior district medical officer,
Dr. Ali Singhano, says there are about 236 HIV positive
cases in Selebi Phikwe and Bubirwa area.

Speaking in/an interview with BOPA recently, Dr. Sing-
hano said about 15 victims have already died as a result
of the disease, and noted that nine cases have again been
confirmed.

Due to the seriousness of the disease, a seminar has been
organized for 21 March at Bosele Hotel. The seminar is
expected to be opened by the director of health services.

GHANA

AIDS Cases Increase by 80 Percent in 1990

AB1303102491 Paris AFP in French 1801 GMT
12 Mar 91

[Text] Accra, 12 Mar (AFP)—AIDS cases in Ghana
increased by 80 percent in one year, according to statis-
tics published today by the National AIDS Control
Program. According to the program, 2,237 persons who
had developed AIDS had been detected by the end of
December 1990 as against 1,240 in the previous year.
The statistics also indicated 4,352 seropositive cases by
the end of 1990.

SOUTH AFRICA

Minister Discusses AIDS, HIV Infection
Statistics

MB1503180491 Johannesburg SAPA in English
1717 GMT 15 Mar 91

[Text] Pretoria Mar 15 SAPA—Some 0.76 percent of
women attending antenatal clinics countrywide had been
found to be HIV positive by the end of last year, the
minister of national health and of health services, Dr.
Rina Venter, said in Pretoria on Friday.

Speaking at a news conference where copies of the “First
National HIV Survey of Women Attending Antenatal
Clinics” were released, she said the highest prevalence of
HIV-infection was shown to pertain to Natal/kwaZulu,
with an infection rate of 1.61 percent.

This was followed by the Orange Free State (0.58 per-
cent), Transvaal (0:53 percent), and the Cape (0.16
percent).

Some’ 0.83 percent of pregnant women tested in the
Johannesburg:area were found to be positive, and 0.70
percent of those tested in Durban.

SUB-SAHARAN AFRICA 3

The rate for Cape Town was only 0.02 percent.

A racial break-down showed that the prevalence rate
among black women was 0.89 percent, coloureds 0.16
percent, and whites 0.06 percent.

Too few Asian women were tested to supply an accept-
able confidence rate in the survey.

The survey said the HIV prevalence rate of 0.76 percent
in pregnant women compared favourably with results
from “some” countries.

These countries were mainly African. Zaire had a rate of
5.8 percent, while Uganda had more than 20 percent.

On the other hand, a study of newborns in London
showed that 0.024 percent were HIV positive.

A total of 14,376 samples, from anonymous blood spec-
imens, had been used in the survey.

Dr. Venter said it was regrettable that there were already
some 100,000 people in South Africa carrying the HIV
virus.

“I appeal to all departments, organisations and commu-
nities to do everything possible to contain this pan-
demic.”

There had been 683 reported AIDS patients, of whom
282 had died, in South Africa to date.

According to statistics released at the news conference,
women are more at risk of the human immunodeficiency
virus infection than men. It was also a matter of great
concern that HIV was present in some pregnant women
in every community.

ANC Launches AIDS Awareness, Other
Campaigns

MB1703150491 Johannesburg SUNDAY TIMES
in English 17 Mar 91 p 5

[Report by Sipho Ngcobo: “ANC Spearheads Big AIDS
Action Drive”]

[Text] The ANC [African National Congress] has
launched a mass house-to-house campaign to educate
people about the dangers of AIDS.

Campaign committee head Mzwai Piliso said this week
that the AIDS education campaign was part of a number
of mass campaigns launched by the ANC.

Others included the education crisis campaign, the cam-
paign for the release of political prisoners and a signature
campaign.

The signature campaign kicks off this week with coun-
trywide newspaper advertisements which have cost the
organisation an estimated R[rand]120,000.

Its aim is to mobilise the masses to campaign for a
constituent assembly and an interim government.



16 SOVIET UNION

foreigners or by persons infected abroad. Its initial
spread is most probable in population groups most
intensively exposed to HIV transmission factors and
Possessing contacts with. foreigners, after which it
spreads rather quickly through these groups as a whole.
From them, the virus penetrates into the population at
large, where it gradually begins spreading through het-
erosexual transmission. Gradually the number. of
infected women and of children infected by them grows.
If epidemic control conditions are not maintained in
medical institutions, the danger of hospital outbreaks
develops as the number of infection sources increases.

The epidemiological situation in the USSR in the period
from 1985 to 1989 may be evaluated as a time of
Penetration of the disease from abroad. By 1990, HIV
was already starting to spread among the USSR’s perma-
nent male homosexual population; individual epidemic
chains of heterosexual transmission of HIV were noted,
as were hospital outbreaks associated with violation of
epidemic control measures by hospitals. Presence of
high-risk population groups and of active transmission
factors allows us to suppose that the epidemic will
develop further in the USSR. HIV will probably strike
the male homosexual part of the USSR population in the
next few years, and it will spread relatively slowly in the
heterosexual population. The probability of the disease’s
parenteral spread will depend entirely on the effective-
ness with which epidemic control measures are observed
in the country’s medical institutions. There are doubts in
the effectiveness of the presently widespread practice of
mandatory HIV testing of persons entering the hospital.
On one hand this expensive measure does not produce
results (for example due to presence of a certain number
of seronegative carriers of the virus, for example in the
first few months after infection and in the terminal stage,
because too much time lapses from the moment blood is
sampled for testing to the time results are obtained, and
due to procedural errors by personnel), while on the
other hand it creates the illusion of safety among medical
Personnel, causing them to make even grosser violations
of epidemic control measures.

Thus it may be asserted that the system of epidemiolog-
ical surveillance of HIV infection in the USSR, which is
oriented on mandatory examination of certain groups of
people, is sufficiently effective and informative when it
is supplemented by epidemiological investigation of
individual cases of HIV infection and with voluntary
anonymous testing of the population for HIV antibodies.
Considering that in the 8 months that the hospital focus
existed in the Kalmyk ASSR 86 persons were infected,
its discovery and elimination averted a minimum of 128
new cases of HIV infection annually (this is not counting
the obvious tendency for further dissemination from the
focus).

We began our clinical study of HIV infection in 1985 at
the time that the first cases of illness were revealed
among foreigners in the country, and among Soviet
citizens beginning in 1987. In contrast to foreign
researchers, who initially studied states developing in the

IJPRS-TEP-91-007
8 April 1991

terminal stage of illness and known as the “acquired
immune deficiency syndrome” (AIDS), we supposed
tight from the start that the disease should be studied
and the patient should be kept under observation from
when it is first revealed. The methods described above
for revealing infected individuals through epidemiolog-
ical surveillance and investigation and through anony-
mous testing made it possible to reveal the earliest stages
of disease.

A total of 683 patients with HIV infection were under
our observation, including 276 foreigners and 407 Soviet
citizens, of whom 209 were children, with the over-
whelming majority of them from hospital foci of HIV
infection. Clinical work with patients was carried out by
associates of the Central Scientific Research Institute of
Epidemiology of the USSR Ministry of Health, Clinical
Infection Hospital No 2 of the city of Moscow, and the
department of infectious diseases of the Moscow Med-
ical Stomatological Institute imeni N. A. Semashko.

Diagnosis

The diagnosis of HIV infection was made on the basis of
data from epidemiological histories, clinical manifesta-
tions of disease, and detection of specific antibodies in
blood, and in a number of cases acquisition of cultures of
the virus as well. HIV infection was revealed in the
overwhelming majority of foreigners as a result of
planned examinations, and only among four of them on
the basis of clinical indications. Soviet citizens were
revealed primarily in the course of epidemiological
investigation of cases of HIV infection, and more rarely
as patients of venerological hospitals, on the basis of
clinical indications and in the course of mandatory
testing of specific population groups. Men made up 62.5
percent of adult Soviet citizens. The ages of the patients
varied within 16 and 64 years; however, these were
young people for the most part. Thus, 90 percent of the
men and 95 percent of the women were less than 40 years
old. This is no surprise, if we consider that the sexual
pathway of the infection’s transmission is dominant. The
young age of the patients also predetermined absence of
serious concomitant diseases among their overwhelming
majority. Most often, HIV infection was combined with
syphilis (in 27 people), which is also easily explainable
from the standpoint of a common pathway of transmis-
sion of both infections.

Clinical Pattern

Most of those who were infected at the time of their
admission to our institute for observation felt them-
selves to be healthy, and they voiced no complaints
about their health. Patients and persons revealed on the
basis of clinical indications were an exception. However,
when interviewed in depth, up to 15 percent of the
patients stated some worsening of their health over the
previous 1-2 years.

