AIDS epidemic is worsening, U.N. warns

68 million people may die over 20 years, report says

July 03, 2002|By Jonathan Bor | Jonathan Bor,SUN STAFF

The world AIDS epidemic continues to worsen and could kill at least 68 million people in the next two decades, defeating earlier predictions that it would have peaked by now, a United Nations report warns.

Though the epidemic has subsided in some Western countries, including the United States, infection rates are reaching levels in sub-Saharan Africa that were once considered unimaginable. The virus also is spreading rapidly in China, Russia and many other countries where AIDS arrived late.

"It's clear to me that we're only at the beginning of the AIDS epidemic in historical terms," Peter Piot, executive director of the United Nations program on AIDS, said yesterday. The report was released in advance of Sunday's opening of the XIV International AIDS Conference in Barcelona, Spain.

Since the beginning of the epidemic, experts have been confounded in their ability to predict how far and fast AIDS would spread, said Piot. "We've consistently underestimated ... the sort of levels the epidemic could have reached," he said.

There were many reasons, he said. Health officials did not recognize the frequency of unprotected sex in certain parts of the world. They failed to appreciate that a person could carry the virus for years and infect many people. And they saw belatedly that a person who was seemingly safe - monogamous and drug-free - could lapse into risky behaviors.

"The original models assumed that society was divided into boxes: people at high risk and people at low risk," Piot said. "But people move in and out of these boxes."

Dr. Neff Walker, senior epidemiologist with the U.N. program, said nobody predicted how social disruption would spark epidemics in regions that previously saw little AIDS.

The economic meltdown in Russia, for instance, sparked a rise in prostitution and, with it, transmission among people having unprotected sex.

By 2020, about 68 million people will die of the disease in the 45 most affected countries unless drastic measures are taken through prevention and treatment, the report warns. That is more than five times the 13 million people who died of AIDS in those countries since the epidemic began in the early 1980s.

To make significant inroads in poor nations, spending on prevention and treatment must soon rise to $10 billion annually - more than triple the amount spent this year, the report says. That figure represents international aid and spending by the countries themselves.

The report paints a particularly bleak picture for sub-Saharan Africa, the world's hardest-hit area, where 28.5 million people are thought to be infected with the human immunodeficiency virus, which causes AIDS.

In Botswana, which has the world's highest infection rate, almost 39 percent of adults are now living with HIV, up from less than 36 percent two years ago. In Zimbabwe, where a quarter of adults carried the virus in 1997, about a third of the adult population was infected by last year.

High infection rates among pregnant women are particularly alarming because the virus can be passed to the child.

More than half of Botswana's pregnant women between the ages of 25 and 29 are thought to be infected. About a third of pregnant women in Zimbabwe and Swaziland carry the virus.

Meanwhile, the epidemic has begun to accelerate in countries that have been largely spared until recently.

In China, about 850,000 people are infected with HIV. The virus was once spread largely by needle-sharing among addicts and by unsafe medical practices. But it has begun to spread there through heterosexual activity.

In Guangxi province in southern China, about 11 percent of prostitutes tested positive for HIV in a study two years ago. The infection was virtually unknown among that group just a few years earlier.

The epidemic is growing faster in Eastern Europe than in any other part of the world, though the number of cases remains far lower than in Africa, Latin America and other hard-hit regions, the report says.

No country in Eastern Europe experienced many cases before 1994. By last year, however, reported infections in the Russian Federation had risen to 170,000, though the true number is estimated to be four times higher. An estimated 250,000 people were infected in Ukraine.

The United Nations report did point to some success stories, even in regions ravaged by AIDS.

In the 1990s, prevention and treatment programs in Uganda made that country the first in Africa to see its rate of new infections drop. Men and women in Zambia are having fewer sexual partners and using condoms more, a study shows. Infection rates there among urban and rural women have declined.

Dr. Kenrad Nelson, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health, said he wasn't surprised by the report's warning of a continued rise in worldwide AIDS.

The fact that the disease is spreading quickly in China - the world's most populous nation - and in Eastern Europe is reason for concern. Also, many countries of West Africa, which have not been as hard-hit as nations to the south, are seeing rising rates. These include Nigeria, the most populous nation on the continent.

Though a vaccine would offer the best hope for stemming the epidemic, a successful one appears far off.

"If we were extremely lucky and everything worked out, I can't see that it would be implemented until five to 10 years from now," Nelson said. "I think [the epidemic] is going to expand. I don't think there's any possibility it won't."

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