Grappling With AIDS Globally

In 1997, the Centers for Disease Control and Prevention (CDC) reported that the number of deaths from AIDS had declined in the United States for the first time since the beginning of the epidemic in the early '80s. Though this decline was attributed to scientific innovation and more effective preventive education, it was also a deceptive indicator of trends in HIV infection in some segments of the population. In fact, the number of HIV cases among women, children and minority groups in the United States continued to rise through 1996.

Inequity, in terms of a particular group's or individual's susceptibility to HIV infection, is a complex issue that involves biology but also economic and social status and cultural biases and taboos. And while these factors are contributing greatly to the rise of HIV in particular groups in the U.S., they are making their presence felt much more greatly in other regions of the world.

Many developing countries are now facing exploding rates of infection that far outstrip those seen in the U.S., both in magnitude and rate of growth. More than 90 percent of all new HIV cases are in developing countries. It was in Manipur, India, in the early 1990s that the fastest growth rate of HIV infection in the world was recorded. Within less than 18 months, rates of infection among the city's intravenous drug users skyrocketed from less than 2 percent to more than 90 percent. India now has more than 5 million cases of HIV, more than any other single nation in the world. Unlike the U.S., where the rates of HIV infection have stabilized, South and Southeast Asia are still in a phase in which the growth in number of infected people is alarmingly steep.

Although they have been affected most severely in recent years, South and Southeast Asia are not alone. Sub-Saharan Africa has battled with HIV for years and still has the largest number of HIV cases as a region. Russia is now experiencing rapid growth in HIV infection, and Eastern Europe, Latin America and China are rapidly joining the ranks of countries severely affected by AIDS.

What makes AIDS especially frightening in the developing world is that the potential for widespread infection is simply astounding, given the vast populations of many of these countries, the relatively low level of literacy and knowledge about HIV, and the lack of financial and human resources through which prevention, treatment and containment programs are administered. The reasons for the rapid rise in HIV cases are as many as the developing countries affected. Among the most important are an inability to recognize the extent of the problem accurately and early, difficulties in devising effective programs to combat AIDS, and a failure to implement programs that have already been developed and even funded.

Three years ago, VISIONS Worldwide Inc., a student organization, was formed to address this rapid rise in AIDS infection, through three principal routes: first, educating students in developing countries; second, empowering local students in these countries to educate their communities, both urban and rural; and third, increasing understanding in the U.S. of the implications of and reasons for the AIDS epidemic in developing countries.

To achieve these goals, VISIONS sends American students to developing countries to share information about HIV and AIDS through creative and interactive educational sessions. They also organize motivated students in these countries to form branches of VISIONS in their communities. The establishment of branches is critical--it makes our impact permanent and it is the means through which we instill in students a strong sense of social responsibility. In the last three years, VISIONS delegates have reached almost 20,000 students through education efforts in India and Nepal; but it is the establishment of two student-run chapters in Bangalore and Mumbai (Bombay), India, that will have the greatest impact on the community. Next summer, we will send four more delegations of students to India, Nepal and Africa.

Although these activities are planting the seeds for eventual self-sufficiency in these areas, assistance from the U.S. and other industrialized nations will be required to effectively counter the global AIDS epidemic. The delivery of effective foreign aid requires an in-depth understanding of the complexities of the epidemic in the developing world. To foster such understanding among populations, the four branches of VISIONS in the U.S., at Harvard, MIT, Tufts and Columbia, organize an annual international conference for students, professionals and leaders of various communities.

That we must understand and address the AIDS crisis in the developing world is clear. Not only are we citizens of the same planet, with humanitarian concern for others; our political and financial interests are also becoming increasingly interdependent. Undoubtedly, the interests of all people are at stake.

Nevertheless, the fact that we need to address concerns abroad does not mean that we should neglect concerns within the country in which we live. In fact, we have reason to be concerned about the situation in the U.S., since not all groups are enjoying the decline in AIDS-related deaths reported by the CDC earlier this year. Here too, VISIONS has sought to promote involvement of students in their local communities. Though its campus chapters, VISIONS has developed a volunteer program through which college students serve the needs of HIV-positive children by acting as Big Siblings. Additionally, we are beginning a peer-education program enabling college students to serve as mentors for high school students in Cambridge and Boston. Peer educators help students develop their understanding of important issues concerning HIV/AIDS, teaching them how to recognize and properly utilize their knowledge in high-risk situations.

So which is more important, addressing AIDS at home or abroad? The answer, of course, is that both are crucial. AIDS is a problem in all societies and at every level in each society; hence, work at a local level is important and must be assumed. But the current state of developing countries demands that much more be done to alleviate the catastrophic future in store for them, and ultimately for the world as a whole. Given the current inefficiencies of developing governments, it seems evident that effective immediate action must come through collaboration with private interests and industrialized nations. Such collaboration will only be possible if the citizens and leaders of developing countries understand the complexities of AIDS and the need for their immediate action.

Achieving this goal requires students in particular to discard their cloaks of complacency and apathy and take an active role in a crisis that will most certainly touch their lives, if not now then certainly in the future.

The ultimate goal of VISIONS Worldwide is to make possible such action, understanding and leadership on an global level. It is to create an informed and motivated population of students and professionals who will act on common understanding and concern to build bridges of trust and cooperation between the people and governments of developing and industrialized countries. And it is through such partnerships that we believe the global AIDS crisis can be addressed most effectively and rapidly.

Vivek H. Murthy '97 is co-founder and president of VISIONS Worldwide Inc., and former co-president of VISIONS Harvard.

"Students must discard their cloaks of apathy and complacency and take an active role in the crisis."