AIDS: a global problem.

This article discusses acquired immunodeficiency syndrome (AIDS) with emphasis on its effects in developing countries. As of September 1986 31646 cases were reported in >70 countries. Several million people are probably infected with HIV the virus causing AIDS. AIDS is relevant in family planning service contexts because some contraceptives protect against trasmission. It is characterized by the unusual occurrence of a life-threatening infection or malignancy caused by destruction of T-helper lymphocytes and is detected clinically by testing blood for the presence of antibodies to HIV although alternative case definitions have been developed in developing countries where invasive diagnostic procedures and viral cultures are not available. The victim develops shortly after infection a mononucleosis-like syndrome followed by the development of antibodies after 6 months. The asymnptomatic period may last up to 5 years but as immune capacity is destroyed victims develop a variety of non-fatal symptoms which can progress to life-threatening infections or malignancies in 25-30% of victims in 5 years. The type of infection or malignancy appearing in response to immunodeficiency tends to vary by region e.g. intestinal and dermatologic infections in Haiti and Africa lymphadenopathy and pulmonary infections in the US. Also varying is the transmission mode: sexual (especiually homosexual) contact blood transfusions or unsterilized needles and mother-infant transmission. AIDS is a serious public health problem in developing coountries especially in South America and Africa. Seropositivity ranges in prevalence in blood donors from 0.7% in the Congo to 18% in Rwanda. It will be necessary to know more about how the virus is transmitted from mother to infants. Efforts to control the infections spread include promotion of barrier contraceptives and limiting of sex partners development of inexpensive tests for blood products and careful vigilance in the use of hypodermic needles.