San Francisco Chronicle - Wednesday, November 27, 2002
Sabin Russell, Chronicle Medical Writer

An estimated 14.4 million people face starvation in Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, said UNAIDS, the Joint U.N. Program on HIV-AIDS in Geneva.

"This is the first sign of larger, society-wide destabilization" as a consequence of AIDS, said UNAIDS executive director Dr. Peter Piot, in a telephone press conference Tuesday. "I didn't think it would occur this fast."

The report was issued in advance of World AIDS Day this Sunday, in what has become an annual rite of gloomy forecasting from the U.N. agency.

It depicts a vicious cycle of famine and HIV disease: "Bereft of food, people are compelled to adopt survival strategies that might further endanger their lives."

Rural families may migrate to urban slums where HIV is rampant, and mothers may barter sex for food.

Worldwide, an estimated 42 million people test positive for HIV, the virus that causes AIDS -- and for the first time, the number of women infected with the virus has approached the same level as men.

The United Nations reported that 19.2 million women are infected, as are 19. 6 million men. Another 3.2 million children under age 15 are also HIV positive.

"The face of AIDS is clearly a woman's face," said Piot, "particularly in southern Africa."

Because much of African subsistence farming is carried out by women, the disease is compounding the danger posed by a drought that has afflicted the southern part of the continent since 1992. Women account for six out of 10 infections in sub-Saharan Africa.

Seven million agricultural workers in 25 African nations have died of AIDS since 1985, according to the U.N. Food and Agricultural Organization.

This year, an estimated 5 million people were newly infected with HIV, and 3 million died of AIDS, a constellation of illnesses brought on after the virus gradually destroys the human immune system.

Although Africa remains the epicenter of the global AIDS epidemic, the UNAIDS survey documents the continuing spread of the disease.

Eastern Europe and Central Asia have the world's fastest growing HIV-AIDS epidemic, according to the U.N. re port. There were a quarter million new infections in these regions this year alone.

In the Commonwealth of Independent States, made up of much of the former Soviet Union, 80 percent of new infections were among people under age 29.

Over 200,000 cases have been reported in the Russian Federation alone -- most of the cases tied to injection drug users.

Epidemiologists are most concerned about the spread of HIV into Asia, where an estimated one million people were infected this year alone, bringing the total for the region to 7.2 million.

India and China, the two most populous nations on earth, already account for at least five million infections.

Indonesia, the world's largest Muslim nation, reported virtually no HIV a decade ago. Today, an estimated 50 percent of injection drug users in Jakarta are infected.

"Just when we thought that that some of these societies would be immune, we see a dramatic outbreak," said Dr. Bernhard Schwartlander, director of HIV- AIDS for the World Health Organization.

In the wealthier European and North American nations, AIDS continues to evolve, becoming less a disease of white gay males and injection drug users and more a disease of women who are infected by their sex partners.

More than half of the 4,279 new cases of HIV in the United Kingdom this year were the result of heterosexual sex, compared with only one third in 1998.

A significant number of these cases involve immigrants from Africa and the Caribbean, according to UNAIDS epidemiologist Neff Walker.

In the United States, AIDS remains primarily a disease of gay men, but 56 percent of new infections among young people aged 13 to 19 were among females, most of them contracting the virus through heterosexual intercourse.

Despite the litany of discouraging news, the UNAIDS report did identify some bright spots.

Prevention efforts in South Africa may be paying off in lower rates of infection among young women. In 2001, the percentage of pregnant women under 20 who are infected with HIV fell to 15.4 percent from 21 percent in 1998.

Rates have fallen among girls in Addis Ababa, Ethiopia, and in Uganda, which was the first African nation to roll back high infection rates with an aggressive, government-supported prevention strategy.

Condom promotion programs for prostitutes in Cambodia have reduced infection rates among sex workers to 29 percent from 42 percent in 1998, according to the U.N. report.

International AIDS experts contend that a properly funded prevention and treatment program, at a cost of $10.5 billion a year by 2005, could avert 29 million new infections otherwise forecast by the end of this decade.

"There is strong evidence from around the world that the AIDS epidemic does yield, in some cases dramatically, to determined intervention," Piot said.

CHART:

WOMEN CLIMB IN RANK AMONG HIV POSITIVE

A new U.N. report finds that for the first time since the AIDS epidemic began women now account for nearly 50 percent of the 42 million people worldwide living with HIV.

-- People HIV positive end of 2002 estimates, in millions

19.6 men - 19.2 women - 3.2 children less than 15 years old - 42.0 total

-- Newly infected with HIV

2.2 men - 2.0 women - 0.8 children less than 15 years old - 5.0 total

-- AIDS deaths

1.3 men - 1.2 women - 0.6 children less than 15 years old - 3.1 total

Sub-Saharan Africa 29.4

North America 0.9

Latin America 1.5

Caribbean 0.4

Australia and New Zealand 0.02

Europe:

Western 6

Eastern 1.2

East Asia 1.2

South Asia 6.0

North Africa and Middle East 0.6 .

Sources: UNAIDS; ESRI

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

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