San Francisco Chronicle - November 24, 2004
Sabin Russell, srussell@sfchronicle.com.

Spending on prevention and treatment in low and middle income countries grew 30 percent to $6.1 billion in 2004, according to projections by UNAIDS, the Joint United Nations Program on HIV/AIDS. Half that amount was spent by the afflicted countries themselves, the rest was contributed to them by wealthier nations. But the flow of dollars still falls short of the $10 billion needed each year to fight the disease in the developing world, according to UNAIDS director Dr. Peter Piot.

"The key challenge is to make that money work," he said during a telephone news conference from Brussels.

Much of global AIDS spending this year has been used to train medical personnel and set up systems to deliver drugs. "We'll see the impact of that in the next few years,'' Piot said.

In its annual statistical assessment of the epidemic, UNAIDS estimated that 39.4 million people are living with HIV, the virus that causes AIDS. That represents a 4 percent increase over revised estimates from 2003.

According to the report, the virus this year will infect 4.9 million -- including 640,000 children. Each year, the rising number of those infected by the virus is partially offset by those who die of AIDS-related illnesses. In 2004, UNAIDS projects the epidemic will claim 2.6 million adults, and half a million children.

AIDS poses a serious threat to densely populated and poor Asian nations. With an estimated 5.1 million infections, India now has the highest number of people living with the disease outside of South Africa. In India, China and Burma, the report found that "inadequate prevention efforts have allowed HIV to filter from people with the highest-risk behaviors to their regular sex partners.''

But the disease continues to strike hardest in sub-Saharan Africa, where 25.4 million are estimated to be infected with HIV -- an increase of 1 million from 2003. UNAIDS estimates that 57 percent of infected adults in the region are women, and that women and girls account for three-quarters of young Africans (ages 14-24) infected with HIV.

Although not quite half the HIV infections worldwide are among women, Piot said that the trend seen in Africa toward a feminization of the epidemic continues.

"In every single region in the world, the percentage of women living with HIV is going up,'' Piot said. As a consequence, he said, the global effort to combat the disease needs to address such issues as sexual violence and unequal status of women that put them at higher risk of HIV infection.

Studies show that, in some poor countries where women hold a subservient status to their husbands, married women are at higher risk of infection than their single counterparts. Studies of sexually active teens in Kenyan and Zambian cities found, for example, that HIV infection rates are 10 percent higher for those who are married than those who are not.

Piot also noted that women are losing out in the efforts to treat AIDS with cheap antiretroviral drugs. "There is growing evidence that increasing access to (the drugs) in the developing world is benefiting men in the first place, less so, women,'' he said.

Worldwide, the effort to provide such medications to poor countries is lagging far behind the World Health Organization's goal of treating 3 million people by 2005. As of June, an estimated 440,000 people in low- and middle- income countries were receiving the treatments, about one-tenth those who need it.

HIV prevention efforts have shown some evidence of success in eastern Africa, according to the report. Infection rates among pregnant women in Ethiopian cities have fallen to 11 percent in 2003, compared with 24 percent in the mid-1990s. Rates in Kenya have fallen to 9 percent, from 14 percent in 1997. Uganda remains Africa's best HIV-prevention success story, with national infection rates falling to 4.1 percent from 13 percent in the early 1990s.

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