This was expressed as heightened tiring, night sweats,
more frequent aggravations of chronic foci of infection



6 CHINA

Foreign Grants, Higher Spending to Fight AIDS

HK1603024491 Beijing CHINA DAILY in English
16 Mar 91 p1

[By staff reporter Zhu Baoxia]

[Text] China can expect an $800,000 grant from foreign
countries and international organizations this year to
help fight AIDS, according to the World Health Organi-
zation (WHO).

Meanwhile, the Chinese Government plans to contribute
$1 million for the medium-term (1990-92) AIDS control
programme.

The money will be used to carry out such activities as
mass publicity and education, surveillance and testing,
in an effort to help curb the spread of the fatal disease.

In addition to importing some necessary medical and
testing facilities, according to Dr. P.R. Kean, WHO
representative to China, WHO plans to invite some
foreign experts to help train Chinese staff with the latest
world experiences and technology, and to help plan
epidemic surveillance and mass publicity.

According to Qi Xiaoqiu, official in charge of the epi-
demic control department under the Ministry of Public
Health, every year the State spends over 10 million yuan
($2 million) for the control of various epidemic diseases,
including AIDS.

Last year, the central government allocated an additional
1.5 million yuan for AIDS-control activities.

Besides, all local governments involved have also
increased funding for this work.

Commentary on Need To Control AIDS

HK1603030491 Beijing CHINA DAILY in English
16 Mar 91 p 4

[CHINA DAILY commentary: “AIDS Control”]

[Text] No country can be immune to the threat of AIDS.
China has already reported five deaths and 493 HIV
positive cases, doubling those of one year ago.

Recognizing the global impact of the deadly disease, the
Chinese government is wasting no time in mapping out
the nation’s prevention and surveillance efforts. Hosting
the two-day international conference on AIDS preven-
tion and control, that ended yesterday in Beijing, in
conjunction with the World Health Organization and the
United Nations Development Programme will undoubt-
edly strengthen and help the implementation of the
Chinese AIDS control plan.

Any effective programme of AIDS prevention must
include two important aspects, namely education and
surveillance.

JPRS-TEP-91-007
8 April 1991

Chinese health authorities have done some work in
surveillance and research into various AIDS therapies.
Blood serum tests have been done on about 500,000
individuals and more than 50 special laboratories have
been set up, 10 of them supported by the World Health
Organization programmes.

China has also not neglected to search for possible
medical treatment and prevention of the spread of AIDS
through traditional herbal medicine. While no major
breakthroughs have been reported so far, continued
research in this area may provide a viable alternative.

Since most of the HIV positive cases reported so far have
been the result of infection through drug abuse in
southwet China, a vigorous fight must be waged there
against illicit drug trafficking and drug abuse.

From a long-term point of view, however, there is also a
need to conduct a sustained educational campaign to
spread a healthy and scientific attitude among the people
on the whole subject of sex and social responsibility.
Young people, in particular, must be warned against the
danger of promiscuous sex.

Minister Urges AIDS Prevention, Control

OW 1403184791 Beijing XINHUA in English
1532 GMT 14 Mar 91

[Text] Beijing, March 14 (XINHUA)—Deputy Minister
of Public Health He Jiesheng pointed out here today that
prevention and control of the AIDS epidemic have
become one of the priorities in China’s health sector in
recent years, due to increased international contacts.

Addressing a conference on the prevention and control
of AIDS in China, she also said that because of lack of
experience in AIDS prevention and control, the predict-
able AIDS incidence will increase in three to five years in
China unless strong measures are adopted.

According to incomplete statistics from China’s Ministry
of Public Health, from 1985 to the end of 1990 some
480,000 of the high-risk population in China were exam-
ined by AIDS sero-screening, among which 493 HIV-
Positive cases were detected. Five of them were AIDS
cases, and 83 HIV-infected cases out 493 were for-
eigners. Two of the five AIDS cases were mainland
citizens.

The deputy minister stressed in her speech that in AIDS
control the key point is to enhance education and pub-
licity and maintain strict control.

Dai Zhicheng, director of the ministry’s Department of
Epidemic Prevention, said at the meeting that the
increasing number of sex transmitted disease (STD)
cases in recent years in the country are the background to
the AIDS epidemic. Consequently, the control of STD is
one of the key steps in the prevention of transmission of
AIDS, he added.



2 SOVIET UNION

them materially, and of protecting the confused, unfor-
tunate people from the inadequate reaction of their
fellow citizens.

Each person should understand that the more patients
there are, the more danger there will be for each one of
us. Alas, healthy people think that none of this has
anything to do with them, that AIDS is someone else’s
problem. Remember that this is a profound misconcep-
tion. We have plenty of plans, and enough energy; now if
we could just make it all work.

Six-Hour Workday for AIDS Care Personnel

91WE02431 Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 11

[Article by A. Porkhachev, director, labor protection
division of the All-Union Federation of Public Health
Workers’ Trade Unions: “To Those Involved With
AIDS”

[Text] “Please tell me how long a workday is established
for medical personnel involved in the diagnosis and
support of AIDS patients.”—V. Ibrailov.

The USSR State Committee for Labor and Social Prob-
lems and the AUCCTU have adopted the proposal of the
USSR Ministry of Health and the central committee of
the medical workers’ trade union on establishing a
reduced, six-hour workday for physicians and middle-
and junior-grade medical personnel of therapeutic-
preventive institutions, and for scientific associates, lab-
oratory assistants and other associates of scientific
research institutes diagnosing and supporting AIDS
patients and HIV carriers, as well as for workers of
enterprises working with AIDS virus and with HIV-
infected material, as being employees of infection insti-
tutions. (See Letter No 1967-NG, 18 June 1990, of the
USSR State Committee for Labor and Social Problems
and the AUCCTU).

Pokroyskiy on AIDS Measures

91WE0244A Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 pp 1,6

[Excerpts from article by USSR Academy of Medical
Sciences Academician V. Pokrovskiy, president, USSR
Academy of Medical Sciences: “The Prognosis Depends
on You As Well”)

[Excerpt] [Passage omitted] The USSR is in a special
position in relation to the AIDS problem. Our country
was given a rare, lucky chance, because of the later
beginning of the epidemic, to utilize world experience in
fighting the “plague of the 20th century.” I often
asserted in certain mass media that the USSR is doing
nothing, or almost nothing, to prevent HIV infection,
and heart-wrenching appeals for assistance are being
voiced.

SJPRS-TEP-91-007
8 April 1991

Oftentimes readers are deliberately misinformed. I don’t
at all believe that the needed attention is being devoted
to fighting AIDS in our country. The fight against AIDS
is not so much a matter of public health as it is a priority
objective of the entire society, the entire state. However,
for the sake of objectivity I must say that the USSR is
doing a significant amount of work in regard to a number
of facets of the problem, and significant results have
been obtained.

I should emphasize first of all that the country has
organized sufficiently effective epidemiological surveil-
lance over HIV infection. The USSR is the world’s first
country to begin registering not just patients with the
acquired immune deficiency syndrome (AIDS)—the
final stage of a long-lasting illness elicited by human
immune deficiency virus, but all persons infected with
this virus. Information on all revealed carriers is trans-
mitted to a special AIDS prevention and treatment
laboratory, where it is fed into a computer, and where
possible relationships between infected persons and the
dynamics of the infection’s spread are analyzed. This is
precisely the means by which an internal hospital focus
of HIV infection was revealed in Elista. Contrary to the
opinion of incompetent persons troubled by the absence
of epidemiological surveillance in our country, this fact
attests to its effectiveness. It is terrible to even imagine
what the population of the Kalmyk ASSR might be
suffering now, had this intensive pathway of the virus’s
transmission by medical personnel not been blocked.

High quality test systems for diagnosis were developed
and provided to the country in sufficient quantities
within a relatively short time. Over 80 million blood
samples from the population have been tested. It was
more difficult to organize industrial production of the
test systems, but ultimately, industry managed to deal
with this problem as well. HIV strains have been isolated
and are now being cultivated. The properties of the virus
and the mechanisms of its interrelationships with the
cells and body of the host are being studied aggressively,
but clearly inadequately.

