Jan. 25, 2002 -- What's the worst plague the human race has ever seen? Is it the Black Death of the middle ages -- or today's AIDS?
Black Death -- bubonic plague -- wiped out a third of Europe's population in six terrible years. Over the next century, it killed 40 million people as it spread across the globe.
AIDS already has killed 25 million. About 40 million people carry the AIDS virus -- an almost certain death sentence for the 38 million who can't afford new AIDS drugs. And every hour there are 600 new infections.
What's the worst form of terrorism on earth? About 3,000 people died in the Sept. 11 attacks. Every day, about 8,000 people die of AIDS.
Is it fair to make these kinds of comparisons?
Yes, says Peter R. Lamptey, MD, DrPH, head of the nonprofit Family Health International AIDS Institute, Arlington, Va. In the Jan. 26 issue of the British Medical Journal, Lamptey says AIDS soon will rank as mankind's greatest scourge. And while 14th-century medicine had nothing to offer plague victims, 21st-century medicine doesn't get to 95% of people with AIDS.
"It is a serious comparison," Lamptey tells WebMD. "A total of 65 million people will have died of AIDS over 15 years. The Black Death happened 700 years ago when science was negligible. Yet despite our modern technology, today we have a disease that is killing a vast number of people. The diseases are similar because of the vast scope of death, the destruction of families, and the destruction of the economies of nations."
The comparison may not be entirely fair, says Randall M. Packard, PhD, chairman of the history of science, medicine, and technology department at Johns Hopkins University. He warns that it might lull us into thinking that AIDS, like the Black Death, is a thing far away and long gone.
"Most people today don't have a clue what the Black Death was all about," Packard tells WebMD. "Projecting them back into the 14th century isn't very helpful. The realities are very different. This isn't how we should limit our thinking about AIDS. It is not just people dying, it is the impact on society. AIDS is much less dramatic and much more extensive and complex."
This is precisely the point Lamptey makes in his article. He notes that an AIDS vaccine remains a pipe dream, that there is no cure in sight, and that the epidemic rages on. The only hope, he says, is preventing new infections. To do this will require a hard look at some facts:
- Unprotected sex between men and women is the most common way AIDS is spread.
- Rampant sexually transmitted diseases speed the spread of the AIDS virus. Few people in poor nations get proper treatment for these infections.
- Only one in 10 people infected with HIV know they carry the virus.
- Lack of access to AIDS drugs means that people with HIV infection will die. This increases the stigma of being infected -- and makes it less likely people will get tested.
- With no hope of access to treatment, there is little incentive to get an HIV test.
"I believe treatment access is necessary for effective prevention," Lamptey says. Why? He lists several reasons:
- Treatment access will convince more people to be tested.
- The counseling that goes with treatment reduces risky behavior.
- When people have hope, they are more realistic about changing their behavior. "Now people say, 'Look, it is a lost cause,' and nothing can be done, Lamptey says.
- Treatment will help reduce the stigma of having HIV infection. This would greatly help prevention efforts.
- Although not proven, it is likely that treatment will make a person with HIV less likely to spread the virus to others.
Of course, there's price tag attached.
"What we estimate is needed to make a difference is $8-10 billion per year for prevention and some treatment," Lamptey says. "The global ADS fund now has a commitment of $1.5 billion, including $200 million from the U.S. That will not make any significant difference at all. Well, it is a start, but it will not stop this epidemic."
President Bush proposes adding another $48 billion to the U.S. defense budget in the war on terrorism. Is AIDS the same kind of priority?
"Nobody should underestimate terrorism," Lamptey says. "But AIDS is killing a lot more people. We should not forget that AIDS will be around for a long time and will continue to kill people. The epidemic in Africa will eventually affect the whole global village. The comparison with the military budget tells us something. It shows us -- the human race -- that we should be spending more money on improving the lives of people than on defending us from ourselves."