AIDS: You Haven't Heard Anything Yet

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Until vaccines become available, many doctors urge that a combination of condoms and spermicides be used to prevent sexual transmission of AIDS. Laboratory tests show that nonoxynol-9, the active ingredient in many U.S. spermicides, can prevent the virus from reproducing. A more potent product, under development by Exovir in Great Neck, N.Y., would contain both nonoxynol- 9 and alpha interferon, a combination that compounds the killing effect. Pharmatex, a spermicide sold in Europe and Africa, also appears to inhibit the virus in the test tube.

Still, in the immediate future, education, not medicine, may well be the single most important weapon in stemming the spread of AIDS. Educational campaigns directed at homosexuals, urging them to limit their number of sex partners and adopt "safe sex" practices, have already paid off. A study conducted at the University of California, Berkeley has shown, for example, that the rate of new AIDS infections among gay men in San Francisco fell from an 18% increase each year between 1982 and 1984 to only about 4% in 1985.

U.S. Surgeon General C. Everett Koop wants to take the message to the general public and even into junior high school classrooms. Though his proposal for early education has met with resistance from religious and conservative groups, Koop is insistent. While pushing his program before a gathering of religious broadcasters in Washington, D.C., last week, he declared, "This is not an age for the faint of heart or of soul."

Most health officials believe the Federal Government will have to take a larger role not only in education but in other areas if an AIDS disaster is to be avoided. More drug-treatment centers, and perhaps even programs to give addicts free sterile needles, may be needed to control the rampant spread of AIDS among intravenous drug users. A free needle program has been highly successful in Amsterdam, known as Europe's drug capital.

Government may have to step in where underwriters fear to tread. Of 325 insurance companies surveyed in 1985, 91% refused to issue policies to people who come up positive on the AIDS blood tests. (Many insurance companies are now requiring high-risk applicants to take these tests.) Without insurance, few Americans can handle the estimated $60,000 to $75,000 lifetime cost of treatment for AIDS, and most AIDS patients are not immediately eligible for Medicare or Medicaid. To fill the gap, Senator Ted Kennedy and others in Congress have proposed that all states establish a pool to provide insurance to people who would otherwise not be covered. Nine states already have such programs.

Last week CDC officials announced plans for a public forum to discuss further steps aimed at controlling the epidemic. At issue: whether AIDS blood tests should be made mandatory for couples seeking a marriage license, for women receiving prenatal care, and for people being admitted to hospitals and clinics where sexually transmitted diseases are treated. A premarital test, says Dr. Walter Dowdle, a deputy director of the CDC, "could provide an opportunity for counseling and protect the noninfected potential partner as well as future children."