What is not certain, however, is whether all patients infected with HIV will develop full-blown AIDS.
In general, these facts are known. What seems to not be widely understood, however, is that HIV does not discriminate. It is a virus. It cannot discern a homosexual from a heterosexual, a drug-user from a hemophiliac. A married woman possesses no greater protection than a prostitute if both share the same man. Citizens of every country, men of all races, are equal. HIV is a democratic pathogen.
While HIV infection remains somewhat contained within certain American ''high-risk" populations, it threatens not only to destroy those groups but also to become widely disseminated throughout society in the face of continued public ignorance and political neglect. At the most recent international conference on AIDS, in Florence, Italy, several reports re- emphasized that HIV infection is essentially a venereal disease. Heterosexuals remain the largest population pool into which this infection may spread.
The conference also pointed out the endemic nature of HIV and AIDS in the Third World.
Indeed, in Africa and Asia, the burden of heterosexual HIV infection augurs disaster. The World Health Organization estimates that 10 million people in those regions will be HIV positive by decade's end. Most will be heterosexual men and women in their 20s and 30s - their reproductive and economic prime. In addition, the explosion of HIV infection among the region's many prostitutes, coupled with the frequency of interaction, threatens to create a reservoir of infection whose eradication may prove our generation's impossible task.
The occasional report of transmission of HIV from patients to health-care workers and the report of transfer of HIV from a dentist to his patients are an unfortunate reality. Such calamities are the consequence of the need for patients and care-givers, the sick and the healthy, to interact intimately. High standards of confidence and circumspection must therefore guide both patients and those who help them.
What then, are we to do?
First, there must be a concerted effort to disseminate knowledge about HIV and AIDS to all ages and groups. If education is society's attempt to preserve and improve itself, then we and our government must commit wholeheartedly to this act of conservation.
Sexual education, adequate contraception, avoidance of promiscuity, and abstinence are all necessary aspects. Truthfulness and ethical behavior begin with the individual. Intimate relationships require openness. We have more to fear than fear alone, but the battle against disease and ignorance begins with personal responsibility and compassion. Individuals can then apply the knowledge science has to offer.
Second, just as judicious application of limits regulates the private sphere, so, too, must equitable rules be applied in public. Sensible policy will permit public regulation yet encourage private responsibility. Ensure a patient's safety, yet do not create an adversarial health-care system. Permit rapid development of pharmaceuticals and vaccines, but do not overlook safety. Laws must be firm but equitable. Yet laws, especially when quickly conceived, can be dangerous; they can set an economic, political and social precedent that outlives their tenure on the statute books.
Third, there must be a worldwide initiative to understand HIV infection, both scientifically and culturally, to create the means to slow, prevent and eradicate HIV and to employ this knowledge equitably throughout the world. This, however, requires more than research. HIV infection is like famine, despotism and violence, a manifestation of ignorance, and like them requires a new order. The fight against AIDS is only one battle in a larger war the wealthy countries need to wage for and with the developing countries. It is a war for individual liberty: freedom from disease, hunger and strife and freedom to enjoy health, justice and peace. Should Americans desire a leadership role in fashioning the "new world order," this is where we should start.
The specter of HIV and AIDS does frighten. Yet, like other plagues, it can be conquered. It remains only to be seen what cost fear and inaction will exact before we mobilize. As Jonathan Mann, former director of the World Health Organization's program on AIDS, has said: "AIDS has the potential to bring us together if we can thwart those who would use it to drive us apart."