Newsday - July 2, 2002
Laurie Garrett, Staff Correspondent

Those predictions were coupled with a startling statement: "We now realize that the HIV/AIDS epidemic is at an early stage of development and that its long term evolution is still unclear."

That report, released today, sets the stage for the XIV International AIDS Conference here, where later this week more than 10,000 scientists, physicians and activists will gather. These grim gatherings, which occur every two years, have become signposts in the 21-year-old epidemic, marking stages in its seemingly unrelenting growth.

Reports are being issued by dozens of international agencies, charities and drug companies, summarizing their views of the state of the pandemic. Many are in line with last week's G-8 gathering in Canada, focusing on what steps the wealthy nations can take to assist Africa -- which has more than 70 percent of all the world's HIV positive population -- and other endemic regions in their battles against AIDS. They also address measures that might slow the epidemics in India and China.

The United Nations believes that China "is on the verge of a catastrophe that could result in unimaginable human suffering . . . indeed, we are now witnessing the unfolding of an HIV/AIDS epidemic of proportions beyond belief," according to a report issued last week in Beijing by seven UN agencies. In April the Chinese Ministry of Health conceded the nation may have 850,000 HIV-positive individuals. The UN states it is more likely that 1.5 million Chinese were infected by last December, and characterizes China as in "titanic peril".

The U.S. Defense Intelligence Agency issued a report concluding that global security is imperiled by AIDS; that more than half of Congo and Angola's armies are infected, along with upwards of 75 percent of the Zimbabwe and Malawi forces.

Today UNAIDS reported that Africa's economy is declining by four percent annually due to AIDS; that labor productivity in hard-hit countries is down by 50 percent, and half the continent's population lives on less than $1 a day. And it found that economic development and life expectancy on most of the continent has returned to World War II levels. Last year, according to the International Monetary Fund, the continent contributed less than four percent of the world domestic product.

"I think we're in a transition to a new phase in the history of this epidemic," Dr. Peter Piot, executive director of UNAIDS, said in an interview. "It certainly involves putting a lot of pressure on the political leaders of the world. Not an activist [pressure], but one of realizing this is one of the biggest political problems of the world, in the same league with terrorism, global warming and trade relations.

"It's not science that dominates anymore. It's not human rights issues that form the theme anymore. It's not treatment -- it's now far beyond all that. ... There's a real failure of public health to handle the epidemic."

At last week's G-8 summit, the U.S. and other wealthy nations agreed to the largest fiscal commitment to Africa ever, in part due to recognition of the devastation wrought by AIDS. Under the accord, coupled with a wealthy nation pledge made at the International Monetary Fund meeting two months ago, development aid to Africa will increase by $18 billion a year by 2006.

According to a financial report prepared in May by UNAIDS for world leaders and recently obtained by Newsday, contributions to hard-hit African, Caribbean and Asian nations trying to cope with AIDS still fall short of the $7 billion to $10 billion annual fund the United Nations believes is necessary to slow the epidemic. Donations have steadily increased since 1999. The financial analysis shows that only $316 million was spent in needy nations for AIDS control in 1999. That money came from the nations themselves and from contributions from Europe, Japan and the U.S. A year later, spending more than tripled to $1.1 billion. Last year it climbed to $1.3 billion, and this year spending will hit $1.895 billion, with nearly 44 percent coming from the U. S. government and charities.

But when donations are compared to the donors' overall wealth, the U.S. ranks at the bottom. Denmark, for example, donated nearly 1.5 percent of its gross domestic product in 2000 to poor nations, with AIDS the key target. In contrast, U.S. contributions constituted 0.1 percent of the American GDP.

UNAIDS reported these HIV infection rates: * Pregnant women in Botswana -- 45 percent HIV-positive. Among those age 25-29 years, 55.6 percent are HIV positive.

* Pregnant women in Zimbabwe -- 35 percent HIV positive. In the 25-29 year old age group, the rate is 40 percent.

* One in nine South Africans are now HIV positive.

* Eleven million children in Africa have been orphaned by AIDS.

"No one is immune," the report states. "If a natural HIV prevalence limit does exist in these countries, it is considerably higher than previously thought."

Piot, a Belgian physician who has been involved in the fight against AIDS since its 1981 discovery, confesses to feeling paralyzed by the scope and relentless growth of the pandemic.

"I had hoped -- well, you know, they say every epidemic has a bell-shaped curve," Piot said, citing classic disease dogma that says all epidemics eventually reach a plateau and then burn out on their own.

"But we don't see any plateau, we don't see any bell. We haven't reached a peak," Piot sighed. "We are still in the early phases of it."
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