The Coming Plague (138 page)
Authors: Laurie Garrett
96
As of March 1990 the Eastern bloc had officially reported cumulative AIDS cases and other related findings as follows:
| GDR (East Germany) | 277 AIDS cases. Government reports a rise in heroin use since the fall of the Wall. |
| Czechoslovakia | 19 AIDS cases |
| Hungary | 32 AIDS cases. Homosexual groups given government approval January 1, 1990, to begin AIDS education campaigns. |
| Albania | 0 AIDS |
| Soviet Union | 18 AIDS cases. 30 million people allegedly HIV-tested since 1987, of whom 722 were found to be positive. |
| Romania | 74 AIDS cases (50 babies). In addition, 799 of 2,850 children tested are HIV-positive. |
| Poland | 348 AIDS cases. Government reports sharp increase in heroin in the country since the fall of the Wall. |
| Bulgaria | 10 AIDS cases. Total of 2.75 million tested, 23 found HIV-positive. |
97
L. Garrett, “AIDS in Eastern Europe: Tragedies Out in the Open,”
Newsday
, March 6, 1990: 1.
Newsday
, March 6, 1990: 1.
98
Trud
investigators estimated that 6 billion injection/withdrawal procedures were performed each year, but only 45 million sterile syringes were manufactured. Thus, each syringe was reused an average of 133 times.
investigators estimated that 6 billion injection/withdrawal procedures were performed each year, but only 45 million sterile syringes were manufactured. Thus, each syringe was reused an average of 133 times.
99
Vadim Pokrovsky headed up the Specialized Research Laboratory on AIDS, located in Moscow. His father, Valentin, was head of the National Virology Institute in Moscow, President of the Soviet Academy of Sciences, and an early pioneer in AIDS research in that country. Their names were often confused in Western press accounts.
100
Based on data compiled by the Russian State Committee on Sanitary and Epidemiologic Surveillance, the Russian Republic Information and Analytic Center, and Science magazine [“Resurging Infectious Diseases in Russia,”
Science
261 (1993): 415], disease rates soared between May 1992 and May 1993:
Science
261 (1993): 415], disease rates soared between May 1992 and May 1993:
101
A. V. Yablokov, “The Need for a New Approach to Definition of Priority Health Problems of Populations of the Russian Federation,” address to the Security Council, March 17, 1993.
102
E. Taylor, C. P. Besse, and T. Healing, “Tuberculosis in Siberia,”
Lancet
343 (1994): 968.
Lancet
343 (1994): 968.
103
Centers for Disease Control, “Diphtheria OutbreakâRussian Federation, 1990â1993,”
Morbidity and Mortality Weekly Report
42 (1993): 840â47; World Health Organization, “Diphtheria in the Former Soviet Union: The Epidemic Continues,” Press Release WHO/70 (September 10, 1993); C. Bohlen, “Diphtheria Epidemic Sweeps Russia,”
New York Times
, January 29, 1993: A12; and S. Erlanger, “Diphtheria Afflicting Russia, Kills 100 This Year,”
New York Times,
August 22, 1993: A8.
Morbidity and Mortality Weekly Report
42 (1993): 840â47; World Health Organization, “Diphtheria in the Former Soviet Union: The Epidemic Continues,” Press Release WHO/70 (September 10, 1993); C. Bohlen, “Diphtheria Epidemic Sweeps Russia,”
New York Times
, January 29, 1993: A12; and S. Erlanger, “Diphtheria Afflicting Russia, Kills 100 This Year,”
New York Times,
August 22, 1993: A8.
104
J. Lumio, M. Jahkola, R. Vuento, et al., “Diphtheria After Visit to Russia,”
Lancet
342 (1993): 53â54; and A. Dezoysa, A. Efstantious, R. C. George, et al., “Diphtheria and Travel,”
Lancet
342 (1993): 446.
Lancet
342 (1993): 53â54; and A. Dezoysa, A. Efstantious, R. C. George, et al., “Diphtheria and Travel,”
Lancet
342 (1993): 446.
105
For details on the Romanian cases, see C. Bohlen, “Romania's AIDS Babies: A Legacy of Neglect,”
New York Times
, February 8, 1990: Al; A. Purvis and M. Hornblower, “Rumania's Other Tragedy,”
Time,
February 19, 1990: 74; 1. V. Patrascu, St. N. Constantinescu, and A. Dublanchet, “HIV-1 Infection in Romanian Children,”
Lancet
I (1990): 672; World Health Organization, “World Health Organization Announces Emergency AIDS Action Plan for Romania,” Press Release WHO/10/ 16 February 1990; S. Dickman, “AIDS in Children Adds to Romania's Troubles,”
Nature
343 (1990): 579; L. Garrett, “The Baby Experiments,”
Newsday
, October 28, 1990: 7; and J. Pope, “Tulane Probing Doctor's Role in AIDS Test,”
Times-Picayune
(New Orleans), October 30, 1990: Al, A6.
