Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
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Newsday - November 25, 2003
Laurie Garrett, Staff Writer
In its annual estimate of the size and scope of the pandemic, UNAIDS reported the epidemic "continues to deepen, to expand, tightening its grip on Southern Africa and increasing its threat to southeast Asia," Executive Director Peter Piot said in the news briefing in London. By the end of the year, one out of every five people in sub-Saharan Africa will be infected. The virus is the leading cause of death on the continent and the fourth cause of death worldwide: More than 3 million people will die of AIDS by the end of the year.
A separate report finds an epidemic resurgence may be under way in the United States. A Centers for Disease Control and Prevention survey of 29 states that require the reporting of HIV diagnosis found an overall 5.1 percent increase in new diagnoses between 1999 and 2002.
More than half the new infections were among African Americans, who by 2002 had 10 times the rate of infection as whites. AIDS was listed as the third-leading cause of death for African-Americans 25 to 44 years old. And though new HIV diagnoses in African American women fell by 19 percent during the time frame, the rate in men soared.
Overall, new HIV diagnosis rates jumped 26 percent among Latinos, 8 percent among whites and 17 percent among gay men of any race.
"We have to raise the possibility that this could be indicating a regurgence of HIV in that [gay male] population," Dr. Ronald Valdeserri, the CDC's deputy director of HIV prevention, said in an interview Tuesday. The HIV findings come on the heels of a CDC report last week that syphilis climbed in 2002, for the second year in a row, with nearly half the new cases seen among gay men.
The CDC data cover 29 states, but do not include New York, California, Illinois and Washington, D.C., which have recently switched from monitoring only full-blown AIDS cases to include data on HIV infection. The four contain a large segment of the nation's gay and Latino population, so infection rates in gay men and Latinos might be steeper if data from the states were available, Valdiserri said.
UNAIDS reported that India has an estimated 5 million to 6 million HIV cases, a comparatively small number for a nation of more than 1 billion people. But in some districts, adult HIV prevalence exceeds 5 percent -- a scale comparable to Africa's.
India constitutes one of the pandemic's "greatest challenges," Piot said, along with China and Russia. China's epidemic has spread to 31 provinces, with hot pockets of infection rates reaching as high as 15 percent of IV drug users and 10 percent of prostitutes.
Russia and the rest of the former Soviet Union are witnessing an expansion of the epidemic, previously concentrated in IV drug users under age 30, into the general population via heterosexual transmission. Piot expressed frustration that the region is "absolutely insufficient" in political and financial commitment to fighting the epidemic.
The situation in sub-Saharan Africa was again ranked the worst, with overall HIV prevalence reaching roughly 8 percent. Though the rate appeared to lessen or level off in some countries, notably Uganda, most areas in southern and western parts of the continent saw a worsening in both infections and deaths. Botswana and Swaziland topped the list, with 40 percent of their populations infected.
The International AIDS Vaccine Initiative said the UNAIDS numbers pointed up the need for massive prevention efforts. "We still have not broken the cycle of new infections," Dr. Seth Berkley, chief executive officer of the Initiative, said in a statement Tuesday. Only a vaccine, the organization insists, can break this annual cycle of grim year-end reports from UNAIDS.
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