United Press International - Tuesday, 27 June 2000
Michael Smith, UPI Science News

And in some places, the death toll could be higher, said Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

In Botswana, about 35 percent of those between the ages of 15 and 49 are infected with HIV, the virus that causes AIDS. "There, at least two thirds of all 15-year-olds (alive today) will die of AIDS," Piot said in a conference call from Geneva.

He was releasing the latest UNAIDS report on the epidemic, which says 34.3 million people around the world are now infected with HIV, about 25 million of those in Africa.

"Barring a miracle," the report says, most of them will die within the next 10 years.

According to the report, there were 5.4 million new infections in 1999, most of them -- 4 million -- in Africa. Nearly 3 million people died of AIDS last year, the report says, bringing the total number of deaths since the epidemic began to 18.8 million.

The report was released 12 days before AIDS experts gather in Durban, South Africa, for the 13th International AIDS Conference. It also comes as South African President Thabo Mbeki is challenging the idea that the human immunodeficiency virus (HIV) is the cause of AIDS.

AIDS researcher Mark Wainberg of McGill University in Canada, president of the International AIDS Society, said the report "highlights the fact that HIV is already the world's number one problem in public health."

Because of the soaring infection toll and the difficulty of treating HIV, he said, "we don't have the means right now at our disposal to stop the situation -- unfortunately and tragically -- from getting much worse."

Piot said the epidemic is already having drastic effects on society in sub-Saharan Africa, where 16 countries have HIV infection rates of more than 10 percent and seven have rates higher than 20 percent.

Beside Botswana, the hardest-hit countries in Africa are Zimbabwe and Swaziland, with infection rates of about one in four. South Africa has the largest number of people infected, with 4.2 million, although the rate is one in five.

The "most spectacular" effect of the disease, Piot said, is on basic education. Teachers are being lost to AIDS and students are being forced to drop out because the cost of caring for ill relatives leaves no money for school.

In Zambia, for instance, the UNAIDS report says 1,300 teachers were lost to AIDS in the first 10 months of 1998 -- equivalent to two-thirds of the new teachers trained annually.

As well, many young people -- 13 million world-wide -- have lost one or both parents to AIDS. These "AIDS orphans" have difficulty continuing their education, Piot said.

Piot said the epidemic is also having dire effects on business and on development. "Skilled laborers and trained professionals are dying of AIDS," he said, making it hard for developing countries to improve their economic position in the world.

Although the report is "sobering," he said, there are glimmers of hope: In some countries, an aggressive prevention campaign has reversed a years-long trend and reduced the infection rate.

In Uganda, for instance, the rate of infection among teen-age girls -- the most vulnerable group -- has fallen from just under 4.5 percent in 1989 to just under 2 percent in 1997, the report says. The girls are most vulnerable, the report says, because their sexual partners tend to be older men, who are more likely to be infected with HIV.

And a study of pregnant teenagers in Lusaka, the capital of Zambia, showed the HIV infection rate had dropped by half between 1993 and 1998.

Piot said the uproar over the cause of AIDS -- unleashed by South Africa's Mbeki earlier this year -- is unproductive. "The debate about the cause of AIDS is closed and had been closed for a long time," he said. "HIV causes AIDS."

Mbeki's position, he said, is unlikely to have much effect outside of South Africa, where the government has refused to treat pregnant HIV-positive women with drugs that prevent that transmission of the virus to the infant.

Piot said more than 620,000 children were born HIV-positive last year, and a short course of drugs could have prevented much of that. "Clearly we can have an impact," he said.

Even in South Africa, he said, there's a tempestuous debate on the issue, although "there's no sign that the line of the government is changing."

Mbeki has convened a meeting of so-called "HIV deniers" and mainstream AIDS experts in South Africa next week to examine the issue. "I don't expect consensus," Piot said, "but I hope they will focus on what can be done."

McGill's Wainberg, who once said HIV deniers are a menace to society, said if Mbeki "continues to cloud the issue...he will be contributing in no small way to further confusion and the spread of this epidemic."
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