New York Times
, February 8, 1990: Al; A. Purvis and M. Hornblower, “Rumania's Other Tragedy,”
Time,
February 19, 1990: 74; 1. V. Patrascu, St. N. Constantinescu, and A. Dublanchet, “HIV-1 Infection in Romanian Children,”
Lancet
I (1990): 672; World Health Organization, “World Health Organization Announces Emergency AIDS Action Plan for Romania,” Press Release WHO/10/ 16 February 1990; S. Dickman, “AIDS in Children Adds to Romania's Troubles,”
Nature
343 (1990): 579; L. Garrett, “The Baby Experiments,”
Newsday
, October 28, 1990: 7; and J. Pope, “Tulane Probing Doctor's Role in AIDS Test,”
Times-Picayune
(New Orleans), October 30, 1990: Al, A6.
106
N. Beldescu, presentation to the Sixth International Conference on AIDS, San Francisco, June 19â23, 1990. (Not formally on the conference agenda.)
107
B. S. Hersh, J. M. Oxtoby, F. Popovici, et al., “Acquired Immunodeficiency Syndrome in Romania,”
Lancet
338 (1991): 645â49.
Lancet
338 (1991): 645â49.
108
J. Knowles, “The Responsibility of the Individual,” in
Doing Better and Feeling Worse: Health in the United States
, Special Issue of
Daedalus,
1977.
Doing Better and Feeling Worse: Health in the United States
, Special Issue of
Daedalus,
1977.
109
J. B. McKinlay and S. M. McKinlay, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century,”
Milbank Memorial Fund Quarterly
, Summer 1977; D. Fife and C. Mode, “AIDS Incidence and Income,”
Journal of Acquired lmmune Deficiency Syndromes
5 (1992): 1105â10; New York State Department of Health, “AIDS in New York Stateâ1992,” Public Affairs Group, Albany, NY, 1993; and Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences. National Research Council, “The AIDS Epidemic in the Second Decade,” Chapter 1 in H. G. Miller, C. F. Turner, and L. E. Moses, eds.,
AIDS: The Second Decade
(Washington, D.C.: National Academy Press, 1990).
Milbank Memorial Fund Quarterly
, Summer 1977; D. Fife and C. Mode, “AIDS Incidence and Income,”
Journal of Acquired lmmune Deficiency Syndromes
5 (1992): 1105â10; New York State Department of Health, “AIDS in New York Stateâ1992,” Public Affairs Group, Albany, NY, 1993; and Committee on AIDS Research and the Behavioral, Social, and Statistical Sciences. National Research Council, “The AIDS Epidemic in the Second Decade,” Chapter 1 in H. G. Miller, C. F. Turner, and L. E. Moses, eds.,
AIDS: The Second Decade
(Washington, D.C.: National Academy Press, 1990).
110
A private survey forecast 80,000 children under age eighteen would be AIDS orphans by the year 2000. See D. Michaels and C. Levine, “Estimates of the Number of Motherless Youth Orphaned by AIDS in the United States,”
Journal of the American Medical Association
268 (1992): 3456â61.
Journal of the American Medical Association
268 (1992): 3456â61.
The researchers made high and low estimates of the New York City orphan problem as follows:
| Cumulative Number | ||
| Year | Low Range | High Range |
|---|---|---|
| 1991 | 15,200 | 22,000 |
| 1995 | 39.200 | 56,700 |
| 2000 | 72,000 | 125,000 |
111
According to Harvard School of Public Health economist Kathy Schwartz, U.S. medical insurance/noninsurance broke down in 1990 as follows:
Completely Uninsured Population: 37 million people
(29%) 10.7 millionâbelow poverty
a
incomes
(20%) 7.4 millionâincomes 100â199% above poverty
(18%) 6.6 millionâincomes 200â300% above poverty
(22%) 8.1 millionâincomes 300% above poverty
a
incomes
(20%) 7.4 millionâincomes 100â199% above poverty
(18%) 6.6 millionâincomes 200â300% above poverty
(22%) 8.1 millionâincomes 300% above poverty
26% were children under 17
25% were 18â24 years of age
10% were 45â54 years of age
7% were 55â64 years of age
25% were 18â24 years of age
10% were 45â54 years of age
7% were 55â64 years of age
60% of adults were employed
Underinsured Population:
40 million people
40 million people
Chronically Uninsured Population:
3â5 million people
3â5 million people
Reinhardt estimated that in 1987 Americans spent $500 billion on health care, or 11.1 percent of the GNP.
According to the U.S. government's Health Care Financing Administration (HCFA), health care spending as a percentage of U.S. GNP rose steadily between 1975 and 1987; from 8.3 percent of GNP in 1975 to 11.1 percent in 1987.
Between 1980 and 1987 actual health care expenditures, in all forms, leapt from about $641.9 billion to $1,306,600,000,000, or $1.3 trillion. That was a 181.5 percent increase in seven years, making health care the most rapidly inflating sector of the U.S. economy, and U.S. health care the most inflationary of any industrialized nation.
See U. E. Reinhardt, “The United States: Breakthroughs and Waste,”
Journal of Health Politics, Policy and Law
17 (1992): 637â66.
Journal of Health Politics, Policy and Law
17 (1992): 637â66.
