United Press International - November 26, 2002
Steve Mitchell, UPI Medical Correspondent

"The face of the epidemic continues to change and for the first time half of the people living with it are women," Peter Piot, executive director of the UNAIDS, said during a teleconference announcing the report titled "AIDS Epidemic Update 2002."

Piot noted this trend has been driven largely by the high rate of infected females in sub-Saharan Africa where nearly 60 percent have contracted the human immunodeficiency virus, which causes AIDS.

"The face of AIDS is clearly a female face in sub-Saharan Africa (and) is far away from the gay white man's disease it used to be in the '80s," he said.

Sub-Saharan Africa continues to have the highest number of people living with HIV/AIDS in the world, the report says. More than 29 million adults and children in that region are infected, which is more than half of the 42 million people infected worldwide. The region accounted for 3.5 million of the 5 million new infections globally this year and 2.4 million of the 3.1 million deaths.

The overwhelming majority of sub-Saharan Africans do not have access to drugs that could help control the disease symptoms. However, there have been declines in infected young women in South Africa and Uganda due to prevention programs, indicating intervention efforts could help to stop the epidemic.

The disease also is on the verge of exploding in several other regions, including China, India and the Russian Federation.

The outbreaks in these regions are driven mainly by the increase in the use of injected drugs, said Bernhard Schwartlander, director of the WHO's HIV/AIDS department. Injecting drug use is "fueling the very rapid spread of HIV," he said, adding it is "a new phenomena" there "so these societies are not prepared to cope with it."

The number of people in China living with HIV/AIDS has reached 1 million and it could grow much higher. Unless effective interventions are put in place, "it's not unrealistic that the number of people living with HIV/AIDS may increase to 10 million by the end of this decade," Schwartlander said.

Nearly 4 million people in India are infected, the second-highest number of any country in the world, after South Africa, the report stated.

Latin America has more than 1 million people infected and also is at risk for a large increase. In some countries in this region, HIV/AIDS is the leading cause of death and the crisis appears to be due mainly to unsafe sex among gay men and to drug users who inject. This is true especially in Argentina, Brazil and Uruguay.

The report estimates 45 million additional people could become infected in low- and middle-income countries unless appropriate intervention efforts are put into place. A combination of programs that encourage postponement of first sexual encounter, increased condom use and reduction of sex partners has shown to be effective at reducing the rate of new infections, Schwartlander said.

However, putting such measures in place and providing effective medications will require the assistance of the developed countries, in particular the United States, the largest funder of AIDS programs, Piot said. The global response is dependent on their participation, he added.

"There is no question that more resources are needed for the global fight against HIV and AIDS," Schwartlander said. "About $10 billion would be needed for an effective response by 2005," he said. That could prevent 29 million new HIV infections this decade. So far, only about $2 billion has been pledged by governments around the world to fight HIV/AIDS.

The world's leading economies likewise are at risk of an increase in HIV/AIDS cases due to complacency, the report says. Young people in developed countries are failing to practice safe sex and are engaging in high-risk behavior, which underscores "the need for renewed prevention efforts," it said. In addition, there is alarming evidence many gay men in developed nations are engaging in unprotected sex even when one of their partners is HIV-positive.

Prevention efforts "have been almost forgotten" in these affluent countries due to the availability of drugs that can manage the disease effectively, Schwartlander said. Developed nations have the resources for effective educational and prevention programs, so "every infection that happens (in these regions) is one infection too many," he said.

In Western European countries, heterosexual sex is becoming a major mode of transmission, accounting for half of new infections in the United Kingdom and Ireland.

In the United States, minorities still are hard hit by the virus. It remains a leading cause of death in African-American males between the ages of 25 and 44 and the third-leading cause of death in Hispanic males in the same age range.

African-American women account for 64 percent of the new cases in women, and they primarily were infected by African-American men who have sex with men, the report says.

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