Important note: Information in this article was accurate in 2007. The state of the art may have changed since the publication date.
San Francisco Chronicle - Tuesday, November 20, 2007
Sabin Russell, Chronicle Medical Writer, srussell@sfchronicle.com
Although this dramatic reduction in HIV estimates is largely the result of new methods of counting cases, the analysis also concludes that the number of new cases of HIV infection peaked in the late 1990s and has been declining slowly ever since because of prevention efforts and natural trends in the epidemic.
UNAIDS, the Joint United Nations Programme on HIV/AIDS, has dramatically revised downward the number of people it counts as living with the infection, to 33.2 million in 2007 compared with 39.5 million in 2006.
It amounts to an admission by the world AIDS agency that it has overestimated the number of people living with HIV infection, but the revamped total still represents a ghastly human tragedy. The same analysis predicts that this year, 2.1 million will die of the disease and another 2.5 million will have become newly infected - 6,800 new infections every day.
Problems with the AIDS estimating system have been apparent for years, when the epidemiologists began more systematic surveys of African cities and rural areas and found that the actual number of infections was lower than official estimates.
Since the early days of the epidemic, researchers relied on testing data from prenatal clinics - one of the few places in impoverished countries where HIV tests were readily available. Those tests showed disturbingly high levels of HIV infection among pregnant women, and those rates were then extrapolated to the entire population.
But when more accurate surveys based on house-to-house interviews were conducted, epidemiologists from sub-Saharan Africa to India were finding fewer HIV infections than the computer models had predicted. Seventy percent of the reductions in the new UNAIDS estimate are the result of revamping statistics from just six countries: Angola, India, Kenya, Mozambique, Nigeria and Zimbabwe.
This time, UNAIDS is insisting, researchers have gotten it right - or at least a far more accurate portrait of the epidemic.
That picture is still grim. Sub-Saharan Africa remains the epicenter of the global pandemic. Two out of 3 people in the world infected with HIV live there, and 3 out of 4 AIDS deaths occur there.
There are still 22.5 million people living with HIV in sub-Saharan Africa, and almost two-thirds of them are women. An estimated 1.6 million men, women and children are expected to have died of AIDS in the region in 2007.
Prenatal clinic testing results in several African nations continue to be discouraging, although in South Africa the numbers appear to have peaked, trending down to 29 percent of women tested in 2006, compared with 30 percent a year earlier.
In Botswana, the rate has fallen to 32 percent in 2006, compared with 36 percent in 2001.
The significant adjustment of global HIV statistics was prompted in part by an intensive study of infections in India, which concluded this spring that the UNAIDS data were way off. After consultations with the Indian government, UNAIDS revised the estimate of infections there to 2.5 million from 5.7 million.
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