112
The American Hospital Association estimated that 14 percent of American hospitalsâall of them large teaching facilities and public institutionsâhandled 80 percent of all inpatients in the United States in 1988.
113
B. Lambert, “One in 61 Babies in New York City Has AIDS Antibodies, Study Says,”
New York Times
, January 13, 1988: Al; and L. F. Novick, ed., “New York State Seroprevalence Project,”
American Journal of Public Health
(Supplement) 81 (1991): 1â61.
New York Times
, January 13, 1988: Al; and L. F. Novick, ed., “New York State Seroprevalence Project,”
American Journal of Public Health
(Supplement) 81 (1991): 1â61.
114
P. S. Rosenberg, R. J. Biggar, and J. J. Goedert, “Declining Age at HIV Infection in the United States,”
New England Journal of Health
330 (1993): 789; and T. A. Green, J. M. Karom, and O. C. Nwanyanwu, “Changes in AIDS Incidence Trends in the United States,”
Journal of Acquired lmmune Deficiency Syndromes
5 (1992): 547â55.
New England Journal of Health
330 (1993): 789; and T. A. Green, J. M. Karom, and O. C. Nwanyanwu, “Changes in AIDS Incidence Trends in the United States,”
Journal of Acquired lmmune Deficiency Syndromes
5 (1992): 547â55.
115
R. Gorter, R. Meakin, A. Keffelew, et al., “Homelessness and HIV Infection: A Population Based Study,” presentation to the Seventh International Conference on AIDS, Florence, June 16â21, 1991.
116
Again, absent the impact of AIDS, racial disparities in health were glaring throughout the United States. Consider the following (1988) data:
⢠White babies were 70 percent more likely than black babies to survive to age four.
⢠Average life expectancies (genders combined) for whites were 76 years, blacks 70.3 years.
⢠Black men were 50 percent more likely to die of heart attacks than their white counterparts.
⢠Black children were three times more likely than whites to die of pneumonia or meningitis due to an assortment of microbial infections.
⢠Thirty-three percent of blacks lived below the official poverty line, compared to 12 percent of whites.
⢠Infant mortality was 9.2 per 1,000 live births for whites, but 18 per 1,000 for blacks.
⢠Fifty percent of black women received a first breast cancer diagnosis after the malignancy had become untreatable, compared with 8 percent of white women.
⢠Between a third to a half of all black men in the United States (rates vary geographically) were unemployed, a rate at least 10 percent higher than the general rate during the Great Depression.
⢠More black men died as a result of homicide in the United States in 1977 than did fighting for over ten years in the Vietnam War.
See J. Taylor Gibbs, ed.,
Young, Black and Male in America: An Endangered Species
(Berkeley, CA: Auburn House, 1988).
Young, Black and Male in America: An Endangered Species
(Berkeley, CA: Auburn House, 1988).
117
The 1990 U.S. Census revealed that half of the nation's five million divorced single mothers were not receiving court-ordered child support payments because the fathers were delinquent: the majority of these women and children ended up among the nation's officially counted impoverished citizens.
See 1993 annual reports of Second Harvest, the Urban Institute, and Food Research and Action Center. See also 1990 U.S. Census Report; R. Pear, “Poverty in U.S. Grew Faster Than Population Last Year,”
New York Times
, October 5, 1993: A20; D. Wallace, “Poverty and Disease in the USA,”
Lancet
343 (1993): 238â39; J. Freedman,
From Cradle to Grave: The Human Face of Poverty in America
(New York: Atheneum, 1993); and E. L. Bassuk, “Homeless Families,”
Scientific American
, December 1991: 66â74.
New York Times
, October 5, 1993: A20; D. Wallace, “Poverty and Disease in the USA,”
Lancet
343 (1993): 238â39; J. Freedman,
From Cradle to Grave: The Human Face of Poverty in America
(New York: Atheneum, 1993); and E. L. Bassuk, “Homeless Families,”
Scientific American
, December 1991: 66â74.
118
Institute of Medicine,
Homelessness, Health, and Human Needs
(Washington, D.C.: National Academy Press, 1988); Committee on Public Health, “Housing and Health: Interrelationship and Community Impact,”
Bulletin of the New York Academy of Medicine
66 (1990): 379â591; and S. L. Neibacher, ed., “Homeless People and Health Care: An Unrelenting Challenge,” United Hospital Fund, Paper Series 14 (December 1990), New York.
Homelessness, Health, and Human Needs
(Washington, D.C.: National Academy Press, 1988); Committee on Public Health, “Housing and Health: Interrelationship and Community Impact,”
Bulletin of the New York Academy of Medicine
66 (1990): 379â591; and S. L. Neibacher, ed., “Homeless People and Health Care: An Unrelenting Challenge,” United Hospital Fund, Paper Series 14 (December 1990), New York.
119
R. Rosenheck, L. Frisman, and A. M. Chung, “The Proportion of Veterans Among Homeless Men,”
American Journal of Public Health
84 (1994): 466â69; and Institute of Medicine (1988), op. cit.
American Journal of Public Health
84 (1994): 466â69; and Institute of Medicine (1988), op. cit.
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