From today’s standpoint, the previously developed state
program for AIDS control was organized on a traditional
basis, and in view of this it did not concentrate the
necessary resources and rights of the program’s leader-
ship upon solution of the problem, and many of its
subdivisions were not mandatory. Many of the decisions
that were previously adopted have not yet been per-
fected. For example the extreme lack of work space
makes it impossible to start up the full volume of
scientific research under conditions of guaranteed safety.
Nota single laboratory in the istry of Health and the
USSR Academy of Medical Sciences fully satifies safety
requirements, and not a single government decree
requiring the construction of such laboratories has been
fulfilled. The miserly financial support enjoyed by the
Program today will cost billions in losses a few years
from now. We will hope that the state program that is
currently being developed by a government commission
that was finally created under the chairmanship of



JPRS-TEP-9 1-007
8 APRIL 1991

Forel ign
Broadcast
Information
Service

ANNIVERSARY
1941 - 1991

Epidemiology —

AIDS

19980506 108

\DEIC QUALITY INGFEUEED &

REPRODUCED BY

U.S. DEPARTMENT OF COMMERCE
NATIONAL TECHNICAL INFORMATION SERVICE

SPRINGFIELD, VA. 22161
TION STA Esai

B ed for ‘public release;
~ Distibation Unlimited.



SJPRS-TEP-91-007
8 April 1991

COSTA RICA
oer 235 AIDS Cases Registered as of March

PA3003171291 San Jose LA REPUBLICA in Spanish
21 Mar 91 p 6a

[From the “Information Summary” column]

[Text] Of the 235 cases of people infected by the AIDS
virus as of March 1991, a great majority are men; 215
men have been inflicted as opposed to 20 women.

These figures reflect the total number of accumulated
cases since records of the disease began to be made in
1981,

To date, the virus has killed 137 people. The number of
dead has increased considerably over the years; in 1981
[number illegible] dead were registered and already by
1990, 43 people were registered to have died from the
disease.

LATIN AMERICA 9

As for the risk groups, homosexuals are the most
affected, with 135 cases. They are followed, in
descending order, by bisexuals with 32, hemophiliacs 26,
unknown situations 8, blood transfusions 7, perinatal
cases 7, intravenous drug users 7, and heterosexuals 3.
[figures as published]

PERU

AIDS Program Director Reports Statistics
PY 1603031091 Lima EXPRESO in Spanish 10 Mar 91
pal

{Summary] Juana Antigon, director of the Special Pro-
gram for AIDS Control [Programa Especial de Control
del SIDA], has reported that approximately 40,000
people are carrying the AIDS virus and that 386 people
have displayed symptoms of the disease. Antigon also
reported that the proportion of infected people is two
men to every woman.



8 EAST ASIA

‘AN

Japanese Researchers Compose AIDS Restrainer

OW 1403153891 Tokyo KYODO in English 1334 GMT
14 Mar 91

[Text] Kyoto, March 14 KYODO—A group of Japanese
researchers has succeeded in composing a compound
that restrains the growth of the AIDS virus, the
researchers said on Thursday.

The joint research team from Kyoto Pharmaceutical
University and Nippon Mining Co’s Biological Research
Institute was able to compose a peptide, an amino acid
compound, which inhibits the function of the protease.

Protease, or proteinase, is an enzyme in the AIDS virus
that dissolves protein. The AIDS virus proliferates by
combining with protease.

The researchers said they will announce the results of
their studies at a pharmaceutical meeting opening in
Tokyo on March 28.

The development of the compound, which seems to
produce few side effects, is expected to make a signifi-
cant contribution to the search for a cure for the disease,
they said.

_JPRS-TEP-91-007
"8 April 1991

Yoshiaki Kiso, professor of the university, said he
expects to achieve encouraging results in clinical trials.

LAOS

One HIV-Positive Case Discovered in Vientiane

BK1303105391 Vientiane KPL in English 0918 GMT
13 Mar 91

[Text] Vientiane, March 13 (KPL)—Dr. Sithat Insisian-
gmai, of the National Committee against AIDS, recently
reported that so far there has been one case of HIV
positive in Vientiane Prefecture out of 2,000 persons
who voluntarily asked for blood tests.

Dr. Sithat said that the person concerned may have got it
through sexual relations. He further added that the
committee will continue giving blood screening tests to
the blood bank, TB [tuberculosis] patients, and other
high risk groups. So doing, he said, a clearer picture of
AIDS in the country may be attained.

So far the National Committee against AIDS has given a
series of lectures on AIDS to public servants in Vientiane
Prefecture.

Lectures supported by audio-visual AIDS were given to
high schools and vocational schools, some factories.
Personnel of hotels, restaurants also attended the semi-
nars.



JPRS-TEP-91-007
8 April 1991

ANC Spokesman Discusses AIDS Awareness
Program

MB2003164691 Johannesburg International Service
in English 1115 GMT 20 Mar 91

[Interview with Mzwai Piliso of the African National
Congress AIDS Action Committee by reporter Cathy
Fitch on the “Africa South” program; date, place not
given—recorded]

[Text] South Africa could learn a lot about AIDS aware-
ness programs from countries such as Zambia, Tanzania,
and Zimbabwe. This is the opinion of the head of the
recently formed African National Congress AIDS Action
Committee, Mr. Mzwai Piliso, who has just returned to
this country. [Begin recording]

Piliso: 1 found it impossible that a country like South
Africa which is so complex in its relations is not going
into the roots of this thing. When you have to recognize
immigrant labor that comes into South Africa and goes
out of South Africa, when you recognize labor from the
different regions of the country, we believe that this is a
subject that ought to be tackled in a more serious manner
than it has been. The campaign committee is working
together with the health department of the African
National Congress and other interested organs of the
movement. We are trying to reach to other organizations
in the country generally to see if we can find possibilities
of getting into as many homes as possible for them to
understand the dangers of AIDS. In particular, we are
interested in educating the youth who we believe has not
been able to understand the gravity of the problem.

Fitch: There was an awful lot of superstition at one time
about the fact that the wearing of the condom was seen as
a ploy to try and make the African people not have so
many children which would be a source of wealth in their
old age. How prevalent do you think that superstition is
now?

Piliso: I don’t know if it is necessarily a superstition. You
know, when we are in a most difficult political era people
are going to give interpretations to a number of things.
This is why we are saying that we need to go right
through the lowest levels of the organization of the
African National Congress to try and meet the people to
explain to them, to try and educate them on this ques-
tion, even to dispel the suspicions that this is a ploy to
limit the birth rate of the African masses.

SUB-SAHARAN AFRICA 5

Fitch: So will you be actually drawing on some of your
expertise from the other countries to put into the ANC
AIDS awareness campaign?

Piliso: This is what we are trying to do. Our medical
department has some experience in the countries where
we have been before we came back home, Zambia, in
particular, Tanzania, Zimbabwe.

Fitch: There was a move a while ago for returning exiles
to be subject to an HIV test. What do you think about
that?

Piliso: I have the impression the main reason for this was
to stigmatize the exiles, to pretend that the disease does
not exist in South Africa and therefore it would be
brought in by exiles. I am sympathetic with the people
that would like to limit the occurrence but to say that
every exile must be examined for HIV when it’s as
prevalent as it is, | am not sympathetic to that. What I
would like to see is for us trying to educate exiles and
people in South Africa generally as to the dangers of the
disease, as to how we can limit it, to how perhaps, the
people can change their sex behavior.

Fi

Would your campaign be restricted only to
African National Congress supporters or would you try
and help to educate the other people as well?

Piliso: The Africa National Congress tries to be as broad
as it possibly can. The campaign is directed to all people,
all South Africans. [End recording]

ZAMBIA

Prime Minister Notes More Than 4,000 AIDS
Cases In Country

MB1803154491 Johannesburg International Service
in English 1500 GMT 18 Mar 91

[Text] The Zambian Prime Minister says the number of
fully blown AIDS cases in Zambia has risen to over
4,000 despite intensified government efforts to contain
the virus.

Opening a medical conference on venereal diseases in
Lusaka, Mr. Malimba Masheke said that while the
government had succeeded in controlling the spread of
other sexually transmitted diseases, AIDS remained an
alarming problem despite increased medical resources
and awareness programs to control its spread.

He said that by the beginning of December last year
more than 4,000 cases of fully blown AIDS had been
reported to the Ministry of Health.



JPRS-TEP-91-007
8 April 1991

This city of 1,300,000 residents, which until quite
recently was closed to foreigners, is now actively estab-
lishing contacts with foreign firms, and over a hundred
guests from abroad are already working in joint ventures.

Police statistics characterize the local risk groups: There
are around 400 homosexuals in the city, and over 700
prostitutes. :

The figures do not of course reflect the true state of
affairs, but they are sufficiently eloquent: Appearing
inadvertently, the virus could spread with lightning
speed.

