Global AIDS epidemic worsens

By David Brown
The Washington Post

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The global AIDS epidemic infected and killed more people than ever this year, spreading rapidly in Eastern Europe and gaining a stronger foothold in the huge populations of India and China.

One in five adults in Africa now has HIV, but infection rates fell in a few hard-hit areas of Africa, and large numbers of people on that continent can realistically hope to get state-of-the-art treatment soon.

Those were the twin messages delivered yesterday by UNAIDS — the program run by the United Nations, the World Health Organization and the World Bank — in its annual report on the epidemic.

"So the glass is either half-full or half-empty, however you want to look at it," said Peter Piot, the Belgian physician and epidemiologist who heads UNAIDS. Worldwide, about 40 million people are living with human immunodeficiency virus (HIV) infection. Of that total, 5 million became infected this year, including about 700,000 children. About 3 million people have died of the disease this year, about 500,000 of them children under age 15.

Key facts about HIV/AIDS • AIDS (Acquired Immune Deficiency Syndrome) was first reported in 1981 among homosexual men in the United States. The Human Immunodeficiency Virus (HIV) that causes AIDS was identified by 1984. • AIDS is a syndrome, a combination of illnesses. The HIV virus attacks the immune system and leaves the body vulnerable to a variety of life-threatening diseases. • The HIV virus is found in semen, blood, breast milk and other bodily fluids. It reproduces inside blood cells, which normally protect the body against infection. It is transmitted through sexual contact, blood transfusions, needle sharing, by pregnant women to the fetus and through an infected mother's breast milk to her baby. • There is no known cure but drugs that suppress the replication of the HIV infection have prolonged the lives of sufferers in countries that can afford them. Scientists are also trying to develop a vaccine. An effective, affordable vaccine is considered the best hope of bringing the global epidemic under control. Source: www.unaids.org

Every day, about 14,000 people were newly infected. "It comes down to 10 people a minute," said Piot.

Africa remains the world's most severely affected region, with two-thirds of all infections and more than two-thirds of the deaths.

Worldwide, about $4.7 billion has been spent on AIDS treatment and prevention in the most affected countries this year, about a 50 percent increase over last year, Piot said in a telephone news conference.

Much of the money came from the affected countries. Brazil provides antiretroviral treatment to all citizens who need it, and South Africa announced a similar commitment last week. The Global Fund to Fight AIDS, Tuberculosis and Malaria, in operation since January 2002, has given three rounds of grants to programs in 121 countries, for a total of $2 billion.

Patients are also spending more for their own care, even in poor countries such as Rwanda, where a recent survey found that 80 percent of AIDS treatment is paid for out of pocket, Piot said. Nevertheless, the sum being spent to fight AIDS is less than half the $10 billion a year that an economic commission appointed by the WHO said is necessary for an adequate response.

That is likely to change soon. The new director-general of WHO, Lee Jong Wook, announced in July his intention to help countries and nongovernmental organizations put 3 million AIDS patients on antiretroviral therapy by the end of 2005. WHO will unveil details of its "3 x 5" plan next week.

The Bush administration is drawing the road map for a five-year, $15 billion "emergency relief plan" for AIDS, tuberculosis and malaria in 14 countries of Africa and the Caribbean.

The highest AIDS prevalence rates are in the tiny African nations of Botswana and Swaziland, where about 40 percent of people ages 15 to 49 are infected. Prevalence rates in this year's report are lower than in previous years in a number of countries, but that generally reflects more accurate data, not a true decline, said Karen Stanecki, senior demographer at UNAIDS.

However, in some places infection rates are falling. In Uganda, AIDS prevalence fell for the 12th consecutive year. In the capital city, Kampala, the rate is 8 percent, compared with 30 percent a decade ago. The percentage of pregnant women who are HIV-infected — the most common gauge of the disease's penetration of the general population — has fallen steeply in the capital cities of Rwanda and Ethiopia.

About 230,000 people in the former Soviet Union became infected last year, mostly through intravenous drug use. In one recent survey, 12 percent of Moscow teenagers ages 15 to 18 said they had injected drugs. The epidemic there is spilling into the heterosexual population, with one-third of new infections in the region in women, compared with one-quarter a few years ago.

India's relatively low total of 3 million to 6 million infections masks epidemics in several regions. Five Indian states — which are larger than many countries — have HIV prevalence rates of more than 1 percent in pregnant women. The infection rate in the commercial sex trade is also high, with about half of the prostitutes in Bombay carrying HIV.

In China, as in most places, HIV infection is appearing first in drug users and prostitutes. Up to 80 percent of drug users in Xinjiang, and about 20 percent of addicts in Guangdong, are believed to be infected. Thousands of Chinese peasants were also infected in the 1990s through contact with unsterile equipment when they sold blood to boost their incomes.

In six countries in the Caribbean basin, HIV prevalence in pregnant women exceeds 2 percent. They are the Bahamas, Belize, Dominican Republic, Guyana, Haiti, and Trinidad and Tobago.

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