Number of HIV cases highest in India

India has surged ahead of South Africa to become the country with the most people living with the AIDS virus — 5.7 million infections compared with South Africa's 5.5 million, according to a new UNAIDS report issued Tuesday.

The epidemic still remains at its worst in sub-Saharan Africa, where per-capita rates continue to climb in several countries. A third of adults were infected with HIV, the virus that causes AIDS, in Swaziland in 2005. By comparison, India's per capita rate is low, at less than 1 percent.

But the country's large population — more than 1 billion compared with South Africa's 45 million — converts that rate into very high numbers of infected individuals, said Karen Stanecki of UNAIDS.

Some progress is being made there, according to the report. In four of India's 28 states, the infection rate in young pregnant women declined from 1.7 percent to 1.1 percent between 2000 and 2004.

Intensive AIDS prevention efforts among prostitutes and the men who frequent them have pushed down HIV infections dramatically in four south Indian states, Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu.

A recent University of Toronto study in those states credited efforts by authorities and non-governmental groups to educate sex workers. Posters, street-theater performances and educators all share information about AIDS and HIV.

UNAIDS coordinator Dr. Peter Piot, at a news conference in New York on Tuesday, said that while the four Indian states had been investing in HIV prevention, "the rest of the country is a totally different situation. There is an increase in new infections.

UNAIDS findings

• Since the first cases were detected 25 years ago, 65 million people have become infected with the HIV virus and 25 million have died.

• Sub-Saharan Africa remains the hardest-hit region, with about 24.5 million infections.

• In Asia, about 8.3 million were living with AIDS at the end of 2005, more than two-thirds of them in India.

Reuters

"With a huge country like India, what matters is basically work in each and every state," he said.

The total number of HIV cases around the world reached an estimated 38.6 million last year, according to the report. About 4.1 million people were infected in 2005 and 2.8 million died. Those numbers are lower than comparable figures for 2004, but UNAIDS attributed the difference to more accurate reporting rather than a decline in rates.

The rapid growth in global AIDS cases that characterized the first quarter-century of the epidemic is slowing as some regions of the world are showing evidence of bringing it under control, the report said.

"The incidence is increasing, but not at the past rate," said Dr. Paul De Lay, director of evaluation for UNAIDS, the United Nations program on HIV/AIDS. De Lay said the slowdown results from "a massive scale-up of prevention and treatment."

Prevention programs have proved particularly effective in Uganda, Kenya, Zimbabwe, Burkina Faso and Haiti, noted Stanecki, who coordinated data compilation for the 630-page report.

HIV prevalence — the proportion of the population infected — has dropped by more than a quarter in those areas among people ages 15 to 24. She attributed the declines to increased condom use, less casual sex and a delay in the beginning of sexual activity.

"This is the first time we have really seen that outside of Uganda," said Dr. Mark Dybul, acting U.S. global AIDS coordinator. "There has been a dramatic partner reduction among young people."

Treatment of AIDS victims in low- and middle-income families has increased significantly as a result of the U.N.'s "3 by 5" program to treat 3 million people by the end of 2005. Although the program didn't reach its goal, the number of people receiving antiretroviral drugs increased to nearly 1.5 million, compared with 240,000 in 2001.

One area where treatment has failed is pregnant women, according to the report. Mother-to-child transmission of HIV infections can be blocked with a relatively cheap drug regimen, and UNAIDS had hoped to reach 80 percent of all pregnant women with the 3 by 5 program.

Instead, about 9 percent of pregnant women are receiving the drugs. Stanecki partially attributed the low rate to the stigma associated with the disease. "A young woman who appears healthy and is pregnant simply does not want to reveal her condition to her family," she noted.

The report was issued on the eve of a three-day U.N. conference on AIDS in New York that begins today. The 25th anniversary of the discovery of AIDS is Monday.

Details of AIDS campaigns in India were reported by The Associated Press.