Estrin recently returned from Odessa. There the AIDS
situation is alarming: Sixty-six virus carriers, two
patients and the death of a five-month old child have
been recorded.

Dnepropetrovsk is not the port of Odessa, but it is still in
the same republic, such that we cannot ignore this
possible channel of the disease’s spread.

Although according to official data there is no AIDS in
Dnepropetrovsk, according to assurances of local med-
ical personnel the fear of AIDS is flourishing throughout.

A MEDITSINSKAYA GAZETA correspondent met sev-
eral young men at the office of trust (an anonmymous
AIDS testing office). And although they were not about
to introduce themselves, the purpose of their visit was
fully understandable.

In the words of N. Ya. Kozina, a doctor specializing in
infectious medicine, two and a half thousand persons
have already been tested here for AIDS this year (of
them, only 300 were anonymous). .

Not only can the office do blood tests, but it is also able
to provide the necessary consultation on AIDS prob-
lems.

There is, by the way, a sizable demand for such assis-
tance among the citizens of Dnepropetrovsk. Natalya
Yakovlevna said for example that dozens of people visit
the office and place calls to it over and over again to
ascertain that they don’t have AIDS.

For example 30-year old Lena, who has two children by
the way, has now been calling the office of trust for 2
months. She gave blood several times, but she can’t
believe that she doesn’t have AIDS. The woman is in
torment, she suffers insomnia, and she has become
obsessive. B. M. Estrin recently referred her to a psychi-
atrist acquaintance of his: The fear of AIDS cannot be
cured by ordinary counseling: Qualified assistance from
“narrow” specialists—psychotherapists, psychiatrists—
is required here.

Estrin feels that it is high time to think about creating a
department for patients suffering the fear of AIDS at the
center.

SOVIET UNION 19

But for the moment this is only a dream, since it turns
out that the AIDS Prevention and Control Center does
not exist as an independent institution in Dnepropetro-
vsk.

When the Union Ministry of Health gave its recommen-
dations on organizing such centers, it granted full inde-
pendence to local public health organizers. One thing
was stipulated clearly: The center must become an inde-
pendent therapeutic-preventive institution.

But it is easy to say that something is independent.
Given the existing shortages in public health, where are
shelter, beds and staff to be found?

And so it happened that in June of this year the Dnepro-
petrovsk City Public Health Department published an
order creating the center—an independent one from a
formal standpoint, but supported by the budget of the
city infection hospital. The city’s immunoenzymatic,
bacteriological, immunological and biochemical labora-
tories that test blood for AIDS are subordinated to the
center by decree, but they remain within the structure of
other therapeutic institutions.

Understandably, being under the administration of one
hospital, the center cannot coordinate and direct the
work of all these laboratories into a single channel.

I visited the city’s central “AIDS and Biochemistry”
laboratory together with a MEDITSINSKAYA
GAZETA photographer. This was once a children’s day
care center. With the advent of the threat of AIDS, the
laboratory became even more crowded, and it was
divided in two: Biochemical tests are run in one wing,
and blood is tested for AIDS in the other.

With what is the laboratory that is to place a barricade
before the “plague of the 20th century” furnished?

“We service more than 30 of the city’s therapeutic
institutions, we run 800 tests a day,” said laboratory
director L. I. Ryabokon, “but unfortunately the tools and
instruments that we have to work with are outdated.”

A multichannel pipette that the medical laboratory assis-
tants dream about costs around 300 rubles in hard
currency. Multiscans and Uniscans—modern Finnish
instruments for immunoenzymatic analysis—cost from
seven to thirty thousand in hard currency.

Where is the Dnepropetrovsk center to get such money?
There is, by the way, hard currency in the city.

It’s no secret that while the hard currency accounts of
many enterprises are frozen at the moment, they may be
used to render assistance to children and disabled per-
sons and for AIDS prevention.

Luckily it seems as if the ice is beginning to break up. A
local heavy press plant, for example, has agreed to
transfer around 20,000 rubles in hard currency to the
center.



JPRS-TEP-91-007
8 April 1991

The survey was made up of 56 AIDS patients who were
treated at the AIDS unit of the A. Syngrou Hospital from
1985 to November 1990. Prior to their being diagnosed
as having the disease, three patients said they had only
one sexual partner while the remainder said they had a
large number of sexual partners, 100-600, in the past two
years. Only two patients used contraceptives regularly,
six used them occasionally while 48 never used them.
After their being diagnosed with AIDS, 13 stopped all
sexual contacts, 10 kept only one sexual partner, 18
changed behavior while 15 did not change their habits.

The diagnosis of the disease finally led most of the
patients to change their sexual behavior. This change,
however, was not such as to sufficiently protect them
from reinfection or to completely prevent their sexual
partners from transmitting the disease. Head of the
survey team was Dr. V. Paparizos. [passage omitted].

‘Unique’ New Method Used in HIV Research

91WE0221B Athens | KATHIMERINI in Greek
26 Jan 91 p4

[Text] New unique techniques for the surveillance of
AIDS carriers and the detection of the HIV virus are
being implemented in laboratories by Greek doctors.

A statement to this effect was made yesterday in a press
conference by Mr. Ang. Khatzakis, an epidemiologist, on
the occasion of the Second All-Greek Congress on AIDS
and Sexually Transmitted Diseases. These universally
novel methods were presented at this congress.

Of special interest was the method presented at the
congress by Mr. N. Malliarakis of the University of
Crete, according ‘to which it is possible to determine
whether someone is an authentic AIDS carrier or not.

With this technique results of the Western blot test can
be verified. This test is widely used to detect the virus. In
some cases the results obtained are doubtful because
they falsely appear to be positive.

The procedure, which is being conducted at the National
Retroviral Reports Center and the University of Crete, is
a very difficult one. It is called PCR or polymerase chain
reaction. It is based on gene amplification technology of
the cell so as to better detect it and, as Mr. Khatzakis
said, it might have other applications in the future.

With yet two new and interesting techniques it is pos-
sible to make known if an AIDS carrier will progress well
or badly so that therapy might begin in time and the
stages of AIDS infection without symptoms might be
anticipated.

New Hepatitis Virus Strain Isolated

91WE0221C Athens I KATHIMERINI in Greek
26 Jan 91 p4

[Article by Galini Foura]

WEST EUROPE 25

[Text] A universally unknown strain of hepatitis virus has
been detected in Greece and has already caused three
deaths.

Another form of hepatitus virus, that does not exist in
Europe and that is endemic in Third World countries,
has been isolated in Greece.

This has to do with the E virus that is particularly
dangerous, especially’among pregnant women that
causes a great percentage of death among them.

The above comments were made yesterday at the Second
All-Greek Congress on AIDS and Sexually Transmitted
Diseases by Prof. Nikos Tassopoulos following research
conducted at the Infectious Diseases Unit in cooperation
with the U.S. Infectious Diseases Center.

Studied were 31 persons who had been taken to hospitals
with severe hepatitis symptoms which, nevertheless,
could not be diagnosed.

As it turned out, these 31 people had not been infected by
any of the known hepatitis viruses, i.e., A, B, or C. One had
the E virus that has caused epidemics in Pakistan, Somalia,
Sudan, Nepal, and the Soviet Union but is unknown in
Europe. The other 30 remained undiagnosed and of the
three subsequently died.

Mr. Tassopoulos said, “Perhaps there is some other
strain in our country that causes hepatitis. This strain, of
course, is unknown and must be studied in cooperation
with foreign centers that have the necessary technology.

“The certain thing is that the E virus exists in our
country since the person infected did not travel abroad.”

As Mr. Tassopoulos made clear, this strain is transmitted
by polluted water. The disease does not drag on but leads
to death in 10-20 percent of Greek women who are
affected in the third quarter of their pregnancy. This
virus is very widespread in Third World countries and
makes up 50 percent of hepatitis cases in the Sudan.

The hepatitis problem is assuming alarming proportions
because of the lack of controls over hepatitis C in blood
donations. Such lack of controls, from what is apparent,
are very widespread in Greece.

A survey conducted at the Tripolis Hospital showed that 41
percent of the patients who had blood dialysis there had
been infected by this virus that is particularly dangerous.

Of 27 patients who had blood dialysis, 11 proved posi-
tive to the C virus. Six of them had had blood transfu-
sions while the remainder seem to have been infected
from the blood dialysis.

Interesting comments were made at the congress with
regard to the spread of AIDS among homosexuals and
drug addicts.

