San Francisco Chronicle - Wednesday, July 3, 2002
Sabin Russell, Chronicle Medical Writer

At least 68 million people will die by 2020 unless there are "drastically expanded" efforts to prevent and treat HIV, the virus that causes AIDS, U.N. experts said.

Their portrait of human misery on a gigantic scale was released in anticipation of the 14th International AIDS Conference, set to open Sunday in Barcelona, Spain.

Highlighting the gap in HIV treatment between rich nations and poor, the report found that only 4 percent of those needing AIDS drugs in developing nations have access to them -- despite successes in bringing down the cost of these medicines to about $1 a day.

"It is clear to me that we are only at the beginning of the AIDS epidemic in historic terms," said Dr. Peter Piot, director of UNAIDS, the Joint United Nations Program on HIV/AIDS, which produced the study.

The U.N. group coupled its regular estimates of HIV infection rates with a ghastly forecast of the human death toll. AIDS has already killed an estimated 20 million, and 40 million are estimated to be living with HIV infection today.

The U.N. prediction of 68 million more deaths is limited to the 45 nations most heavily affected by the disease -- yet the figure would eclipse the 55 million killed in World War II.

ASIAN AIDS EXPLOSION FEARED

Scientists fear that AIDS is expanding beyond Africa and is poised to explode in Asia, particularly in the most populous nations on Earth, India and China.

An estimated 850,000 Chinese are living with HIV, but signs point to a spread beyond injection drug users and prostitutes into the general population.

Without countermeasures, 10 million could be infected by the end of this decade. In India, 3.9 million are already believed to be HIV positive.

World leaders are now paying serious attention to HIV as a human catastrophe and a threat to global security, but the worldwide response has remained lackluster.

"One of the reasons we have such a huge AIDS epidemic is a failure of leadership," said Piot, during a telephone press briefing. "Look how long it took the world to wake up. We've lost precious time -- lost time that is now being translated into millions and millions of deaths."

On the plus side, nations such as Uganda and Thailand have rolled back their HIV-infection rates with high-profile prevention programs. Although global financing for the battle against AIDS remains inadequate, it has risen sixfold since 1999, according to Piot.

Neff Walker, senior epidemiologist for UNAIDS, said previous attempts to forecast HIV infection rates have fallen short. In southern Africa, for example, earlier models "predicted one-third to one-half what we have now," he said.

Earlier efforts had foreseen a leveling off of infection rates in hard-hit countries such as Zimbabwe. Yet HIV infection rates have been climbing higher than previously believed possible. Two years ago, 1 in 4 adults in Zimbabwe was believed to be HIV positive. Now the estimate is 1 in 3. "We've consistently underestimated the levels the epidemic can reach," Walker said.

Sub-Saharan Africa remains the epicenter of the global AIDS disaster, and the new report forecasts that Africans will account for 55 million of the 68 million projected deaths by 2020.

Based on tests of selected groups, such as pregnant women, UNAIDS epidemiologists have found shocking rates of infection among Africans in the prime of their lives. In Botswana, 39 percent of those ages 15 to 49 are believed to be HIV-positive; in South Africa, the estimate is 20 percent, in Zambia, 21.5 percent.

DRUGS OUT OF REACH FOR MANY

Currently, there are 6 million people in developing nations whose HIV infections have progressed to AIDS and who could benefit -- as patients in industrialized nations do -- from combinations of antiretroviral drugs.

Yet only 230,000 citizens in low- to moderate-income nations are taking the drugs. Most of those are in Brazil, which has made great strides against the epidemic by defiantly producing its own versions of patented AIDS drugs.

Half a million AIDS patients in the United States, Europe and other industrialized nations currently take antiviral drugs, and last year 25,000 of them died of AIDS. In Africa, 30,000 of the estimated 28.5 million who are infected with HIV have access to the drugs. Last year 2.2 million of them died.

In the United States, these AIDS drug cocktails can cost $12,000 to $15,000 a year. Under international pressure, drug companies have lowered their costs for such medicines to $500 a year in developing nations; and generic versions can be made for $350.

U.N. Secretary-General Kofi Annan estimated last year that $7 billion to $10 billion a year was needed to turn the tide against AIDS. To date, worldwide spending on AIDS is estimated to be $3 billion.

At the previous International AIDS Conference in Durban, South Africa, two years ago, it was estimated that only 3,000 Africans had access to antiviral drugs. There has been a tenfold increase since then, "but it is still insignificant compared to what is needed," Piot said. "The challenge now is to find the money to pay for it."

E-mail Sabin Russell at srussell@sfchronicle.com.

CHART 1: A heavy toll

AIDS is a severe crisis in sub-Saharan Africa, the worst affected region in the world. Even if effective prevention and treatment programs take hold immediately, the scale of the epidemic means that the human and socioeconomic toll will remain huge for many generations.

Seven countries have HIV infection rates higher than 20 percent of people 15 to 49 years old.

1 Botswana: 39%

2 Zimbabwe: 33.7%

3 Swaziland: 33.4%

4 Lesotho: 31%

5 Namibia: 22.5%

6 Zambia: 21.5%

7 South Africa: 20%

Source: UNAIDS

CHART 2:

Call for more action to fight global epidemic The UNAIDS report released Tuesday appeals for more action by governments and the private sector to provide easier access to drugs to fight climbing infection rates of HIV. More than 40 million people worldwide currently live with HIV/AIDS.

HIV/AIDS epidemic estimates at end of 2001

People living with HIV/AIDS: 40.1 million total

18.6 million adult men

18.5 million adult women

3.0 million children younger than 15 years old

People newly infected with HIV in 2001: 5 million total

AIDS deaths in 2001: 3.0 million total

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