Inter Press Service - November 21, 2005
Sanjay Suri

Last year we were saying that this was the region after sub-Saharan Africa that had the biggest increase," policy director with the United Nations Programme on HIV/AIDS (Unaids) Dr Purnima Mane told IPS. But these countries "really took the prevention messages very seriously."

Barbados, Bahamas, Bermuda, the Dominican Republic, some parts of Haiti and Cuba have made significant advances in checking HIV/AIDS, she said.

"I think the advantage they've had is they are smaller, and they have been able therefore to reach out to people in a bigger way," she said. But they have managed also to overcome particular difficulties, she said.

"The problem is that the islands have had so much contact with each other, that it's very difficult to control HIV," she said. "So they have a challenge, but they've managed to take advantage of the fact that they're small, and got their programmes together and put them in place, and made an impact."

Kenya and Zimbabwe are other countries that show declines in prevalence of HIV over the past few years, the UN report says. In Kenya the prevalence rates have declined from a peak of 10 percent in the late 1990s to 7 percent in 2003, the report says.

In Zimbabwe prevalence rates of 36 percent among pregnant women in 2003 declined to 21 percent in 2004. In the urban areas of Burkina Faso prevalence among young pregnant women declined from just under 4 percent in 2001 to just under 2 percent in 2003.

The Aids Epidemic Update 2005 was released ahead of World AIDS Day Dec. 1.

But the global picture is not very bright. "The report says that 40 million people are infected, which is about three million up from the last two years, there are five million people who are newly infected in 2005, and about three million people who died in 2005," Mane said.

"Geographically sub-Saharan Africa has been the biggest worry because even today 60 percent of all people living with AIDS come from sub- Saharan Africa," she said. But the new worry for the last couple of years has been Eastern Europe, she said.

"There is a phenomenal injecting drug use epidemic here, which overlaps with the HIV epidemic," she said. There is little access to clean needles and syringes, and this limits programmes for prevention of drugs use, she said. "This has become a major problem for us."

Where prevalence has declined, changes in behaviour to prevent infections, such as increased use of condoms, delay of the first sexual experience and fewer sexual partners have played a key part in these declines, the report says. Expansion of voluntary HIV testing and counselling was also a factor.

The report says access to HIV treatment has improved markedly over the past two years. "More than one million people in low and middle-income group countries are now living longer and better lives because they are on anti-retroviral treatment," the report says.

"An estimated 250,000 to 350,000 deaths were averted this year because of expanded access to HIV treatment," it adds.

But while the increase in the spread of AIDS was checked in some African countries, "the overall number of people living with HIV has continued to increase in all regions of the world except the Caribbean," the report says. Of the three million who have died of AIDS-related illnesses this year, more than half a million were children.

The number of cases in Eastern Europe rose by 25 percent over last year to 1.6 million this year.

In East Europe, but also in Asia and Latin America, "the combination of injecting drug use and sex work is fuelling epidemics, and prevention programmes are falling short of addressing this overlap," the report says.

But even here there has been patchy success. In Kolkata (in India) HIV cases among commercial sex workers have been very successful," Mane said. Condom use among sex workers is as high as 85 percent, and HIV prevalence among them declined to less than 4 percent last year after crossing 11 percent in 2001.

"But in Mumbai some occasional moves were not that successful," she said. HIV prevalence among sex workers there remains above the 52 percent level recorded in 2000.

Much of the spread of the disease is still being fuelled by ignorance, the UN report says. In sub-Saharan Africa, two-thirds of young women aged 15 to 24 lacked comprehensive knowledge on transmission of HIV. More than 90 percent of people surveyed in the Philippines in 2003 thought that HIV can be communicated by sharing a meal, and almost half of sex workers in India said in a survey that they rely on a man's appearance to tell whether he is HIV positive or not.

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