United Press International - July 6, 2004
Ed Susman, UPI Science News

In its biennial report, the Joint United Nations Program on HIV/AIDS -- also known as UNAIDS -- reports 38 million people are now living with the disease that is robbing nations of its most productive workers at an unprecedented rate.

"Half of the 15 year olds in parts of southern Africa will not live to be 60 years of age due to AIDS," said Kathleen Cravero, deputy executive director of UNAIDS at a news briefing to review the "UNAIDS 2004 Report on the global AIDS epidemic."

Cravero said the estimate of 38 million people living with HIV infection -- the human immunodeficiency virus, which causes AIDS -- is lower than the 40 million estimate in 2002. However, she noted, the updated figure represents more accurate reporting, not a reduction in the epidemic. She added that the statistical range of the estimate suggests as few as 35 million people may be infected, but as many as 42 million may have the disease.

"Whether it is 35 million or 38 million or 40 million," Cravero said, "this is a catastrophe that has to be dealt with." Since the last report, she said, 9 million more people have become infected with HIV and 5 million people have died from the disease.

Cravero said as bad as the situation is in Africa -- where an estimated 25 million people are living with the disease, it might be far, far worse in Asia.

Several Asian nations, including the population behemoths China and India -- with more than 1 billion people each -- are seeing HIV infection rates hovering near 1 percent. Cravero said the 1 percent figure represent the threshold at which the epidemic is considered generalized among the population -- and a point at which control of the epidemic is critical.

"Asia is facing a life-or-death chance to control the epidemic," she said. "Asia has a narrow window of opportunity to prevent AIDS from having a more severe impact on the region."

If those countries do not show the political and social will to fight HIV, Cravero said, that window of opportunity will close forever.

"If we don't succeed," she said, "Asia will suffer an epidemic the likes of which we have never seen -- despite what we have already seen in Africa. If we do not seize this window of opportunity it will slam shut forever."

The U.N. report notes particular worrisome trends in China, Indonesia and Vietnam, where the HIV epidemic is being fueled by infections among injecting drug users. The report also expressed concern about the epidemic in India, where an estimated 0.4 percent to 1.3 percent of the population is infected. That means as few as 4 million people or as many as 13 million people in India are infected. The report suggests the likely figure in India is 5.1 million people, making it the second-most affected nation. In South Africa, about 5.3 million people are thought to be carrying the disease.

In the two years since the last UNAIDS report, Cravero said, more people are being treated for the disease -- 230,000 in 2002 vs. 400,000 in 2004. That trend is encouraging, she said, but it is a far cry from the "4 by '05" goal set by the World Health Organization, which aims at having 4 million people under treatment by the end of 2005.

The report was released just days before the start of the 15th International AIDS Conference in Bangkok, which is expected to draw more than 15,000 attendees.

"Asia has the opportunity to avoid going the route of Africa," Dr. Joep Lange, professor of Internal Medicine at the Academic Medical Center of the University of Amsterdam and president of the International AIDS Society, the sponsor of the conference, told United Press International.

Lange said the government of China is making efforts to put controls on the epidemic that has exploded among injecting drug users and in contaminated blood products in that country.

Cravero said one of the key elements in turning the tide against AIDS will be changing the attitudes of governments and individuals concerning the stigma and discrimination that occurs when someone infected with AIDS is identified.

Robert England, United Nations Develop Programme resident representative in Thailand, said that stigmatization is a major factor in Asia and Africa where people with "HIV are shunned by neighbors, fired from their jobs and are badly treated by the health care system because of their disease. This kind of discrimination undermines prevention programs and treatment programs."

Cravero told UPI stigmatization can be attacked and overcome if there is an effort made at both the top of the political leadership and among those at the local levels. In Uganda, where AIDS prevalence has dropped from more than 20 percent to less than 8 percent of the population, a concerted government program of acknowledging and discussing AIDS cracked the stigma in that county, she said.

Cravero cited progress in reducing stigmatization in Malawi -- after the president's brother was identified as having died of AIDS -- and in Lesotho, where the president and 80 ministers volunteered to undergo AIDS testing.

Nevertheless, the AIDS stigma persists, Lange said, even in Botswana, where AIDS is openly discussed, condoms are handed out at hotels and restaurants and the government and private industry have teamed up to guarantee treatment with combination anti-retroviral therapy (HIV is a retrovirus). Yet barely one in six Botswanans who need treatment seeks it, due to the stigma still associated with the disease.

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Ed Susman covers medical issues and research for UPI Science News. E-mail sciencemail@upi.com
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