Newsday - November 24, 1998
Laurie Garrett - Staff Writer

The HIV epidemic continues to expand at a staggering pace, particularly among teenagers and post-adolescent adults in the poorer countries of the world, according to a report released yesterday by the United Nations Programme on AIDS, or UNAIDS. And worldwide, AIDS has claimed more lives than Europe's Black Death.

The organization's new findings are "mind blowing," UNAIDS director Dr. Peter Piot said in an interview.

To date, 13.9 million people worldwide have died of the disease, UNAIDS says, and 33.4 million are currently HIV-infected. Nearly half of all new HIV infections this year - 5.8 million - occurred in people aged 10 to 24 years. And the hardest hit region continues to be sub-Saharan Africa.

Surveys in some African countries found up to 50 percent of all pregnant women have HIV, as in parts of Zimbabwe. None of the hardest-hit countries on the continent had HIV rates in pregnant women below 20 percent. A teenager's first sexual encounter carries a risk with 1-in-5 to a staggering 1-in-2 odds of being with an infected partner, Piot said.

He noted that girls have up to seven times greater HIV rates than boys their own ages. "So they are infected by older men; that's clear. So one has to work a lot with the men, I think. One has to induce a massive change of culture."

Similar trends are emerging in Asia, where HIV has made its way into rural villages in India and possibly China. UNAIDS believes that these two massive countries, which combined hold more than one-third of the world's population, may now be experiencing an African-style HIV epidemic.

"And when you consider the differences in populations, a 1 percent increase [in HIV cases] in India or China is equivalent to much more than a 20 percent increase in most African countries," Piot said. What happens in the two giants of Asia over the next five years will largely determine the future of the pandemic, he said.

Sub-Saharan Africa has 22.5 million people living with HIV, or 8 percent of the region's entire population. India, China and Southeast Asia follow with 6.7 million people living with HIV, or 0.69 percent of that region's population. Latin America - particularly Brazil - ranks third with 1.4 million active HIV cases, or 0.5 percent of the region's population.

North America - Canada and the United States, combined - has 890,000 HIV positive people or 0.56 percent of the population. That means that infection rates in the United States and Brazil are about the same. But the infection rate in the United States is double that in Western Europe.

In the former Soviet Union and Eastern Europe, where the epidemic is relatively new, 270,000 people are HIV positive. Most of these infections are among IV drug users who are under 24 years of age and who were infected within the last five years, Piot said.

"We are probably going to have a worse situation there" than in the Americas, Piot said.

The numbers found in yesterday's UNAIDS report are so large, given the first case in this epidemic was seen less than 20 years ago, that it is hard "to think today of HIV without in the same moment thinking of the Black Death in the Middle Ages," Piot said. "It's the same scale, just slower."

When the Black Death, or pneumonic plague, hit Europe in 1346 the region's population was about 25 million. An estimated 9 million to 11 million people, or roughly one-third, died during the four-year-long epidemic. Five years ago the World Health Organization forecast that it would not be until at least the year 2000 for the HIV epidemic's deaths to surpass those of the Black Death. As of this year, however, with 13.9 million deaths counted, HIV has well surpassed the Black Death's grim totals. And it will soon eclipse the toll of 21 million globally who died in the 1918 influenza epidemic, the largest new disease outbreak of the 20th Century.

North America saw marked declines in new HIV cases in some groups. Gay male populations in New York, San Francisco, Los Angeles and Chicago, for example, had HIV rates of as much as 50 percent in 1985; today the rates in the California cities are down to 20 percent, and New York's is 14 percent, according to a report released last week by the University of California in San Francisco.

But for the rest of the world the epidemic grows, claiming not only lives, but also economies, according to UNAIDS. Botswana, for example, was until recently forecast by the World Bank to experience steady annual economic growth and an average life expectancy of 70 years by 2010. Now, however, entirely because of an HIV epidemic that currently afflicts 25 percent of the country's adults, Botswana's economy is in a tailspin and the average life expectancy will plummet by 2010 to less than 40 years. In Zimbabwe, UNAIDS says, 2,400 people will, by the year 2000, die weekly of AIDS and 15 percent of its children will be orphans.

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