Health Enter the Aids Pandemic

After the first cases appeared in the U.S. nearly a decade ago, the public generally assumed that victims of AIDS would be confined to certain well- defined "risk groups," notably homosexuals and intravenous drug users. But there is an ever growing body of medical evidence that almost everyone is vulnerable to the mysterious, deadly and so far incurable disease. Last week produced the most frightening prediction yet. By 1990, warned the World Health Organization, the number of people infected by the AIDS virus worldwide could reach 100 million. Not all of them would become fatally ill, but they would nonetheless be carriers.

What faces the world's population, said Dr. Halfdan Mahler, the Danish director of WHO, is a "health crisis of pandemic proportions." Meeting it, he said, will require expenditures of $1.5 billion a year by the start of the 1990s for a massive global public-health program. In the past five years, there have been an estimated 100,000 AIDS cases throughout the world, most of them in North America, Africa and Western Europe. One million people are currently suffering from AIDS-related disorders. Moreover, as many as 10 million have been infected with the AIDS virus and are capable of spreading the disease. Most experts agree that the real statistics for Africa, where the disease is spread principally by heterosexual intercourse, may be far greater than has been reported. In the U.S., a total of more than 28,000 AIDS cases have been reported, an increase of more than 10,000 since Jan. 1. The U.S. Public Health Service has predicted that the number of cases will increase to 270,000 by 1991, by which time 179,000 of the victims will have died.

The first effective anti-AIDS vaccine could come into use by 1990 at the earliest, WHO officials believe. The $1.5 billion a year that the Geneva-based United Nations agency will need by then to fight the disease will be three times the organization's current annual budget. Put another way, the cost of the battle will be five times as great as the amount WHO spent between 1967 and 1977 in its successful campaign to eradicate smallpox.

The campaign has started slowly, in part because only the U.S. and a handful of West European nations have so far contributed to the program. In addition, a number of countries in both the East and the West have been reluctant to participate, either because they did not think they had a serious AIDS problem or possibly out of a misplaced sense of national pride. But that reluctance is fast disappearing. At a WHO conference this month in the Congo, a number of African governments, alarmed at the enormity of the crisis, agreed for the first time to join in.

WHO plans an elaborate campaign of education for interested government agencies, health workers and social scientists, Mahler said. The effort will include a global system for sharing information among scientists and a research program to study drugs, vaccines and other preventive measures.

Mahler admitted last week that he, like almost everyone else, had been slow to grasp the seriousness of the crisis. "Everything is getting worse and worse in AIDS, and all of us have been underestimating it, and I in particular," he told the New York Times. "I don't know of any greater killer than AIDS."

President Jose Sarney of Brazil is a head of state by happenstance: he inherited his post in April 1985 from Tancredo de Almeida Neves, who died before taking office. Sarney, 56, last week received a mandate of his own. His center-left Brazilian Democratic Movement Party (P.M.D.B.) won a landslide victory that gave it majority control of the 559-member congress and at least 20 of the country's 23 state governorships. The outcome ensured that the P.M.D.B. will also have a dominant voice when legislators draft a new constitution next year.

Last week's turnout for Brazil's first nationwide general election after 21 years of military rule was a tribute to the country's long-suppressed commitment to democracy. Some 69 million voters, or 95% of those registered, cast their ballots. That showing was a record even in a country where voting is compulsory. In working-class neighborhoods in Sao Paulo, residents waited up to an hour in midday heat for the chance to vote.

The outcome was also a testament to Sarney's growth-oriented economic policies. Beginning last February, he braked an inflation rate that had been nearing 250% by freezing prices and introducing a new currency called the cruzado. Said Sarney: "This is a victory for the Cruzado Plan," as his policies are called. But the plan generated a surge in consumer spending without a corresponding increase in investment, and has recently produced signs of renewed inflation, which the government now estimates to be running at an annual rate of 10.2%. After the election, the government announced a new set of tax increases to help cool the economy.

Sarney intends to continue his push for a more equal distribution of Brazilian wealth. The P.M.D.B. pledged during the campaign to push for a higher level of government spending for health, education and other social programs. In 1983 the richest 10% of Brazilians owned nearly half the country's wealth, while the poorest 50% owned just 14%. Sarney hopes the combination of increased government outlays and the Cruzado Plan, with its price freeze and wage hikes for workers, will help change that.

Ironically, Sarney's very success could gradually limit his power. The ambitious new politicians who will now take their seats in congress and state governors' mansions are already jockeying for position within the P.M.D.B. It may not be long before the boldest among them begin to challenge Sarney's authority.