The study was conducted among an anonymous sample
of homosexuals with acute hepatitis by Messrs. Ang.
Khatzakis and N. Tassopoulos. A great increase in the



JPRS-TEP-91-007
8 April 1991

REGIONAL AFFAIRS

Leading Johannesburg Banker on AIDS Impact

91WE0237A Stockholm DAGENS NYHETER
in Swedish 21 Feb 91 p C4

[Article by Sven-Ivan Sundqvist: ‘“‘AIDS Wrecks
Progress”]

[Text] Johannesburg—Edward Osborn of the commer-
cial bank, Nedbank, in Johannesburg, South Africa,
maintains that the AIDS epidemic must be considered
the most important economic factor in all long-term
planning for southern Africa.

“Take for instance South Africa. The great political
agreement between the whites and the blacks is about
democracy, about poverty and unemployment, about a
mixed economy, or a fully forged market economy.
Those are trifles compared to the looming AIDS prob-
lem,” says Osborn.

He bases his figures on statistics from the large insurance
company, Old Mutual.

These figures, first published in August 1990, indicate
that the number of deaths from AIDS in South Africa
will culminate around the year 2008 with over a million
deaths per year.

Controversial Question

Compare this to a little more than 100,000 deaths
annually from other causes. Those statistics also lead to
the conclusion that the adult HIV- negative popula-
tion—the “healthy” part which today numbers around
20 million—will be reduced to 13 million in the year
2000 and will remain at that level during the first decade
of the twenty-first century.

That would be similar to 5 million adult, healthy Swedes
being reduced to 3.25 million by the turn of the century.

“You could argue the time for doubling the number of
HIV-positive people in South Africa,” says Osborn. “But
it is definitely important for all future planning, if, in the
year 2000, South Africa has an adult population of 21
million, of which 6 million are HIV- infected and 2
million are dying of AIDS.”

Osborn maintains that the macroeconomic conse-
quences can be summarized both in these demographic
figures and in the supply of workers.

Poor Hard Hit

The demographic changes affect all planning: education,
housing, urbanizing, water and electricity supplies, infra-
structure investments, etc.

The other important factor is the supply of workers. The
adult population not infected with HIV will decrease as
of 1990 from about 20 million to 13 million in the year
2000.

SUB-SAHARAN AFRICA 1

Osborn believes that the poorly educated, poor, black
urban population will be harder hit than other catego-
Ties.

This in turn should mean that the current oversupply of
unskilled labor will be turned into a deficit. Conse-
quently, South Africa must prepare for even more capi-
tal-intensive industry and agriculture.

AIDS is the single most important factor in the economy
of Zimbabwe. The accompanying table shows the popu-
lation of Zimbabwe stagnating around 8 million during
the balance of the century.

Since the annual population increase is around 3 per-
cent, the total population number is not reduced by the
40 percent of the current population which is dying of
AIDS.

The macroeconomic consequences of figures like these
are obvious. The greater part of those dying of AIDS is to
be found in the active generation, not among the old.

Thread Will Break

When almost 40 percent of the working population in
Zimbabwe becomes sick, the nation will be struck by
multiple costs. At the turn of the century, the cost of
caring for the sick will require resources from those who
are not afflicted, resources which will not be available.

The decline in production from those who become sick is
the “current value” of all their future efforts. The slender
thread of trained workers, necessary for generating
growth, will break, resulting in further economic stagna-
tion.

Economists are not yet speaking openly in these terms.
In several countries in southern Africa, not only the
statistics but the analysis of the consequences are being
hidden.

A thought-provoking publication with statistics from the
research institution IRIS (International Research and
Information Services, Capetown) has been published in
South Africa. A report from 25 April 1990, “AIDS, A
Strategy for Business,” gives HIV information from a
number of countries in southern Africa with emphasis on
the situation in South Africa. The aim of the publication
is to make South African businesses aware of the extent
of the problem.

The level of information on AIDS is summarized in the
following points:

© Politicians still do not want to come out in the open;

+ All statistics underestimate the number of dead;

* Many of those who are stricken with AIDS, do not
want to be tested for fear of being ostracized.

Official estimates of HIV-positive figures for Africa
south of the Sahara is around 5-8 percent. The actual
percentage might very well be higher.



12 SOVIET UNION

republic epidemiological stations. We believe this deci-
sion to be hasty and not thoroughly thought out. This
would destroy the unified system of clinical epidemio-
logical surveillance over HIV infection that has already
been developed, and it would reduce the efficiency of
epidemic control and preventive measures. We conclude
this from our work experience with eight cases of infec-
tion. As an example just keeping control over examina-
tion of persons who had contact with a patient, who may
number in the hundreds and even thousands in some
cases, would require literally daily work by epidemiolog-
ical station associates in center laboratories to gather the
information, to compare lists and so on.

The initiators of this order took absolutely no account of
the moral and psychological factors of those who are
working in the centers either. A small collective of just 20
persons, who started with literally nothing, were able to
organize a workable medical institution producing posi-
tive results in a very short time. The collective met to
express its indignation at the logic upon which the
structure of the service was based. The center’s activities
have already received the approval and positive response
of our republic's medical community. It is sharing its
work experience with other territorial centers.

But that’s not all. It has now become known that
territorial centers will be completely disbanded, and
their functions will be transferred to some other institu-
tions. If the disease which has come to be called the
“plague of the 20th century” and which kills patients is
no longer all that menacing in the minds of the initiators
of the effort to eliminate the service, then why is there
such a need for so much information and propaganda,
why publish the terrible predictions of a threat to the
very existence of civilization itself? A year ago local
governments were ordered to organize the centers imme-
diately, and now they’re being told to disband them!
Who is directing this effort, and who needs such exper-
iments? This is not even to mention the human factor
(which, as we can see, has no meaning in our country)!
Won’t we once again have to create a specialized service
to fight AIDS several years from now? Experience shows
that the volume of preventive and especially epidemic
control work will increase dramatically from one year to
the next, and the work will need to be improved further,
but this will be impossible if we divide the AIDS
problem into parts. We cannot wage a piecemeal attack
on a problem that threatens people more than any other
infection ever has. Some time ago, malaria control
stations were created in the country, and they were
disbanded when their preventive and control functions
were transferred to the epidemiological service, after a
large amount of work was done and the main objective—
‘eliminating malaria—was achieved. As we know, the
Soviet Union’s experience in fighting malaria received
the approval of the entire world. The editor’s office, and
those who work with it, know how serious the problem of
fighting AIDS today is. The newspaper's opinion, or at
least that expressed in many of its articles, concerning
the problems of organizing and developing the centers is

JPRS-TEP-91-007
8 April 1991

clear to all, and it has never even been suggested that
creating the AIDS prevention and control service was
unsuitable (see MEDITSINSKAYA GAZETA, No 117,
30 September 1990).

We are certain that you will receive similar letters and
appeals from other regions. We appeal to you to state
your opinion on this matter in the newspaper. Perhaps
you should publish a sampling of materials “pro” and
“con”.

Respectfully, physicians of the Chechen-Ingush Republic
AIDS Prevention and Control Center.

Baltic AIDS Organizations Confer in Latvia

91WE0243D Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 6

[Article: “In a Worldwide Effort”}

[Text] The founding conference of a new public organi-
zation having the goal of coordinating the efforts of the
Baltic Republics in the fight against human immune
deficiency virus was held in the capital of Latvia. Rep-
resentatives from Latvia, Lithuania, Estonia and Lenin-
grad took part in the conference proceedings.

Converted Military Facility Studies AIDS Virus

91WE0243E Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p7

[Article by correspondent Ye. Prikhodko: “Dust-Free’
Work”]

[Text] “Our work,” said Andrey Georgiyevich Pok-
rovskiy, “is dust-free: model cleanliness, oxygen fed into
a sterile suit through a hose, and a hot shower several
times a day. The water flows, and the money keeps
coming.... We are away from the smoggy city, in what
you might almost call fresh country air. With things
being so good, there’s just one slight hitch—we’re always
in the ‘sights’ of AIDS virus.”

We can excuse his irony. It is evident from everything
that A. Pokrovskiy, director of the retrovirus cultivation
and diagnosis department of the Novosibirsk Vektor
Scientific-Production Association, and his colleagues
have no intention of glamorizing their work. But I
suspect that their humor is just a “defense reaction,”
since the work the scientists do here (such work is being
done in our country only in Moscow) is as noble as it is
dangerous. They are conducting research directly with
AIDS virus: They are manipulating it, growing it, and
like trainers, they are trying to tame it.

