San Francisco Chronicle - November 22, 2005
Sabin Russell, srussell@sfchronicle.com.

On Monday, for the first time in a decade, the U.N. affiliate that tracks the epidemic reported continuous reductions in the number of people living with the virus in a handful of countries in the Caribbean and Africa.

"We are encouraged by the gains that have been made in some countries and by the fact that sustained HIV prevention programs have played a key part in bringing down infections," said Dr. Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS, or UNAIDS.

The agency's report provides a yearly benchmark of the global progress -- or lack of it -- against the disease, which has killed more than 25 million people since it was discovered in 1981. This year, 4.9 million people were infected with HIV, the virus that causes AIDS, and 3.1 million died of that disease.

The recital of grim statistics was tempered by reports that, at least in some corners of the world, AIDS prevention efforts might be working.

"We are finally, after almost 10 years, seeing additional countries showing declines of national HIV prevalence," Dr. Paul De Lay, director of evaluation at UNAIDS, said in a telephone press conference.

Thailand and Uganda first reported similar encouraging news nearly a decade ago.

In sub-Saharan Africa, 25.8 million people are living with HIV infection -- an increase of 3.6 percent from 2003. But the report finds that infection rates among adults in Kenya have fallen to 7 percent from 10 percent in the 1990s.

"Significant numbers of Kenyans in recent years have adopted safer sexual behavior," the report said. For example, condom use among women with casual partners rose to 24 percent from 15 percent in 1998.

Zimbabwe, racked by political strife and economic collapse, also appears on the UNAIDS list of improved results: The percentage of adults believed to be infected by HIV there has fallen since 2002 from 26 percent to 21 percent. Agency officials attribute the decline to high rates of condom use in casual sexual partnerships.

Lower infection rates in some Caribbean nations kept the overall rate of HIV prevalence stable in that region, where 1.6 percent of adults are living with HIV or have progressed to AIDS. This is particularly heartening, because no other region of the world outside sub-Saharan Africa has been hit as hard by AIDS.

In urban areas of Haiti in 2003 and 2004, for example, the percentage of pregnant women testing positive for HIV has decreased to 3.7 percent from 9 percent a decade earlier.

"Haiti's epidemic, one of the oldest in the world, could be turning a corner," the UNAIDS report concluded.

In the Dominican Republic -- on the eastern half of Hispaniola, the island it shares with Haiti -- epidemiologists have found HIV infection rates among pregnant women declined during the 1990s and have reached a stable rate of 1.4 percent, lower than in many other poor countries.

In both countries, the lower infection rates coincide with statistics showing improved measures of HIV prevention. One survey in Haiti, for example, showed men and women were more likely today than in 1994 to either abstain from sex or have sex with only one partner; in the Dominican Republic, a study shows 87 percent of prostitutes reporting they used a condom the last time they had sex.

Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said the overall picture painted by the report is mixed. "It confirms that investment in AIDS works but that we are seriously under-investing," he said.

The U.N.-inspired Global Fund has set a target of $7.1 billion to spend on programs for the three diseases in 2006-07 but has received pledges from wealthy nations of only $3.8 billion so far.

For every piece of good news about AIDS, the virus has a way of casting a cloud. As encouraging as Haiti's data may be, there are also indications of rising rates of unsafe sex among younger Haitians. Surveys are showing decreased rates of sexual abstinence among Haitian teens; that they are having sex at an earlier age and are less likely to use condoms than teens did in the mid-1990s.

Uganda's much-heralded success in driving HIV infection rates down a decade ago also may be waning. A recent Uganda survey has found that 7 percent of adults there were HIV positive -- up from an estimate of 6.2 percent in 2003. "Despite the admirable achievements in prevention, treatment and care in the past decade, Uganda has not overcome its epidemic," the report said.

World attention on AIDS tends to focus on Africa -- where 3.2 million people are newly infected every year -- but the fastest rates of HIV infection are occurring in Eastern Europe, primarily in the nations of the old Soviet Union.

Since 2003, the number of adults and children living with HIV in Eastern Europe and Central Asia has risen to 1.6 million from 1.2 million -- part of a 20-fold increase in the past 10 years.

Drug users who share contaminated needles are driving the epidemic in those areas, where it is also spreading among their sex partners. In the Russian Federation alone, UNAIDS estimates 860,000 people are living with AIDS. The U.N. report also raised alarm about infection rates among injection drug users in Indonesia and Pakistan, where HIV rates are steadily climbing.

In India and China, the world's two most populous nations, even small increases in the percentage of the population infected with HIV translate into huge numbers. In India, statisticians show a widely diverse epidemic reflecting the diversity of the country itself. More than 5 million are believed to be living with HIV or AIDS.

HIV has been detected in half of China's provinces, and the report said the country has made slow progress in fulfilling its pledge made in 2003 to provide free antiviral drugs to all who need them.

Worldwide, nearly 1 million poor people are benefiting from antiviral drugs, 250,000 of them in sub-Saharan Africa. The World Health Organization's Dr. Jim Kim, who set a goal of 3 million people to be treated with antiviral drugs by then end of this year, said the goal won't be met but that the drugs are saving many lives.

Kim said that the UNAIDS estimate that 5 million new HIV infections are occurring each year shows "we are really failing in our efforts to prevent this epidemic in most parts of the world."

051122
SC051111

Always watch for outdated information. This article first appeared in 2005. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2005. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .