San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Thursday, November 28, 1996 - Page A1
David Perlman, Chronicle Science Editor

In a year-end estimate of the epidemic's worldwide toll, leaders of the U.N. AIDS program estimate that 22.6 million people are now living with AIDS or are infected by HIV, the virus that causes the disease. More than 3 million people were newly infected this year alone -- and for the first time, nearly half of them were women and at least 400,000 were children, according to the report. "The HIV epidemic is far from over and in fact continues to strengthen its grip on the world's most vulnerable populations," said Dr. Peter Piot, executive director of UNAIDS, the specialized agency of the World Health Organization that did the report, in a telephone conference call from Geneva with American reporters.

The detailed U.N. report was released yesterday to mark the ninth annual observance of "World AIDS Day," on Sunday, in which health agencies and activist organizations in many nations sponsor efforts to increase public awareness of the disease and its impact.

The report's most striking finding is the speed with which the numbers are climbing and the degree to which the disease is spreading into countries barely touched by it until now.

Infection rates are increasing in parts of Asia that have been relatively unaffected by the epidemic, Piot said, particularly in China, Vietnam and Cambodia.

AIDS is also spreading rapidly in the newly independent nations of the former Soviet Union -- most strikingly in Russia, Belarus and Kazakhstan, Piot said. With social systems breaking down, prostitution and hard-core drug use increasing and the rate of sexually transmitted diseases rising throughout the former Soviet Union, the increase in HIV infections is not surprising, Piot said.

THE SAME STORY

"It's the same story all over again there," he said. "The virus spreads first among the most vulnerable populations, and then it spreads quickly and widely."

New drug combinations that include the anti-viral compounds called protease inhibitors are reversing AIDS symptoms and lowering virus levels dramatically for many patients in the United States, Piot acknowledged. But those drugs are almost entirely unavailable in the developing continents of Africa and Asia, where the epidemic strikes most tragically, he said.

The problem there is not just obtaining the new drugs, but distributing them and monitoring the levels of the AIDS virus in every patient as the drugs take effect, Piot said.

`TECHNICAL COMPLEXITY'

"The technical complexity of such an effort in most countries makes it simply impossible," he said.

Only intensified prevention campaigns reaching into every community in the developing world can possibly slow the epidemic's spread for now, but ultimately the crucial need is for vaccines against the various strains of the virus, Piot said.

"As long as HIV exists anywhere in the world, the industrialized countries must take responsibility for the rest of the world by helping to finance stronger prevention efforts and making vaccine development the highest international priority," Piot said. He estimated that only 1 percent of all AIDS research spending worldwide goes to vaccine research today.

"Prevention will never be enough," he said. "If we could make anti-viral drugs to fight HIV, we can make a vaccine."

United Nations figures on the epidemic from two years ago reveal the unabated pace of the epidemic's spread. By the end of 1994, for example, the world total of people living with the disease or infected by HIV was estimated at 15 million -- compared with 22.6 million this year. And the total of AIDS cases reported since the epidemic was first documented in 1981 stood at 4.5 million two years ago, compared with 8.4 million today.

PROBLEM IN CHINA

In another indication of the epidemic's rapid spread, the U.N. agency noted that in 1993, China's public health officials reported that there were 10,000 HIV-infected people in the country. By the beginning of this year, that number had jumped to 100,000, the Chinese officials reported.

And in Africa, countries ravaged by wars and rebellions, the situation is growing steadily worse, Piot said. "As we see the pictures of refugees marching home through the countryside of Rwanda and Burundi, we must consider the fact that these countries have one of the oldest and most severe HIV epidemics on the continent," he said.

"In fact," Piot warned, "HIV infection rates of over 20 percent among pregnant women and 50 percent among clinic patients with sexually transmitted diseases are now common. The possibility of dramatic new HIV and (sexually transmitted disease) outbreaks there should not be ignored." ------------------------------------------------------------

CHART (1):

THE WORLDWIDE TOLL OF THE AIDS EPIDEMIC CONTINUES TO RISE

As AIDS explodes into new regions, here are the latest United Nations estimates of new cases of infection and disease in 1996, the numbers of people living with the disease or infected by the AIDS virus, and the cumulative totals since the epidemic was first detected.

REGIONAL HIV/AIDS TOTALS

Sub-Saharan Africa 14.0 Million

South and Southeast Aisa 5.2 Million

Latin America 1.3 Million

North America Western Europe

New Zealand/Australia 1.3 Million

Caribbean 270,000

North Africa and Middle East 200,000

East Aisa/ Pacific 100,000

Central and Eastern Europe and Central Asia 50,000

Note: Regional figures are tentative

CHRONICLE GRAPHIC

CHART (2):

WORLD HIV/AIDS TOTALS

New HIV infections 1n 1996 3.1 million

HIV/AIDS-associated deaths 1.5 million

People living with HIV/AIDS

In 1996 22.6 million

In 1994 15 million

..

Cumulative HIV infections

In 1996 29.4 million

In 1994 18 million

..

Cumulative AIDS cases

In 1996 8.4 million

In 1994 4.5 million

..

Cumulative HIV/AIDS deaths 6.4 million

Source: United Nations AIDS Program

CHRONICLE GRAPHIC
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