Quite recently Vektor was oriented on defense needs,
which is why the settlement of Koltsovo, near
Novosibirsk, could not be found on any maps. Now the
scientific-production association (it contains a scientific
research institute of microbiology, a scientific experi-
mental industrial base, and scientific research and design



14 SOVIET UNION

established the Specialized Scientific Research Labora-
tory of AIDS Epidemiology and Prevention, which is now
studying the problems of the epidemiology, pathogenesis,
clinical pattern, treatment, diagnosis and prevention of
HIV infection.

Epidemiological Analysis

The following were introduced in stages during epidemi-
ological research: selective testing of different popula-
tion groups (beginning in August 1985), anonymous
voluntary examination of the public (beginning in Feb-
tuary 1987), epidemiological investigation of cases of
HIV infection (beginning in February 1987), and man-
datory examination of population groups singled out by
decree (beginning in August 1987).

It should be noted that in contrast to the surveillance
methods adopted by public health agencies of other
countries, we registered all cases of HIV infection from
the very beginning (and not just AIDS cases). As a result
a possibility appeared for observing the role of the most
active and numerous sources of infection—persons
having no obvious clinical signs of disease.

Data were processed from HIV antibody tests carried out
on a total of 46,618,000 Soviet and 69,900 foreign
citizens in planned examinations and more than 126,000
Soviet citizens in epidemiological investigations of HIV
cases. A total of 867,810 persons were examined at the
TsNIIE [Central Scientific Research Institute of Epide-
miology]. Data from epidemiological investigations of
434 cases of HIV infection among Soviet citizens were
analyzed (146 cases were investigated directly by the
TsNIIE). Anonymous tests were run on 10,117 persons.

During the time of observation since 1985, 553 cases of
HIV infection were revealed among Soviet citizens
(1985, 1986—0; 1987—34; 1988—85; 1989—322; 10
months of 1990—112). The sharp rise in the number of
HIV infections revealed in 1989 is the product of the
discovery of outbreaks of HIV infection in hospitals of a
number of cities in the Russian south. Processing and
analysis of data obtained from examinations of groups
requiring mandatory testing showed that the incidence
of HIV infection is extremely low among blood donors
and pregnant women (1 case out of 0.5-2 million sub-
jects). It is somewhat higher among patients of venero-
logical clinics, among homosexual and bisexual men,
and among returnees from abroad (1 case out of 50,000-
150,000 analyses).

These data suggest that the incidence of HIV infection is
still low in the country.

Because it was known at the beginning of this work that
the incidence of HIV infection was high in Africa, the
Caribbean Basin and the USA, and it was assumed with
fully adequate grounds that the level of incidence is
lower in the USSR than in these regions, the question of
the intensity of the infection’s penetration onto USSR
territory together with foreign citizens became para-
mount. A mass examination of foreign students coming

IJPRS-TEP-91-007
8 April 1991

to the USSR to attend school was conducted in order to
test this hypothesis. From November 1985 to August
1987 108 infected individuals were revealed among
them, which is why the USSR. Ministry of Health
decided to test all foreigners, visiting the USSR for a
period of less than 3 months, for HIV antibodies. A total
of 19,441 foreigners from Africa were tested in the
TsNIIE’s laboratory; 292 infected individuals were dis-
covered among them (1.5 percent). Tests were also run
on 54,888 foreigners from other regions, among whom
nine infected individuals were revealed (0.016 percent).

A survey of seropositive and seronegative foreigners
showed that during their time in the USSR they had a
sizable number of sexual partners, in. connection with
which they can be responsible for importing HIV infec-
tion into the country and for being its source as well.
Epidemiological investigation of cases of HIV infection
among foreigners revealed cases of infection of Soviet
citizens who had-sexual relations with them. A total of
up to 40 percent of USSR citizens infected by sexual
means had sexual contacts with foreigners. It was shown
that in a number of cases HIV infection was also
imported into the country by persons visiting for less
than 3 months, which once again confirmed the condi-
tional nature of this time period. In contrast to hetero-
sexuals, only an insignificant number of infected homo-
sexuals had sexual contacts with foreigners, which is an
indication that the virus has been circulating in their
milieu. It was shown that HIV infection may also be
imported from abroad by Soviet citizens infected there.
So it was with the first revealed infected Soviet citizen.

Other Soviet citizens infected through sexual contacts,
blood transfusions and other parenteral manipulations
during their presence in countries endemic in relation to
HIV were revealed later on. On returning to the USSR,
some of them became sources of major outbreaks of HIV
infection, including the hospital outbreak in the Kalmyk
ASSR. The qualification should be made here once again
that in this case we cannot place an equal sign between
the concepts of the “source” of an outbreak and its
“culprit,” as sometimes happens, even in the minds of
medical personnel.

Cases of HIV infection revealed in planned examina-
tions were subjected to epidemiological investigation.
The combination of these two methods made it possible
to significantly increase the quantity of revealed sources
of HIV infection. An. epidemiological investigation
made it possible to assess the role of individual pathways
and factors of HIV transmission, and in a number of
cases to take steps to prevent its spread. It demonstrated
the high effectiveness of this method both in studying the
epidemiology of HIV infection and as an epidemic
control measure.

Eighteen seropositive persons were revealed among 58
examined just during epidemiological investigation of
the first case of HIV infection revealed in the USSR and
69.12 percent of all seropositive Soviet citizens were
revealed by epidemiological investigation. Cases of



IJPRS-TEP-91-007

8 April 1991 2 AIDS
LATIN AMERICA
COSTA RICA
Over 235 AIDS Cases Registered as of March 1991 [San Jose LA REPUBLICA, 21 Mar DI] vee O
PERU

AIDS Program Director Reports Statistics /Lima EXPRESO, 10 Mar 91] ....
SOVIET UNION
New AIDS Control Association /4. Semenov; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] . 10

AIDS Training for Soviet Nurses /I/va Borich; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] .. 10
Decentralization of AIDS Control Criticized

[A. Oshayev, I. Labazanov, et al.; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90) ..... Bt
Baltic AIDS Organizations Confer in Latvia’ [Moscow MEDITSINSKAYA GAZETA, 30 Nov 90) 12
Converted Military Facility Studies AIDS Virus

[Ye. Prikhodko; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] 12
Work of AIDS Epidemiology Center

[V. Pokrovskiy, O. Yurin; Moscow MEDITSINSKAYA GAZETA, 30 Nov a 13
Dnepropetrovsk Official Estimates 30-40 Cities at Risk

[Marina Kushnareva; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] .... 18
Anti-AIDS Campaign for Youth

[Natalya Borisovna Karatayeva; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] . 20

Six-Hour Workday for AIDS Care Personnel

[A. Porkhachev; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90]
Pokrovskiy on AIDS Measures /V. Pokrovskiy; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90]
Improved Soviet Condom Production Still Insufficient

G. Sobakina, S. Kitain; Moscow MEDITSINSKAYA GAZETA, 30 Nov 90] ....

WEST EUROPE
FRANCE

AIDS Patients Eligible for Life Insurance /Jean-Michel Bezat; Paris LES ECHOS, I Mar 91] ...... 24
GREECE

No Behavioral Changes in AIDS Carriers [Athens ELEVTHEROTIPIA, 28 Jan 91]
‘Unique’ New Method Used in HIV Research | [Athens 1 KATHIMERINI, 26 Jan 91]
New Hepatitis Virus Strain Isolated /Galini Foura; Athens | KATHIMERINI, 26 Jan 91]
AIDS Statistics Show Heterosexual Transmission [Athens I KATHIMERINI, 25 Jan 91] ..



JPRS-TEP-91-007
8 April 1991

Academician N. P. Laverov, deputy chairman of the
USSR Council of Ministers, can expect a more fortunate
future, and that the prognosis of the fight against AIDS
will be more hopeful.

In 1987 the Presidium of the USSR Supreme Soviet
published the ukase “On Methods of Preventing AIDS
Virus Infection.” This ukase had a mixed reception from
the public. Many saw it as a transgression upon the rights
of HIV-infected persons and AIDS patients. However,
this ukase played a large role in protecting the society
from HIV infection. For example in 1987 an examina-
tion of foreign graduate students who came to the USSR
for training revealed around 100 infected individuals
who were highly active sources of infection, while in
1990 an examination revealed 12. In this way, owing to
the ukase, more than 400 active sources of HIV were
eliminated or kept out of the USSR, and this means a
minimum of 8,000-10,000 prevented infections.

The law of the Union of Soviet Socialist Republics “On
AIDS Prevention,” signed by President of the Union of
Soviet Socialist Republics M. Gorbachev on 23 April
1990, gave legal backing to measures directed at pro-
tecting the society from the spread of AIDS, and it laid
the foundation for ensuring the social protection of
persons infected with human immune deficiency virus or
sick with AIDS.

