San Francisco Chronicle; Wednesday, June 24, 1998
David Perlman, Chronicle Science Editor

In the first country-by-country report on the global AIDS epidemic, the U.N. health experts say more than 40 million people have contracted the disease since the early 1980s, and nearly 12 million of them have died. The report found that prevention efforts are lagging badly in most of the world's developing nations and that the new virus-fighting drugs remain far out of reach for millions of patients. "The tragic news," said Dr. Peter Piot, director of the United Nations' AIDS program, "is that even though we know more than ever before about how to fight it, AIDS is winning. Infection rates are reaching new heights in much of the developing world, and if they cannot be halted, the world will confront a major catastrophe." In the Western industrialized world, powerful new drugs are restoring many patients to health -- at least temporarily -- and government-supported prevention programs are proving dramatically effective.

But in developing countries, the epidemic is leaving millions near death and uninformed millions at dreadful risk of infection. In poorer regions of the globe, public health budgets are meager, drugs are unavailable and AIDS prevention efforts are often mired in bureaucracy or are stymied by cultural or religious taboos.

The epidemic is spreading so swiftly, and so few nations are equipped to monitor the onslaught closely, that the only firm figures available right now are based on U.N. surveillance through the end of last year.

Those numbers are frightening, indeed, Piot said: 30.6 million people, including more than a million children, are now living with AIDS; 2.3 million men, women and children died last year alone; HIV, the virus that causes AIDS, is infecting nearly 16,000 people a day, and 8.2 million children are already orphaned with their mothers or both parents dead of AIDS.

The rate of new infections is perhaps the most frightening of all, epidemic-fighters say: With cures nonexistent, vaccines many years away, and expensive, life- prolonging drugs far beyond the ability of most nations to afford, 90 percent or more of newly infected people will perish within a decade.

FAR CRY FROM VANCOUVER

The new U.N. report was released yesterday in time for the upcoming 12th International AIDS conference, which opens in Geneva on Sunday. Nearly 12,000 scientists, physicians, health care workers, activists and drug company representatives are expected to attend the six-day event. Two years ago, at the 11th conference in Vancouver, B.C., the mood was virtually ecstatic over the promise of a new class of AIDS drugs called protease inhibitors. In large-scale clinical trials, they seemed miraculous because -- with regular use in combination with more traditional anti-viral AIDS drugs -- they were able to reduce HIV to undetectable levels in the blood of infected people.

In countries like the United States -- where protease inhibitors are accessible with the support of the government and medical insurance -- there were heartening tales of patients recovering Lazarus-like from what appeared to be terminal illnesses and returning to health and jobs.

But the celebrations of Vancouver have proven short-lived. The cost of the complicated drug combinations -- $12,000 a year or more -- are prohibitive. The medicines must be taken on a schedule so rigorous that many patients, ill and often desperate, simply cannot comply with the demanding regimen day and night. And as the virus mutates, a growing number of patients are developing resistance to the multidrug "cocktail."

GRIM REPORTS

So in Geneva next week there will be reports of more new drugs and more scientific knowledge about the nature of the virus and the pathways it exploits to infect and destroy the cells of the immune system. But there will be little evidence that those drug combinations are reaching the millions whom they might help -- even if only temporarily.

So making effective prevention programs more accessible remains the most urgent need in slowing the epidemic, Piot said, and countless pilot programs have proven scientifically that they work. For example, the U.N. AIDS expert said, in a few developing nations like

Thailand and Uganda, government-supported prevention efforts involving accessible AIDS testing and counseling plus intensive education and subsidized condom distribution have cut the prevalence of AIDS dramatically --by more than a quarter in Uganda and by nearly 15 percent in Thailand. And in countries where injected drugs are a major source of infection, needle exchange programs supported by the United Nations at the request of local governments are proving to be effective prevention strategies, too, Piot said.

On the tragic side, however, the U.N. survey found that in 13 nations of Sub-Saharan Africa at least 10 percent of all adults are now infected with HIV; that in Botswana and Zimbabwe the AIDS virus has infected one of every four adults; and that in some Africa towns with populations of 50,000 or fewer, infection rates are running as high as 70 percent. That last statistic, said Piot and his senior epidemiologist, Bernhard Schwartlander, is "unbelievable, but true."

CHART:

THE WORLDWIDE TOLL OF THE AIDS EPIDEMIC CONTINUES TO RISE

As AIDS explodes into new regions, here are the latest U.N. estimates of new cases of infection and disease in 1997, the numbers of people living with the disease or infected by the AIDS virus, and the cumulative totals since the epidemic was first detected.

Table 1. Global estimates of HIV/AIDS

Group	Estimates as of end of 1997
People newly infected with HIV in 1997	5.8 million
Number of people living with HIV/AIDS	30.6 million
AIDS deaths in 1997	2.3 million
Number of AIDS deaths	-----------
since the beginning of the epidemic	11.7 million
Number of AIDS orphans(a)
since the begining of the epidemic	8.2 million

a) - Defined as children who lost their mother or both parents to AIDS when they were under the age of 15.

Table 2. Global Demographics

Area	People living	Newly infected with HIV
	with AIDS	(infected during 1997)
North America	860,000	44,000
Western Europe	480,000	30,000
North Africa
and Middle East	210,000	19,000
Sub-Saharan Africa	21 mil.	4 mil.
Eastern Europe
and Central Asia	190,000	100,000
South and
Southeast Asia	5.8 mil.	1.3 mil.
East Asia
and Pacific	420,000	180,000
Australia and
New Zealand	12,000	600
Caribbean	310,000	47,000
Latin America	1.3 mil.	180,000

Source: United Nations AIDS Program

STEVE KEARSLEY / THE CHRONICLE

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