The future of AIDS.

The impact of acquired immune deficiency syndrome (AIDS) in the 1990s could be as great as a major war unless a vaccine or cure is developed soon. Although the spread of AIDS is still small on a national scale it is staggering in certain areas. The Centers for Disease Control (CDC) estimated in 1987 that there were about 1.5 million infections in the US with 1 in 30 men aged 30-50 being seropositive. Yet in New York City which has 30% of all cases and deaths the rates were 10 times higher. In addition AIDS is now the leading cause of death in New York City for both men and women in their 30s. Drug abuse intensifies the problem in the black and Hispanic communities and in New York-area prisons where the death rate from AIDS is 100 times that in the general population. San Francisco and Miami also are heavily affected followed by Houston and Washington D.C. A 1986 report of the Institute of Medicine-National Academy of Sciences projected a total of about 270000 cases in 1991. If the factor or 30-50 infections per diagnosed AIDS case continues to hold this number of cases would imply some 10 million infections by 1991. And if half of those infected get AIDS and die within 10 years the death rate would reach half a million/year in the 1990s. The World Health Organization (WHO) reports on AIDS from 113 countries estimating 5-10 million persons infected. The number is projected to increase to 100 million by 1991. It is probable that the spread of AIDS will be limited even without a vaccine or cure unless it changes its behavior markedly. This is because every society can be divided into 2 populations: the "restraint sector" or R-Sector in which anyone infected will usually infect no more than 1 other person before he/she dies; and the "propagation sector" or P-sector in which the average carrier infects more than 1 other person so that the epidemic spreads in a chain reaction. With a predominantly sexual route of transmission the R-sector will be made up of groups that are essentially monogamous with little premarital experimentation and little use of prostitutes. If condoms are used consistently even a regular sex partner usually will not became infected and in such groups even occasional infections by nonsexual routes still will not spread beyond 1 or 2 people. The P-sector may be a sizable minority possibly 25-50 million people and their behavior could make them part of the chain reaction in the next few years. It is estimated that by 1991 New York City will need 2500-5000 hospital beds for AIDS patients every day. Nationwide costs will necessitate federal help possibly even a new federal agency. If the AIDS epidemic in the US continues to go on growing after 1991 much greater effects on society are possible. Hospitals will be desperately overcrowded and many AIDS patients will die at home or be abandoned. Victims of AIDS may grow violent and the effects on daily life will multiply.