Chicago Tribune - July 7, 2004
Judith Graham, Tribune staff reporter

At the same time, almost 3 million people died of AIDS, another record, as potentially life-saving drugs remained largely unavailable to patients in all but the wealthiest countries.

The study paints an alarming picture of a worldwide epidemic that is defeating inadequate efforts at control, from the United States, where infections are on the rise, to Asia, where AIDS is escalating dramatically.

"The virus is running faster than all of us," said Dr. Peter Piot, executive director of UNAIDS, the United Nations agency that issued the report.

Despite substantial funding increases for the global fight against AIDS, prevention programs currently reach fewer than one in five people worldwide, leaving the vast majority of people uninformed about HIV, the virus that causes AIDS, or how to stop it. Fewer than one in 10 people receives drug therapies in developing countries, contributing to a mounting death toll.

The report was issued on the eve of a major international conference on AIDS this week in Bangkok, where experts are expected to call for new measures to aggressively combat the epidemic.

Newly revised UNAIDS data show 38 million people were living with HIV across the world last year, up from 35 million in 2001. Of the 20 million people who have died of AIDS since 1981, when the disease was first reported, 5.6 million have perished in the last two years.

In Asia, Latin America and Eastern Europe, injection-drug use appears to be a primary driver behind HIV's spread. In Africa, the ongoing epicenter of the epidemic, heterosexual contact remains the main means of transmission.

To stop the disease's rampage, far more resources are needed, officials warned. At about $5 billion a year, global spending on AIDS is only half the estimated $12 billion needed in developing countries next year and a fraction of the $20 billion needed by 2007, the UNAIDS study said.

Those sums would finance drug therapy for 6 million people, counseling and testing for 100 million adults, and school-based AIDS education for 900 million students, among other recommended measures.

Particularly alarming, Piot and others said, is the sharp rise in infections in young people across the world.

Almost half of all new HIV infections are now found among 15 to 24 year olds; 10 million young people worldwide are living with HIV, including 6.2 million in sub-Saharan Africa. Of those, three-quarters are young women, who are at substantial risk of being exposed to sexual exploitation, according to a separate report released Tuesday.

In Eastern Europe, where HIV is expanding rapidly, more than 80 percent of the 1.3 million people infected with HIV are younger than 30, UNAIDS reported.

In the United States and Western Europe, where a generation of young people takes for granted access to life-prolonging drug therapies should they contract HIV, infections have risen over the past two years.

About 950,000 people are now living with HIV and AIDS in the U.S., up from 900,000 in 2001; half of all those who are newly infected are African-Americans. In Western Europe, 580,000 people have the virus, a rise from 540,000 two years before.

Those numbers pale, however, in comparison with the threat that AIDS poses in Asia, home to 60 percent of the world's population. Last year there were 1.1 million new HIV infections there.

"There seems to be a serious lack of leadership in Asia," said Dominique DeSantis, a UNAIDS official.

India now has 5.1 million people with HIV, more than anywhere outside South Africa. In addition to widespread ignorance about HIV in India, the "down low" phenomenon that has surfaced in the U.S.-- men who have sex with men in private but who have relationships publicly with women--is an emerging concern.

More than one of every four men surveyed in five Indian cities two years ago reported being married or living with a woman while engaging in secret sexual relations with men, according to a 2002 survey.

In Indonesia, six of 31 provinces are struggling with serious AIDS problems. Though Thailand and Cambodia have stemmed the rate of new infections with programs targeting sex workers, outbreaks are occurring in Vietnam, Bangladesh and Pakistan.

"I fear that ... in several Asian countries ... there's a gross underestimate, not only of what is actually going on but what the potential is," Dr. Anthony Fauci of the National Institutes of Health said in an interview recorded by the Kaiser Family Foundation.

Even though a small percentage of India's 1 billion people is HIV-infected, "you're talking tens of millions of additional infections" if those numbers double or triple, Fauci said.

"Same holds true in China. ... You have the potential for an explosion that, given the numbers of people who live in Asia, could potentially dwarf what we're seeing in Africa."

In Africa, 25 million people are living with AIDS, and 2.2 million people died of the disease last year, accounting for three-quarters of the world's deaths from the illness.

In the worst-hit countries in east and south Africa, 60 percent of today's 15-year-olds will not reach their 60th birthdays if current infection rates continue and treatment is not expanded, the UNAIDS report cautioned.

Unless anti-retroviral drugs become distributed more widely in Swaziland, Zambia and Zimbabwe, average life expectancy in those countries is expected to drop below 35, the study said.

According to the International Labor Organization, the labor force in 34 African counties will probably shrink between 5 percent and 35 percent by 2020 because of AIDS deaths.

Girls and women are especially vulnerable to AIDS in Africa because of their lack of power in sexual relationships with men, noted DeSantis of UNAIDS. As older men spread HIV to younger females, rates of HIV infections in young women (age 15 to 24) are double those of young men in South Africa, and four times higher in Kenya and Mali.

Women also suffer disproportionately from the impact of AIDS in Africa because they're responsible for raising crops, caring for children who have lost their parents to AIDS, and attending to adults who are sick with the disease. Some 12 million AIDS orphans live in Africa; by the end of the decade, that number could reach 18 million.

The U.S. is likely to come under criticism for its AIDS policies at the Bangkok meetings. Despite President Bush's commitment in his 2003 State of the Union address to spend $15 billion over five years on AIDS in Africa and the Caribbean, budget requests have not come anywhere near that goal.

The administration has also come under fire for not allowing U.S. funds to be spent in the Third World on generic AIDS drugs, which it claims have not been proved effective. In May, however, the administration indicated some flexibility when it said generic AIDS drug makers could apply for approval from the Food and Drug Administration, which reviews drugs' safety and effectiveness.

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