San Francisco Chronicle - November 22, 2006
Sabin Russell, srussell@sfchronicle.com.

In 8 of 11 sub-Saharan African nations where sufficient amounts of data could be collected, a survey found that the percentage of young people ages 15-24 infected with the AIDS virus was decreasing.

HIV-prevalence among youth in Kenya had decreased more than 25 percent in both urban and rural areas. Better than 25 percent declines were also detected in cities in Ivory Coast, Malawi and Zimbabwe, while a similar drop was reported in rural Botswana.

A turnaround in the spread of HIV among young people would be particularly important because 4 out of 10 new infections worldwide occur in this age group, and Africa accounts for two-thirds of all people living with the virus.

"The future course of the world's HIV epidemics hinges in many respects on the behaviors young people adopt or maintain,'' said the report by the Joint United Nations Program on HIV/AIDS, or UNAIDS.

This encouraging news was tempered by findings that the overall number of people living with the virus -- 39.5 million in 2006 -- continues to grow. The Geneva-based agency estimates that a record 4.3 million adults and children will be newly infected with HIV, and 2.9 million will die of AIDS-related illnesses this year.

"There are worrying trends, as well as encouraging ones,'' said Dr. Kevin De Cock, director of HIV/AIDS at the World Health Organization, during a telephone press conference Tuesday morning.

Women continue to bear the brunt of the spreading epidemic in Africa, and there was no evidence of a decline in the number of new infections among young people in South Africa, Mozambique and Zambia -- all countries heavily impacted by HIV.

Among the more alarming findings were signs that HIV infection rates may be creeping up again in Uganda, a country with a widely imitated prevention program that has driven infection rates down by two-thirds since the early 1990s. Recent studies show that HIV-prevalence among men in rural areas of Uganda has increased to 6.5 percent from 5.6 percent since 2000; and among women to 8.8 percent from 6.9 percent.

Other studies show an increase in the number of Ugandan men who report having sex with more than one partner, and "erratic" condom use among men and women under the age of 50.

"It's not unique to Uganda. We're seeing a decline in the intensity of prevention programs,'' said Paul Delay, director of Monitoring and Evaluation for UNAIDS. "There is a complacency that surrounds this disease."

Ominously, the report also found that injection-drug use, previously not a major factor in the spread of HIV in Africa, now appears to be linked to new cases in Kenya, Tanzania, Nigeria and South Africa.

In other parts of the globe, sharing of unsterilized needles among drug users has been a major driver of the epidemic.

Nowhere is that more evident than in Ukraine. According to the UNAIDS report, half of injection-drug users in Kiev, for example, are HIV-positive, and rates top 66 percent among drug users in the city of Mykolayiv. In the Odessa region, half of all new infections are attributed to transmission through unprotected sex with infected drug-using partners.

Russia and Ukraine account for 90 percent of the people living with HIV in Eastern Europe and Central Asia, where the number of people infected has risen twentyfold, to 1.7 million, in the past 10 years. Young people account for one-third of new infections, and 2 out of 3 new cases where the origin of infection is known are linked to the sharing of unsterile needles.

In Russia, where injection-drug use drove HIV infections to a high of 87,000 in 2001, infection rates are declining -- a phenomenon attributed to the fact that the majority of drug users likely to become infected had already contracted the virus. However, 40 percent of new infections in Russia are among women, most of whom are thought to have become infected through unprotected sex with HIV-positive drug-using male partners.

Ukraine is also experiencing a surge in transmission among heterosexuals: one-third of all new HIV diagnoses in the first six months of this year.

International efforts to expand treatment with antiviral drugs have brought life-prolonging medications to more than 1 million people in Africa, about a quarter of those whose illnesses have progressed to the point where they need the drugs to survive. As a result, UNAIDS estimates that nearly 800,000 years of life have been gained since 2002.

However, because the number of people with AIDS continues to outpace the spread of medications, the epidemiologists have yet to detect a decline in death rates due to the expanded availability of antiviral drugs.

"Progress is still too slow, and too limited,'' said Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

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