Newsday - November 27, 2002
Laurie Garrett
The HIV/AIDS pandemic has expanded its reach across the planet, afflicting more than 70 million people since it began, United Nations officials reported yesterday. And, for the first time, most of those living with the infection are females who acquired the virus through intercourse with men.
In its annual report, the UNAIDS Programme depicts a patchwork of regional epidemics, a few actually declining in size while others appear to be exploding. Overall, the global epidemic grew in the past 12 months by 5 million cases, reaching 42 million people living with HIV. Three million people with AIDS died during the same period.
The pandemic is constantly evolving, "presenting a new face," Dr. Peter Piot, the UNAIDS executive director, said in a telephone interview from his Geneva office. For example: In western Europe, for the first time, the majority of new infections were acquired through heterosexual sex, rather than either intravenous drug use or homosexual intercourse. In Central America, the rates of infection in gay men climbed steeply. In pockets across Asia, HIV took hold among intravenous drug users, with infection rates as high as 70 percent.
Amid the grim findings, Piot reported that in some areas of sub-Saharan Africa rates of new infection are on the decline.
The report, released jointly with the World Health Organization, identified four trends: the gender shift; threats to political stability, due to economic devastation; effectiveness of HIV prevention efforts in some locales; and insufficient resources to continue funding such efforts.
"The face of AIDS is changing - no doubt about it," Piot said of the gender shift. In part that's because in many countries AIDS has claimed the lives of a significant percentage of men.
Dr. Bernhard Schwartlander, director of AIDS programs for WHO, said in a news teleconference yesterday from Geneva that a teenage female infection pattern is "fueling the epidemic."
"Ten percent overall in sub-Saharan Africa of young girls carry the virus..." he said.
High rates of rape, too, play a role because of the greater likelihood of bleeding, which enhances transmission of the virus from the assailant. Yesterday's report notes, for example, that 17 percent of female rape victims in Rwanda are HIV-positive, versus 11 percent of Rwandan women, generally.
In the Democratic Republic of Congo, where war has raged since 1998, 55 percent of all HIV infections are now among women, according to that nation's Ministry of Health, and war-related rape appears to be fueling the rising incidence.
The clearest evidence of HIV's economic impact can be found in the widening famine in Africa, UN officials say. What began several months ago as a crop-destroying drought in the southern regions of Zimbabwe, Zambia, Malawi and Swaziland has expanded and threatens more than 16 million lives, the report says; by comparison, the 1984 famine in Ethiopia claimed roughly a million lives.
"All the food in the world will not help out with dealing with the underlying cause of this famine - the real problem - AIDS," Stephen Lewis, UN special envoy on AIDS in Africa, said in an interview. Lewis, Piot and yesterday's report all point out that the populations in drought-struck regions are less resilient, less able to cope with the challenge. UNICEF officials say this is typified by as basic a problem as having the strength to manage an irrigation hand pump for an hour.
Simon Wright of Action Aid in London gave this example: "It causes people to change the kind of crops they grow, or at what distance they grow them, because they are too weak."
But "there is some good news," Piot insisted: Prevention campaigns - particularly AIDS education targeting teens and young children - appear to be paying off. In South Africa, the number of HIV-positive teens fell to 15.4 percent from 21 percent in 1998.
The report tempered that optimism by detailing the shortage of funds. Donors from wealthy nations have not met the funding levels needed by the Global Fund to Fight AIDS, Tuberculosis and Malaria, created in 2001. "No one's even near the levels of donation commitment they ought to reach," Lewis said.
| Region | Adults and Children living with HIV/AIDS |
Adults and Children newly infected with HIV |
Adults and Prevalence Rate | % of HIV-positive adults who are women |
| Sup-Saharan Africa | 29.4 million | 3.5million | 8.8% | 58% |
| South & South-East Asia | 6.0 million | 700,000 | 0.6% | 36% |
| Latin America | 1.5 million | 150,000 | 0.6% | 30% |
| East Asia & Pacific | 1.2 million | 270,000 | 0.1% | 24% |
| Eastern Europe & Central Asia | 1.2 million | 250,000 | 0.6% | 27% |
| North America | 980,000 | 45,000 | 0.6% | 20% |
| Western Europe | 570,000 | 30,000 | 0.3% | 25% |
| North Africa & Middle East | 550,000 | 83,000 | 0.3% | 55% |
| Caribbean | 440,000 | 60,000 | 2.4% | 50% |
| Australia & New Zealand | 15,000 | 500 | 0.1% | 7% |
| Total | 42 million | 5 million | 1.2% | 50% |
| SOURCE: UNAIDS / World Heath Organization | ||||
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