One decade after the first description of the acquired immunodeficiency syndrome (AIDS), the epidemic has become a world-wide public health problem. Infection with the human immunodeficiency virus (HIV) is now spreading most rapidly among the poorer populations in the industrialised world and in the developing world. It has become the most important cause of death among adults in the major African cities and it absorbs an ever increasing proportion of health care budgets. On a global scale heterosexual intercourse is now the most common mode of transmission of HIV, resulting in a growing problem of transmission of the virus from mother to child. As a result of the AIDS epidemic, the incidence of tuberculosis is rising in virtually all populations. Developing countries face a double, gigantic challenge in an unfavourable economic and political climate: caring for those infected with HIV and preventing new infections.
PIP: AIDS is a world-wide public health problem spreading most rapidly among poorer populations. 200,000 people in Latin America, the Caribbean, Africa, and Asia had been reported to the World Health Organization (WHO) by early 1992 as having AIDS. Far more people are most likely afflicted, but unidentified as a result of widespread underreporting in the tropics. The WHO Global Program on AIDS estimates that 10 million adults and 1 million children have been infected with HIV since the start of the pandemic; 85% in developing countries. It may be that 1 in 40 adults in sub-Saharan Africa is HIV-seropositive. HIV infection will continue to spread throughout the tropics, especially in Africa South of the Sahara and South and southeast Asia. The cumulative number of infections will probably reach 40 million by the year 2000, of which more than 90% will be in developing countries. Factors supporting the pandemic are: large, young, sexually-active populations; untreated sexually transmitted diseases; lack of circumcision; and frequent sexual intercourse with prostitutes in cities with unbalanced male/female ratios. AIDS has become the most important cause of death among adults in major African cities, absorbing an ever-increasing proportion of heath care budgets. Heterosexual intercourse is the most common mode of HIV transmission. The impact of HIV infection and AIDS as well as the need for prevention in the developing world are discussed.