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THE CONTINENT of Europe is experiencing two kinds of AIDS epidemic.
The one in the West still affects mostly homosexual men and an increasing
number of heterosexuals who are intravenous drug users. The epidemic in
Eastern Europe is at a much earlier stage than it is in the West yet, despite
attempts to limit the spread of the AIDS virus by placing strict controls
on foreigners, the virus has already become established in the general population
there.

Last month, at a meeting organised by the World Health Organization
in Moscow, researchers from all over Europe discussed ways to pool their
knowledge of the spread of AIDS across the Continent. They could help to
ensure that the lessons learnt in the West contribute to limiting the spread
of the disease in the Soviet Union and the rest of Eastern Europe.

Some countries in both Eastern and Western Europe have begun far-reaching
programmes of surveillance of their populations to track the spread of HIV,
which causes AIDS. But until now, data assembled at the European headquarters
of the WHO in Copenhagen have related solely to cases of full-blown AIDS.

At last month’s meeting, European governments agreed to extend this
reporting to include cases of infection with HIV – people who are HIV positive.
This could dramatically improve epidemiologists’ understanding of the spread
of the virus.

The chairman of the Moscow meeting, Lars Olof Kallings, a scientific
adviser to the Swedish government, said: ‘AIDS is the final phase of a very
long infection. It takes 5, 10 or 15 years to develop after the initial
infection. To count the number of AIDS cases and make statistics of AIDS
cases does not mirror the present situation. It is almost of historical
interest because it depicts what happened in the 1970s and beginning of
the 1980s, so it is important to focus on HIV infection.’

Western Europe’s epidemic, he said, is a little behind those in the
US and Africa. ‘This has given us some time to prepare. And for some Eastern
European countries where AIDS is even more recent, such as the Soviet Union,
there are even more years to prepare.’

Kallings said that countries in Eastern and Western Europe should cooperate
on serosurveillance – the testing of blood for antibodies for HIV. ‘We have
now come forward with firm recommendations on how to perform serosurveillance,’
he said. ‘Up to now, it has been done in different fashions and without
proper structuring so the results have not always been very useful. Serosurveillance
must be done in a scientifically sound way.’

One issue remained unresolved at the meeting in Moscow. There was no
consensus on the ethical issue of whether serosurveillance should be completely
anonymous. For anonymity, all identifying details would be stripped from
the samples of blood being tested. Some countries, such as Britain, have
accepted the need for complete anonymity, because this is the only way to
address the arguments against testing people without their consent.

Other countries, particularly in the Eastern bloc, argue that the rights
of society at large outweigh those of the individual. These countries prefer
a form of so-called anonymous screening where the results can be linked
to those people who are found to be infected with HIV. Elsewhere in Eastern
Europe, the health authorities conduct compulsory screening. In this way,
governments can identify the carriers of HIV and, they believe, take appropriate
action to prevent the spread of the virus.

The Soviet Union has deported hundreds of foreigners after identifying
them as carriers of HIV. For some years, the nation’s authorities believed
this is the best way of limiting the spread of HIV. But the practice appears
increasingly futile in the light of the rising number of Russians who have
become infected with HIV.

One of the Soviet Union’s leading AIDS specialists, Valentin Pokrovsky,
the president of the Academy of Medical Sciences, said at the Moscow meeting
that 176 Soviet citizens are known to be infected with HIV. This compares
with about 378 infected foreigners who have at some time lived in the Soviet
Union.

The USSR reported its first HIV-positive citizen in 1987. Since then,
the number of official cases has increased sharply. Last year, there were
81 new infections and, in the first few weeks of this year, the health authorities
have reported more than 60 infected people. Most are children who became
infected as a result of doctors using dirty syringes at a hospital in Elista
near the Caspian Sea .

Pokrovsky believes that HIV has been present in the USSR for longer
than the official statistics suggest. ‘The arrival of the first detected
(infected) foreigner in the USSR dates back to 1980, and the first of all
reported HIV-infected Soviet citizens was probably infected in 1981,’ he
said.

Since 1987, the Soviet health authorities have undertaken a massive
programme of screening. Last year, more than 18 million Soviet citizens
(roughly 6 per cent of the country’s population) had a test for HIV infection.
The results explain why epidemiologists classify the epidemic in the Soviet
Union and the rest of Eastern Europe as being different from the epidemic
in Western Europe.

Tests on 19 000 Russian homosexuals revealed just two who were positive
for the virus. In Western Europe, various studies indicate that between
10 per cent and more than 50 per cent of some homosexual groups are infected.

Out of more than 120 000 drug users in the Soviet Union who were tested,
none has been found to be positive. In Western Europe, this group is one
of those at highest risk of HIV infection.

In parts of southern Europe, notably Spain and Italy, and southern France,
drug users are at greater risk of HIV infection than homosexuals. Furthermore,
the WHO has discovered that the penetration of HIV into these groups has
been very sudden and very dramatic.

