Newsday - June 24, 1998
Laurie Garrett - Staff Writer

Releasing the first country-by-country analysis ever compiled for the disease, UNAIDS described acute differences in the spread of the virus.

In some towns and cities along the Zimbabwe-South Africa border, 70 percent of all adults (ages 15 to 49) carry the HIV time bomb. And in most sub-Saharan capitals, between a quarter and a third of all adults are HIV-positive. In contrast, fewer than 1 percent of Americans of all ages are infected with HIV.

As AIDS rates plummet in North America and Western Europe because of prevention campaigns and improved HIV treatments, the contrast between wealthy nations and the poorer nations in Africa, Asia and Eastern Europe grow acute, Dr. Peter Piot, UNAIDS director, said yesterday in a news conference.

Piot noted that in 27 nations the prevalence of HIV more than doubled between 1995-97. And death rates in those countries have doubled - in some cases, tripled. In most of sub-Saharan African cities 75 to 80 percent of all adult deaths are now due to AIDS, and in rural areas up to a quarter are.

For example, in the African nation of Botswana, a quarter of the population aged 15-49 is infected. The impact on development is already becoming clear. Between 1996 and 1997, the country dropped 26 places down the Human Development Index, a ranking of countries that takes into account wealth, literacy and life expectancy, the report said.

In Zimbabwe, 1.5 million people are infected with HIV, or 13 percent of the population. Among adults 15 to 49, that figure rises to 26 percent. Zambia has 770,000 HIV cases, or 11 percent of the population. And in Tanzania, South Africa and Swaziland, one out of every 10 people of all ages are infected.

But in the United States, 820,000 people - or 0.3 percent of the population - are HIV-positive. And in France, the figure is just under 0.2 percent.

"We see a clear picture of increasing AIDS gaps," Piot said. "There's only one option here: we must scale up our operations."

Four of the biggest AIDS drugs companies have agreed to bring prices for such anti-HIV drugs as protease inhibitors and AZT down for poor countries by more than 50 percent of what is charged in the United States. UNAIDS estimates that with these discounts drug therapy comparable to what HIV patients receive in this country could cost as little as $400 to $500 a month in East Africa.

But that, Piot said, "is still too high for most Africans."

UNAIDS hopes to make the discounted drug combinations available to middle-class Africans and Asians. In the meanwhile, such drugs as AZT and the protease inhibitor indinavir are already available worldwide through drug dealers and black marketeers. People are not taking these drugs properly, Piot said, and resistant HIV strains are emerging.

To stem HIV drug resistance, UNAIDS is training doctors and nurses among poor nations in the proper use of anti-HIV drugs. "Our top priority, though, is to increase community standards of care for tuberculosis and other opportunistic infections of HIV disease," Piot said.

The most successful medical prevention of AIOS involves the use of AZT in pregnant women to prevent transmission of the virus to their babies. American researchers showed nearly 10 years ago that giving AZT to pregnant women and their newborns reduced the numbers of infected children by 66 percent. A Swiss team showed last month that it could eliminate mother-to-child transmission by coupling AZT treatment with C-section deliveries.

There are nearly 1 million HIV-positive children in Africa, 81,000 in South Asia and 15,000 in Latin America, according to UNAIDS. These are preventable infections, Piot said.

Glaxo Wellcome, the British corporation that manufactures AZT, has agreed to make the drug available to UNAIDS for use on pregnant women at a bargainbasement price. "Our role is to facilitate [treatment] by making significant adjustments in pricing," said Peter Young, vice president for HIV Therapeutics at Glaxo-Wellcome.

Noting that an estimated 600,000 HIV-positive women give birth annually, Young said Glaxo will charge "well under $100" for six to eight weeks of treatment.

In the 1980s, Merck Pharmaceuticals donated their drug, Ivermectin, to the World Health Organization for treatment of blinding eye disease in Africa. Young said the lack of health infrastructures in Africa made it extremely difficult to get the drug to those who most needed it.

"These infrastructural issues can be overwhelming," he admitted. "But I think you're left with an off-dichotomy: Do you shrug your shoulders and say it's impossible? Or do you use this as an opportunity to build that infrastructure?"

Yesterday, UNAIDS credited AIDS education with bringing down HIV rates in the United States and Western Europe. It also credited condom promotion and education with bringing rates down in Thailand from 13 percent in 21-year-old men living in the north of the country in 1993 to about 7 percent in 1995.

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Table 1: Infection Rates: The 10 countries with the highest percentage of HIV infection among people aged 15-49 in 1997.

Country	Percentage
Zimbabwe	25.8%.
Botswana	25.1%.
Namibia	19.9%.
Zambia	19.1%.
Swaziland	18.5%.
Malawi	14.9%.
Mozambique	14.2%.
South Africa	12.9%.
Rwanda	12.8%.
Kenya	11.6%.

SOURCE: World Health Organization.

Table 2: Others: Some other countries' 1997 percentage of people 15-49 with HIV..

Country	Percentage
Haiti	5.17%.
Bahamas	3.77%.
Cambodia	2.40%.
Guyana	2.13%.
Belize	1.89%.
Myanmar	1.79%.
India	0.82%.
United States	0.76%.
Portugal	0.69%.
Spain	0.57%.
Ukraine	0.43%.
France	0.37%.
Canada	0.33%.
Mexico	0.35%.
Italy	0.31%.
United Kingdom	0.09%.
Germany	0.08%.
China	0.06%.
Russia	0.05%.
Japan	0.01%.

SOURCE: World Health Organization.
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