The incidence of HIV infection in the population will
doubtlessly grow. It must be understood that the virus is
already circulating in the USSR population. It is impos-
sible to eliminate or destroy it. My hope is that the most
intensive pathway of circulation—in internal hospital
infection focihas been blocked. The sexual pathway
remains dominant—both heterosexual (the primary
one!) and homosexual. Therefore the USSR’s preventive
and epidemic control measures must be oriented on
blocking sexual transmission of HIV by limiting the
activity of existing transmission factors.

Improved Soviet Condom Production Still
Insufficient

91WE0244B Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p7

[Excerpts from article by G. Sobakina and S. Kitain: “To
Stallone for a Coupon, or How the Bakovka Rubber
Article Plant Reached Its Rated Capacity”)

[Excerpts] Many civilized countries are conducting offi-
cial condom ad campaigns.

So it is that we find the condom as the hero of the
commercials. It makes its appearance at the tensest
moment of the evening television program. The great
Sylvester Stallone has just fought a duel to the death with
a murderous maniac, when suddenly his place on the
screen is substituted by a man in a white smock saying
good things about our little rubber friend. Lovers of box
office smashes grumble, of course, but after such a

SOVIET UNION 23

showing of this short ad, the sale of condoms increases
by 30 percent. This is why AIDS infection by the sexual
pathway has been minimized in developed countries.

In our country, however, the situation is clearly dif-
ferent. There is nothing to advertise: Instead of a billion,
Soviet industry produces only 280 million, plus the 377
million purchased abroad, for a total of just a little more
than half of the demand. And what if suddenly we were
given orders “from above” to do what they do in the
West—air commercials... [passage omitted]

I'm afraid that such a storyline wouldn’t work, at least
for now.... Even veterans of the Great Patriotic War and
disabled persons, not to mention simple mortals, do not
enjoy any advantages in acquiring these highly scarce
goods. So lets work on our traditional, Soviet variant of
the commercial.

Part I. The Bakovka Rubber Article Plant, which at one
time had been able to satisfy the population’s demand
for condoms completely, has lost its leading position: In
its race for quantity, it forgot about quality. Having
purchased imported equipment, its competitor, a plant
in Armavir, has pulled forward. But it has another
problem—having gotten carried away with quality, it
was unable to get a handle on quantity. The country
found itself defenseless in the face of AIDS.

Part II. The alarm is sounded in Bakovka. Its experi-
enced, energetic director, Yu. V. Andreyev, is eager to
help the country, and to recapture the plant’s former
glory at the same time. A new production building is
erected, new equipment is purchased, and surmounting
colossal difficulties, the raw materials are requisitioned.
“At the top,” the efforts of enthusiasts at the Ministry of
Construction of Petroleum and Gas Industry Enterprises
create the Medizdeliya Production Association, of which
the Bakovka plant becomes the head plant. Just this year
alone, the association will manufacture 60 million con-
doms, and that’s just the beginning. A Soviet-
Vietnamese joint venture will go into operation in Jan-
uary of next year, producing 280 million units; add to
this the two lines that are being installed in Zelenograd,
which will be able to provide another 70 million or more.

And on the whole, the sector plans to open four plants in
the immediate future to manufacture these products that
we need so greatly.

Part III. A MEDITSINSKAYA GAZETA photographer-
reporter visits the Bakovka plant. He finds its collective
fully resolved to honorably complete its task. Everyone is
working excellently, enthusiastically. In accordance with
the contract, products manufactured in excess of the
plan are sent to the capital’s pharmacies, such that
Muscovites could now “sleep” silently, if of course they
could. A happy ending.

Photographs [not reproduced]: in the finished products
electronic quality control section; “‘Bakovka condoms
are at the level of world standards!”



Epidemiology
AIDS

JPRS-TEP-91-007 CONTENTS 8 April 1991

{This EPIDEMIOLOGY report contains only material on AIDS. Other epidemiology topics are covered in a later
issue.]

SUB-SAHARAN AFRICA
REGIONAL AFFAIRS

Leading Johannesburg Banker on AIDS Impact
[Sven-Ivan Sundqvist; Stockholm DAGENS NYHETER; 21 Feb 91]

ANGOLA

Blood Treatment Lab Installed in Cunene Province

[Luanda JORNAL DE ANGOLA, 20 Feb 91] 2
BOTSWANA
District Medical Official Notes AIDS Cases, Deaths /Gaborone Domestic Service, 16 Mar 91] ...... 3
GHANA
AIDS Cases Increase by 80 Percent in 1990 /Paris AFP, 12 Mar 91] 3
SOUTH AFRICA
Minister Discusses AIDS, HIV Infection Statistics /Johannesburg SAPA, 15 Mar 91] ..... 3
ANC Launches AIDS Awareness, Other Campaigns
[Sipho Ngcobo; Johannesburg SUNDAY TIMES, 17 Mar 91] 3
Data Shows 693 Recorded AIDS Cases in Country
[Carina la Grange; Johannesburg THE STAR, 18 Mar 91] ....... 4
ANC Spokesman Discusses AIDS Awareness Program
[Cathy Fitch; Johannesburg International Service, 20 Mar 91) .... 5
ZAMBIA
Prime Minister Notes More Than 4,000 AIDS Cases In Country
[Johannesburg International Service, 18 Mar 91] 5

CHINA
Foreign Grants, Higher Spending to Fight AIDS {Zhu Baoxia; Beijing CHINA DAILY, 16 Mar 91] ..
Commentary on Need To Control AIDS /Beijing CHINA DAILY, 16 Mar 91]
Minister Urges AIDS Prevention, Control /Beijing XINHUA, 14 Mar 91] ...

EAST ASIA

JAPAN

Japanese Researchers Compose AIDS Restrainer /Tokyo KYODO, 14 Mar 91] ... 8
LAOS

One HIV-Positive Case Discovered in Vientiane Vientiane KPL, 13 Mar 91] .... 8



26 WEST EUROPE

AIDS rate was found among homosexuals, rising from
1.5 percent in 1987 to 5.7 percent in 1990.

On the other hand, of 340 drug addicts with acute
hepatitis who had been tested in the last five years, not
one was found to be an AIDS carrier.

Nevertheless, there is the danger of spread of AIDS
among drug addicts because, as it was determined from
the sample of 340 drug addicts, use is made of acommon
injection needle in the majority of cases.

AIDS Statistics Show Heterosexual Transmission

91WE0221D Athens | KATHIMERINI in Greek
25 Jan 91 p4

[Text] There were 19 new cases of AIDS in Greece in the
past three months, thus bringing the total number of
cases reported up to now to 412, of which 12 are small
children.

JPRS-TEP-91-007
8 April 1991

The above statistics were publicly announced yesterday
by G. Soulas, alternate minister of health, welfare, and
social insurance, who emphasized that the spread of the
disease among heterosexual people in Greece has
assumed alarming dimensions. He noted that the spread
of the disease has been greater than in other EEC
countries.

For that reason greater vigilance and better under-
standing by young people is needed. Even though we are
in last place among EEC countries as far as overall AIDS
cases is concerned, the problem exists and no relaxation
can be permitted.

According to the data Mr. Sourlas provided, of the 412
AIDS cases, 205 are to be found among homosexuals, 14
among drug addicts while 89 cases came from hetero-
sexual relationships.



New AIDS Control Association

91WE0243A Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 1

[Article by A. Semenov: “Vladimir Pozner’s New Line of
Work]

[Text] The list of organizations mounting the attack on
AIDS has now been increased by one more. The Moscow
City Soviet registered an association for fighting this
disease under the Soviet Charity and Health Fund.

Its founders include the USSR Ministry of Health, the
USSR Academy of Medical Sciences, the Central Scien-
tific Research Institute of Epidemiology of the USSR
Ministry of Health, the All-Union AIDS Prevention and
Control Center of the USSR Ministry of Health, the
Executive Committee of the Union of USSR Red Cross
and Red Crescent Societies, and many other organiza-
tions.

It was announced at the first meeting of the founders and
members of the association that “the main goal of the
new organization’s activity is to implement measures
directed at upgrading the quality of prevention of HIV
infection and treatment of persons infected with HIV
and stricken with AIDS, and improve their social pro-
tection and their material and personal support.”