In September 1984, about 1 per cent of the total number of cases of
AIDS in Europe were intravenous drug users. Four years later, they accounted
for about one-quarter of all cases. Researchers are worried that this surge
in cases represents only what happened several years ago, because of the
long time-lag between infection with HIV and the appearance of symptoms
of AIDS.

In the USSR, the groups at highest risk of HIV are the children and
heterosexual partners of people infected with HIV, and recipients of infected
blood. In these groups, Soviet health authorities found 37 infected people
out of a total of 510, representing a level of infection of 7.2 per cent.

Doctors in the Soviet Union have tested some 4 million pregnant women
and found only six to be HIV positive, Pokrovsky said. This amounts to a
level of infection with HIV of just 0.00015 per cent. ‘This programme does
not appear to be cost-effective, therefore,’ he said.

‘Far fewer Soviet citizens, about 19 000 people, were tested anonymously
and this identified four carriers of the virus. This means that (anonymous
testing) is 1400 times more effective than the examination (testing) of
pregnant women, as it covers groups at risk which are usually inaccessible
to testing.’

Not the least striking contrast between the two halves of Europe is
that there are almost equal numbers of males and females in the USSR who
are infected with HIV. In countries such as Britain and France, there are
about 10 infected males to every infected female.

Sieghart Dittmann, a professor at East Germany’s Central Institute of
Hygiene, Microbiology and Epidemiology in East Berlin, has studied the HIV
epidemic in Eastern Europe. ‘The prevalence of HIV infection in high-risk
behaviour groups is very low and practically zero in the general population,
but the virus is present in these areas and evidence of within-country spread
of HIV is increasing,’ he said.

This pattern is typical of countries where the virus is a newcomer and
where there is still no clear epidemiological picture, Dittmann said. In
Czechoslovakia, two people suspected of having AIDS died in 1983 and 1984.
This was before it was possible to test specifically for HIV and confirm
their infection.

‘When serological tests became available, the first HIV-positive people
were detected in Eastern European countries in 1985. In 1986, the first
AIDS cases occurred in Bulgaria, Czechoslovakia, East Germany, Hungary,
Poland, Rumania and the USSR, Dittmann said. ‘The assumption is justified
that HIV had spread – though in very small amounts – in countries of Eastern
Europe since the beginning of the 1980s.’

In the USSR, Dittmann said, the major source of HIV infection was heterosexual
contact with infected foreigners, but, for the rest of Eastern Europe, visiting
homosexual Westerners first brought HIV.

‘By now, HIV infection has become an indigenous infectious disease in
countries of Eastern Europe and transmission – though on a small scale –
is going on in the populations of these countries.’

HIV may be a relative newcomer to the countries of Eastern Europe, and
it may not be spreading in the same pattern as in the West, but it is clear
that Eastern Europe can no longer say that AIDS is a capitalist disease.
HIV is clearly a problem for all Europeans.

* * *

How babies infected their mothers with the virus

SCIENTISTS are now able to trace the events that led to a mysterious
outbreak of HIV infection at a hospital in Elista in the southern Soviet
republic of Kalmykiya near the Caspian Sea. Earlier this year, virologists
reported that nearly 30 children and a handful of mothers had become carriers
of HIV. Now, the figure has risen to nearly 40 children and eight mothers.

It all began in 1981, when a Soviet man returned home from work in Congo.
Unknown to him, he had become infected with HIV. During an interview this
year with scientists, he denied having sexual intercourse while he was away.
He said that he had received injections that could have led to his infection.

Between 1981 and 1988, the man infected his wife through sexual contact,
and she gave birth in 1988 to a child who was subsequently found to be infected
with HIV. The child became ill, perhaps but not necessarily because of infection
with HIV, and was admitted to the hospital in Elista in May last year.

The child subsequently died, but not before its blood had contaminated
syringes and catheters that were subsequently used on other children in
the hospital without first being sterilised. In this way, HIV spread rapidly
to at least 40 children during the summer of 1988.

The virus spread to a second hospital when children from the first hospital
were transferred there. Again, dirty syringes and medical equipment exacerbated
the problem. The most intriguing aspect of this story, however, is that
some of the children were responsible for passing the virus on to their
mothers during breast-feeding. In this region of the USSR, women regularly
breast-feed their children up to the age of two years.

Vadim Pokrovsky, the head of a laboratory specialising in AIDS in Moscow,
and son of Valentin, the president of the Academy of Medical Sciences, said
that the virus was transmitted by blood-to-blood contact. The children had
mouth infections that led to bleeding from the gums. The mothers had cracked
nipples. Given that the children were also old enough to bite their mothers,
this combination of events meant that the virus could be transferred from
child to mother, Vadim Pokrovsky said.

He has found that eight of the women with children at the hospital have
developed antibodies to HIV, though none of their husbands has yet become
HIV positive.

Soviet epidemiologists have tested nearly 20 000 people in the region
of Kalmykiya and have found just two other people who are HIV positive.
One was a blood donor, and the other had clinical signs of AIDS.

Valentin Pokrovsky said that this showed that HIV has not spread to
the general population as a result of the epidemic at Elista. The scientists
hope to publish a full account of their work on the Elista outbreak later
this year.