Confronting a calamity: to combat the world's most menacing epidemic, the UN mounts a new joint programme.

• Position: Includes related articles on AIDS information, demographics, vaccine research and sex research - Fight AIDS Worldwide - Cover Story

With a quick smile and flashing eyes, Wingston Zulu of Zambia stood at the threshold of his adult life. it was 1990 and the promise of a scholarship to study abroad had thrown the door to adventure wide open for him.

"We were supposed to go to the Soviet Union in about five days time, so they asked us to go for a quick medical check-up", he told a World Health Organization (WHO) team in Lusaka. That routine examination, however, brought devastating news: Wingston had contracted the human immunodeficiency virus (HIV), which ultimately leads to the crippling acquired immune deficiency syndrome (AIDS).

Unheard of before the late 1970s, the medical condition known as HIV/AIDS now dominates public health concerns in many countries--and can be expected to for years to come. Transmitted primarily through sexual intercourse, HIV erodes a body's defenses, eventually causing a series of AIDS-related illnesses. There is no cure yet for AIDS, and an effective vaccine is unlikely to be ready by the end of this century.

"I couldn't believe it", said 26-year-old Wingston, recalling the day he and his colleagues received their medical test results. "There were seven of us who went and five were found HIV positive."

Those numbers may sound incredible, but they're fast becoming a reality in some parts of the world, especially in Africa. WHO estimates that currently one in four Zambian adults are HIV positive. In some African cities, as many as one third of all people aged 15 to 49 are infected with HIV. Hardest hit are the youth, since 60 per cent of new infections in Africa are among 15 to 24 year olds.

No region untouched

While sub-Saharan Africa and parts of East and South-east Asia present the greatest challenge in the fight against AIDS, no region has been left untouched. "Countries spared the consequences of this epidemic are getting fewer and fewer", Dr. Michael Merson, Executive Director of the WHO Global Programme on AIDS, told the WHO Executive Board on 24 january

To improve efforts to fight the spread of AIDS now and to prepare for increasing numbers of HIV cases, UN agencies agreed to cooperate in a new joint and co-sponsored United Nations programme on HIV/AIDS.

The effort will bring together the work of six UN organizations--who, the UN Children's Fund (UNICEF), the UN Development Programme (UNDP), the UN Educational, Scientific and Cultural Organization (UNESCO), the UN Population Fund (UNFPA), and the World Bank.

A WHO official described the new programme as a "UN family-wide response" to AIDS, which will combine existing efforts in the form of an overall management structure. WHO will administer the joint programme, which will incorporate ongoing activities. The expectation is that the joint programme will strengthen the worldwide fight against AIDS at a country level.

The task these agencies face is considerable. The cumulative total of HIV infections worldwide by late 1993 topped 14 million adults and 1 million children, many of them in developed countries (see map on page 51). WHO projects that by the year 2000, a global total of at least 30 million to 40 million men, women and children will have been infected with HIV since the start of the pandemic. This is a calamity whose dimensions are scarcely comprehensible.

Focusing on numbers alone, though, may only blur the real image of AIDS--that of a child left motherless, a woman who loses her job due to discrimination, a young man who faces not scholastic honour but rejection by his community.

"AIDS isn't just a statistical chart with breakdowns of Africans, Blacks, Hispanics, Haitians, babies and white homosexuals. . . . AIDS violently strikes our bodies and the bodies are of individuals--people living like me", said Ilka Tanya Payan, an HIV-positive actress and member of the New York City Commission on Human Rights, at the World AIDS Day observance at UN Headquarters in New York on 1 December 1993.

A woman from New York who became HIV-infected at age 16 described her emotional stress. "It can be very lonely to be a 23-year-old woman who has friends who are dating and getting married. There are times when you can't sleep or you don't want to get up in the morning", she said quietly.

With a dark curtain of hair pulled back to reveal a lovely, clear face, the young woman looked perfectly healthy. HIV is a "stealth intruder". It may not take visible form for as many as 10 years, leaving both the virus carrier and any of his or her sexual partners unaware of its deadly presence. "The person sitting next to you could be HIV positive", said a man named Simon at an AIDS discussion in Zambia.

Beyond the immediate impact HIV has on infected individuals, those who survive--often children and the elderly--must struggle to cope with...