Chicago Tribune - November 27, 2002
Jeremy Manier, Tribune staff reporter

The figures also present a stark warning about the swift inroads the deadly disease is making among millions of heterosexual victims from China--where officials fear there could be 10 million cases within a decade--to Africa.

HIV has so thoroughly devastated parts of southern Africa that it is amplifying the effects of an already urgent food crisis, with up to 60 percent of farms reporting some loss of agricultural workers to AIDS, according to the UN report released Tuesday.

Most of the disease's spread in Asia is coming from heterosexual contact and intravenous drug use, adding to concerns that the toll there could climb rapidly.

"We are far away from the gay white men's disease [AIDS] used to be," said Peter Piot, executive director of the UN program UNAIDS. "Heterosexual transmission is on the rise in just about every continent."

Amid the worsening crisis of a disease that infects 42 million worldwide, the new report offers signs of hope that some prevention efforts are working. In Cambodia, rates of HIV infection among prostitutes have fallen steadily since 1998 as their use of condoms has increased.

Some infection rates down

Infection rates among young mothers in South Africa edged down in the last three years from 21 percent to about 15 percent, an improvement experts traced to more young people delaying their first sexual activity, limiting their number of sexual partners and using condoms.

Yet even such gains have come at a cost, said Dr. Desmond Johns, a South African physician who has represented his country at international AIDS conferences. A major reason AIDS education may be sinking in among young South Africans, Johns said, is "the reality of seeing their peers die."

"Saturday used to be a day for weddings in South Africa," said Johns, director of UNAIDS's New York office. "Now it's a day for funerals for young people."

Simple biology is source

One source of the increase in women's HIV numbers is simple biology. Researchers have long known that because of the way fluids are exchanged during sex, it's easier for women to contract HIV from men than it is for men to get the virus from women.

But young women may also be at increased risk for infection in parts of Africa and Southeast Asia because some older men believe it's safer to have sex with younger partners with less sexual experience.

In areas where most infected men do not know they are carrying the virus, that's a recipe for spreading the disease to a new generation of women, experts say.

Women account for 58 percent of HIV-infected adults in Sub-Saharan Africa, according to the new report.

"The biggest rate of new cases that we see is in girls 14 to 19 years old," said Dr. Eric Goemaere, a physician with the medical group Doctors Without Borders who works at an AIDS clinic in Khayelitsha Township near Cape Town, South Africa.

"It's sort of a lottery," Goemaere said. "People tend to just play the game and try to have sex with young women because they believe it's less likely that they're infected." Goemaere said one in four young mothers who come to his clinic are HIV-positive.

The new UN estimates suggest that women still account for slightly fewer HIV cases than men: 19.2 million adult women worldwide, compared with 19.4 million adult men. Children make up another 3.2 million cases.

UN officials said this is the first time the estimates for men and women have been nearly equal.

Increasing HIV rates among women have the potential to change whole societies, experts said.

"Very often women are the ones who make sure their children get the right education," said Bernhard Schwartlander, HIV/AIDS director at the World Health Organization. "If the center pole of the family is affected by HIV, it has an impact on a large scale."

On many small family farms in Africa, women may take care of most daily chores, increasing the effect of famine when they sicken or die from AIDS.

In Malawi, a southern African nation that has experienced a food emergency in the last year, a recent study showed that half of poor households affected by AIDS and other chronic diseases have delayed their farming because of financial troubles.

"We can probably count on a longer food crisis than the region is used to," said Piot of UNAIDS.

The UN report also documented HIV outbreaks in areas of the world that have seen little of the disease until recently.

In Eastern Europe and the former Soviet republics of Central Asia, the spread of intravenous drug use has brought a new wave of HIV infections.

In Uzbekistan, the number of new infections in the first six months of 2002 was six times the figure reported one year earlier; in Estonia, HIV cases spiked from 11 in 1999 to 1,474 in 2001.

Overall infections in the Russian Federation climbed from fewer than 11,000 at the end of 1998 to more than 200,000 this year.

The trend also has struck Indonesia, where nearly half of IV drug users have HIV, up from virtually zero in 1998.

The sheer number of potential victims in India and China has caused concern. India's 4 million HIV cases are second only to South Africa among all nations. China has an estimated 1 million HIV patients, in part because many rural blood donation centers have ignored basic blood-safety procedures, the report said.

Targets are not met

Last year, the UN special session on HIV and AIDS produced numerous commitments from member states on measures to stem the spread of the disease.

The session set goals such as reducing the number of infants infected by one-half by 2010, expanding access to condoms and strengthening community health programs to treat people living with the disease.

The countries also set a target of spending between $7 billion and $10 billion by 2005 to fight AIDS in low-and middle-income countries. But with that spending figure at $3 billion today, Schwartlander of the World Health Organization said there is a long way to go.

"We have a huge window of opportunity," Schwartlander said. "More than half of all the new infections we project could be avoided if all countries would live up to the commitments they made last year."

Doctors who fight the disease said help must also come in the form of treatment for those already infected, not just prevention.

Goemaere of Doctors Without Borders said it is difficult to persuade many of his clinic patients that they should even get tested for the disease because they cannot afford treatment if the result is positive.

"If you're told there's nothing they can do for you, well, I'd say I wouldn't get tested myself," Goemaere said.
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