Newsday - November 29, 2001
Laurie Garrett, Staff Writer

In its annual state-of-the-world report released yesterday, the United Nations AIDS Programme issued new estimates of the scope of the pandemic, highlighting concern about surges of HIV in eastern Europe, the former Soviet Union, China and Indonesia.

"Some 5 million people became infected this year," Dr. Peter Piot, director of UNAIDS, said in a Moscow teleconference yesterday.

"AIDS is unequivocally the most devastating epidemic that mankind has ever faced," Piot said.

Worldwide there are now three types of epidemics unfolding. The smallest are in wealthy countries, such as the United States, where the epidemics are heterogeneous but dominantly involve male-to-male sexual transmission. After a long period of decline, those epidemics are showing troubling signs of resurgence, largely due to unsafe sexual practices among gay men, the UNAIDS reports.

The second pattern is seen in sub-Saharan Africa and Latin America, driven by heterosexual transmission. Africa continues to have the largest numbers of people living with HIV and dying of AIDS, though the region saw a slight dip in its new infection rates. In 2000, some 3.8 million sub-Saharan Africans acquired new HIV infections, according to UNAIDS. This year that number fell to 3.4 million, largely due to AIDS prevention efforts in Uganda, Tanzania and Zambia.

But the third epidemic dynamic, labeled "explosive" by Piot, has almost nothing to do with sex. It is driven by needles shared among people who inject narcotics. All over the world the narcotics-driven HIV epidemic seems to begin, unnoticed by government officials, in isolated communities of IV drug users, spreads like wildfire and then suddenly takes on national significance.

The most disturbing examples of this phenomenon are the epidemics of eastern Europe, which regionally "are in the midst of an explosion that has been predicted years ago," Piot said.

The fastest-growing HIV epidemic in the world right now is in Russia, where some 1 million of its 148 million citizens are now infected, largely as a result of IV drug use, Piot said. Nearby Ukraine has the highest regional prevalence of HIV, at 1 percent of its adult population. Tiny Estonia has nearly the same prevalence. While these rates of infection are dwarfed by those in Africa, where 16 nations now have adult prevalences above 10 percent, Piot said the rapid increases in eastern Europe are dire for the region.

Similarly, IV drug use outbreaks in China and Indonesia have caused consternation among UN officials. In the last six months the number of officially reported HIV cases in China soared 67.4 percent, according to UNAIDS. Surveys of IV drug users in Xinjiang and Yunnan provinces show 70 percent are already HIV positive.

In Indonesia, which is the most populous nation of the Pacific, 40 percent of the IV drug users in the capital, Jakarta, tested HIV positive this year. Drug-using populations nationwide have tested at between 14 percent to 53 percent HIV positive in 2001.

"The world after 11 September has made us all think more deeply about the kind of world we want for our children," UN Secretary General Kofi Annan said in a statement. "That means redoubling our efforts to turn back HIV/AIDS."

But since Sept. 11, HIV has largely fallen off the world community's political radar screen, and efforts to raise some $7 billion to $10 billion to combat the virus, along with malaria and tuberculosis, in poor countries have slowed to a near standstill. Two weeks ago the U.S. Senate voted to reduce the United States' commitment to the fund by 90 percent. Only Italy has deposited promised dollars in the Global Fund's account at the World Bank. That means the fund has just $200 million.

Promises to the fund add up to an additional $1.3 billion, $400 million of which comes from the United States. Of that $400 million, a quarter has been promised by billionaire Bill Gates, half by the White House and the remainder from Congress.

"It's definitely not easy to set up the very first multibillion- dollar Global Health Fund," Piot acknowledged, though he predicted the final outlines of the fund's management and leadership will be announced in two weeks, and some programs in Africa could receive its financial support early next year.

Sources involved in the negotiations over the future of the Global Fund were less sanguine. They said political haggling behind the scenes has been fierce, and compromises have resulted in what may be an unwieldy leadership board of more than 30 directors. So far the organizers haven't been able to agree in broad terms on who should be allowed to receive the fund's largesse, the sources say. And the fund's transitional leader, former Ugandan Minister of Health Crispus Kyonga, will step down shortly. Well-placed sources said Annan plans to announce a global search for a new leader in the war on AIDS, drawn from the ranks of CEOs of the world's top corporations.

AIDS Epidemic

Summary of HIV/AIDS cases around the world

Number of People Living with HIV/AIDS

Total 40 million

Adults 37.2 million

Women 17.6 million

Children

under 15 2.7 million

People Newly Infected with HIV in 2001

Total 5 million

Adults 4.3 million

Women 1.8 million

Children

under 15 1.8 million

AIDS Deaths in 2001

Total 3 million

Adults 2.4 million

Women 1.1 million

Children

under 15 580,000

SOURCE: UNAIDS

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