All speakers noted the need for uniting all interested
parties for successful solution of the problems facing the
country as a result of the danger of the spread of the
“plague of the century.” Also, the press received some
criticism: USSR Academy of Medical Sciences Academi-
cian V. I. Pokrovskiy noted the superficiality and incom-
petency, and sometimes even the irresponsibility of the
mass media in dealing with the topic of AIDS. He gave a
high assessment to the work of the Soviet Epidemiolog-
ical Service, which in his words is a model for the entire
world.

Although the press was censured, a journalist was elected
to lead the new association—Vladimir Pozner.

AIDS Training for Soviet Nurses

91WE0243B Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 p 2

[Article by reviewer Ilya Borich: “We Never Had This in
School: Notes From a WHO Seminar ‘Activity of Nurses
in Prevention and Control of HIV and AIDS””]

[Text] When Doctor Sandra Anderson, an associate of
the headquarters of the World Health Organization in
Geneva, raised some AIDS pamphlets, already known in
many countries of the world, and asked the participants
of the Moscow seminar whether they were familiar with
them, all she got in return was total silence. In my
interview with her, Sandra admitted that she was
extremely amazed by this. After all, several pamphlets of
this series, which has now been printed in seven editions,
were translated into Russian.

VIET UNION

JPRS-TEP-91-007
8 April 1991

This mute scene spoke better than any words could of the
fact that although it is clearly recognized in our country,
the danger of AIDS has not yet become a stimulus for
immediate and decisive action. The WHO materials and
recommendations on developing national programs, on
methods of sterilization and disinfection, on nursing
care of HIV carriers, and on other aspects of the prob-
lems are a distillation of all world experience. They are a
concentration of the results attained by specialists in the
years of their attack upon the disease over the entire
planet. A loss of momentum in acquainting a wide range
of medical personnel and the public with this experience
dangerous, and it can only make the fight against AIDS
the Soviet Union more difficult.

The seminar, which was conducted in the last third of
November, first in Moscow and then in Alma-Ata, had
the purpose of remedying this omission in regard to
nurse activities. Let me recall that back in April 1987 the
International Nurses’ Council and WHO adopted a joint
declaration on AIDS. It determined the rights and
responsibilities of nurses and midwives providing care to
people infected with HIV. The council promised to help
national nurses’ associations in supplying the needed
information.

What happened next? WHO and the international
council jointly wrote a handbook on organizing nursing
care to AIDS patients. Naturally it could not be an ideal
variant for all regions and countries—it had to be
adapted to local conditions, with regard for the tradi-
tions, beliefs and spiritual values of the given ethnic
group.

But it was not until this year that these and other
materials were adapted to the conditions of the USSR.
Motivation for doing so was provided by a WHO con-
sultative conference of nursing specialists in Eastern
European countries, conducted in Copenhagen in March
1990. Through the efforts of WHO specialists, as well as
experts and coordinators from our country—Zh. Kara-
gulova and G. Perfilyeva, training materials were
selected with regard for specific national features. A
regional bureau translated them into Russian, and there
are now three substantial documents in the possession of
each participant of the seminar. Their joy was like that of
little children. This was quite a feast of information to
them, given the starvation diet of training and method-
ological literature that we are accustomed to. There was
a nurse’s handbook on caring for HIV carriers and AIDS
patients, and on the means of preventing HIV transmis-
sion in therapeutic institutions. And finally, there were
the primary modules of a basic training course for nurses
and midwives in prevention and control of HIV infec-
tion, written by WHO’s Global Program (excerpts are
published in this issue).

The goal of the seminar, you see, was to teach the
teachers. Teachers from medical schools and advanced
training schools, senior and chief nurses, and nursing
affairs organizers from different levels were invited from
all republics in strictly limited numbers—25_ from



JPRS-TEP-91-007
8 April 1991

institutes in Berdsk, as well as an experimental agricul-
tural production enterprise) has been respecialized for
the development and industrial production of extremely
scarce diagnostic and therapeutic preparations. In the
next 5 years, 230-250 million rubles’ worth of them are
to be produced.

The search for ways to fight AIDS is one of the main
objectives of Vektor scientists.

Hoppers with hermetically sealed metallic doors, a com-
plex system of ducts isolated from each other in accor-
dance with the principle of nesting dolls (one inside the
other), and finally a small pressure chamber, in which a
lethal disease agent that has been terrorizing mankind is
cringing. Scientists are permitted access to work with it
after a meticulous doctor’s examination: Are there any
scratches on their hands, and are their blood pressure
and general psychological and physical state normal? All
of this is in keeping with the international requirements
of working with AIDS virus.

Research is being conducted in four basic directions, A.
Pokrovskiy told me: isolation of the structures of the
virus, its cultivation with the purpose of obtaining
antigen for use in diagnostic tests, development and
improvement of test systems, and creation of drugs.
Understandably, no one is guaranteeing quick success.
Nonetheless, the first results are already available. A
number of drugs by which to prevent immune deficiency
were developed jointly with scientists of the Siberian
Department of the USSR Academy of Sciences, Lenin-
grad and Ufa. The most recent item is a highly sensitive
(98-100 percent accuracy) immunoenzyme test system
used for clinical and epidemiological analyses and for
testing donated blood. The kit is intended for 192
analyses, including test sera. Separate use of each system
of 96 analyses is foreseen for small batches of samples.
The test system is furnished with all of the necessary
reagents in ready-to-use form. And what is very impor-
tant, the diagnosticum produces results quickly: It takes
only 4-5 hours of one associate’s work day to carry out all
192 analyses.

There is one other highly important merit. The seven-
component reagent, which was obtained by genetic engi-
neering, is absolutely safe. It contains no materials
isolated from the blood of patients, and it does not
present the danger of hepatitis B infection. And by the
way, in contrast to its Western analogues, the new
Siberian test system costs 169 rubles, as compared to
$200. Last year 97,000 such kits were produced, and this
year a time and a half more will be made.

I learned from Vektor’s general director, USSR
Academy of Sciences Corresponding Member L. S. San-
dakhchiyev, that the association plans to create a
number of joint ventures with American, French and
Danish companies. It is closely ‘cooperating with the
country’s leading institutes, and it is carrying out joint
programs of action with AIDS control centers. The idea
of creating a regional AIDS control center for Siberia and

SOVIET UNION 13

the Far East is being tossed around. Scientists feel that
the region needs an infection clinic, together with the
entire spectrum of medical services for sick people,
capable of solving the entire chain of medical and social
problems that we now know unavoidably arise. This will
protect AIDS patients from discrimination in the
society, examples of which are not isolated, unfortu-
nately. Specialists assure us that a base for the center
already exists in Koltsov. There has been a hospital
specializing in the treatment of rare and especially dan-
gerous infections here for a number of years. There is a
stable collective of physicians here, adapted to psycho-
logical stresses. A virus laboratory has been organized.

On talking with the scientists, medical personnel and
producers, I came to the conclusion that the impact of
Vektor’s work would be greater if it were not for a
paradox typical of our reality: An urgent and insistent
demand of life is colliding, as usual, with sluggishness
and indifference. In the words of the subjects of my
interview, the financing of projects is 10 times below the
most modest needs. Plans for placing new capacities into
operation are not being met: Last year for example the
volume of contracted jobs dropped by half, operations
producing unique drugs are set up in hallways and
closets, and things are being done primarily by hand.
Production is being held back by the absence of bottles
and packaging material, and by chronic breakdowns in
transportation.

Need I explain that interdepartmental disorganization in
delivering the kits to users often leads to waste, since the
proper storage conditions are not maintained, and shelf
life expires? Because of the absence of advertising and
the incompetency of some medical personnel locally,
these highly needed diagnosticums often fail to find a
market. Eleven thousand of the test systems have already
failed.

It is in this way that the labor of highly skilled specialists
who risk their lives daily in their “dust-free” work is
reduced to naught.

Work of AIDS Epidemiology Center

91WE0243F Moscow MEDITSINSKAYA GAZETA
in Russian No 141-143, 30 Nov 90 pp 8-9

[Article by candidates of medical sciences V. Pokrovskiy
and O. Yurin: “Epidemiological Analysis and Clinical
Pattern of HIV Infection”)

[Text] Considering the extreme urgency of the problem of
HIV infection and the absence of complete information on
jts incidence in the USSR, in 1985 the Central Scientific
Research Institute of Epidemiology of the USSR Ministry
of Health began studying the epidemiology of HIV infec-
tion, and with the detection of the first patients, its clinical
pattern in the USSR. During our work we became increas-
ingly more aware of the seriousness of this problem, and of
the need for concentrating the efforts of specialists of
different profiles on its solution. As a result the institute