perinatal transmission continues to have a major impact on infant and child morbidity and mortality among populations with a high HIV seroprevalence. Studies using modified treatment regimens with Zidovudine (AZT), hyperimmune gammaglobulin, vitamin A, vaginal washes, and other means of intervention should be undertaken to determine their overall effectiveness and cost-effectiveness in decreasing HIV perinatal transmission.

MITIGATING THE IMPACT OF THE EPIDEMIC

AIDS will have a large social, psychological, demographic, and economic impact on both individuals and societies. In addition to the physical suffering and grief caused by the disease, AIDS can lead to social and economic hardship, isolation, stigmatization, and discrimination.

As noted above, even if transmission of HIV were halted today, millions of Africans who are currently infected would still develop AIDS and die over the next 10 to 20 years. But transmission has not ceased. To the contrary, evidence from a variety of populations in Africa suggests that seroprevalence either is continuing to climb or has leveled off at discouragingly high levels. For at least the next several decades, the HIV/AIDS epidemic will continue to ravage African prime-age adults and their children with death rates as much as 10 times higher than they would otherwise have been.

Although not immediately visible, the cumulative mortality effects of this ''slow plague" will be substantial. Increases in infant and child mortality will be accompanied by increases in adult mortality and reductions in life expectancy. Population growth will decline more rapidly than expected, and the populations in sub-Saharan Africa in the year 2000, particularly among the countries in the main AIDS belt, will be somewhat smaller than those projected in the absence of AIDS. In many of the worst-afflicted countries, deaths will more than double during the 1990s as compared with the number estimated without AIDS. These additional deaths will put increasing strains on already overburdened health-care systems and on individual households trying to manage with limited economic resources. Care and support for orphans will be a growing concern, and traditional inheritance and other legal rights will be challenged.

Relatively little research has been conducted on the economic consequences of adult morbidity and mortality. AIDS is one of several diseases with potentially great economic significance for developing countries. Diseases such as malaria and measles are far more prevalent in Africa, yet there are reasons to believe that the economic impact of AIDS will be greater. The long incubation period of HIV implies that the economic impact of existing levels of infection would be felt for 10 years or more even if all infection were to cease today. The benefits of averting a case of HIV are very high relative to other diseases.

Whether directed at individuals with AIDS and their households or at other



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