More people – 5 million - were newly infected with HIV in 2003 than any previous year, according to UNAIDS in their 2004 Report on the global AIDS epidemic. The report has been produced in advance of the international AIDS conference which starts in Bangkok this weekend.
Since the last conference in Barcelona two years ago 9 million people have been newly infected with HIV and there have been 6 million deaths because of AIDS. The report also emphasises that only 7% of people in need of HIV treatment in resource limited countries are currently getting it.
Revised prevalence figures include rural data
UNAIDS have also published revised estimates for global HIV prevalence. These show that in 2003 35 million people worldwide were HIV-positive. Although this estimate is slightly lower than the December 2003 estimate of 42 million, there has been no reduction in the actual number of HIV-positive people. Indeed, according to the revised figures the global total increased from 31 million in 2001 to 38 million in 2003. Improved methodology has enabled UNAIDS to revise its estimates. Earlier prevalence figures were extrapolated from data largely obtained from prevalence studies conducted in urban centres in resource-limited settings. These data have been augmented by studies looking at prevalence in rural areas, which is lower.
UNAIDS is clearly concerned that these new data will be interpreted as a sign that the global HIV epidemic is not as severe as previously thought. “This is no time to misread the signals”, warned director, Peter Piot.
Epidemic worsens around the world
An analysis of the impact of HIV around the globe shows that Asia and India are emerging as new “hot spots” of the epidemic, with an apparent stabilisation in the number of infections in southern Africa – due to an increase in AIDS deaths.
Over 1 million people were newly infected with HIV in east and south-east Asia in 2003 alone, a record for the region. Sharp increases were recorded in China, Indonesia and Vietnam. There are now 7,400,000 HIV-positive individuals in the region.
With 25 million HIV-positive people sub-Saharan Africa remains the world worst hit region. Although these figures suggest on the surface that HIV prevalence has stabalised in the region, UNAIDS emphasise that the apparent slowing of the epidemic is, in fact, due to an increase in AIDS-related mortality, and that new infections continue to increase.
HIV is having an uneven impact on Latin America, the report also shows. A total of 1.6 million people are infected with HIV in this region, with the epidemic largely concentrated in certain higher-risk populations, particularly injecting drug users and gay men. This is well illustrated by Brazil, where a quarter of all the region’s HIV cases are located. Although national HIV prevalence is less than 1%, in some cities almost two thirds of injecting drug users are infected with HIV.
The rapid spread of HIV continues in eastern Europe, Russia and central Asia, where 1.3 million individuals are now thought to have been infected with HIV. Injecting drug users remain the group most affected in these regions, but sexual transmission is leading to the spread of HIV outside this group. Women are also increasingly affected in this region, accounting for a little under a third of all cases, up from 20% in 2001. UNAIDS also draws attention to the relative youth of the HIV-positive population in these regions, noting that 80% of all infected individuals are under 30 years of age. As condom use is low in this age group, UNAIDS warns that the epidemic is likely to continue to spread in this region.
Infections are also rising in the world’s wealthiest regions. In the US the total number of HIV cases increased by 50,000 from 2001 to 2003 to 950,000, with over half of all new infections located in African Americans, although there are concerns about a reemerging epidemic amongst gay men. There was also an increase in new infections in western Europe between 2001 and 2003, the total number of HIV cases rising from 540,000 to 580,000. This increase was fuelled by continuing HIV transmission amongst gay men, although there was also an increase in the total number of heterosexual cases, largely due to migration from resource limited countries.
Treatment access
Only 7% of people – 400,000 - in resource limited countries have access to antiretrovirals. The WHO “3 X 5” initiative aims to have 5 million people in poorer countries on HIV therapy by the end of 2005.
UNAIDS is hopeful that this will reduce the stigma which surrounds HIV and boost testing. Current research suggests that only 9% of people in resource limited countries have been tested.
Funding
An estimated $12bn (up from $10bn) will be needed to fund HIV education, treatment and care programmes by 2005, and $20bn by 2007. Although the amount of money given to HIV efforts has increased in recent years, with $5bn spent in 2003, UNAIDS is emphasising how much more still needs to be spent.
”Fully funding the response to AIDS will require an extraordinary effort, which cannot be met from currently planned regular domestic and international development budgets”, warn UNAIDS, who stress that in order to find this amount of money “extraordinary leadership will have to use currently untapped resources.”
Other obstacles
Stigma still continues to surround HIV. This stigma is directed not only towards HIV but the groups in most need of HIV education. “In some countries in Latin America and Asia, prevention programmes have not targeted injecting drug users and men who have sex with men…the groups most vulnerable to HIV in those regions”, stress UNAIDS.
Shortage of key staff in Africa is also highlighted by UNAIDS. The situation has been made worse by the migration of healthcare professionals overseas to help meet staffing shortfalls in western healthcare, the NHS included.
Better coordination between donor nations and organisations is also needed. The UNAIDS led “Three Ones” initiative was highlighted by UNAIDS as a model of best practice. This includes one national AIDS plan, one national AIDS authority, and one monitoring and evaluation system. “Promoting effective coordination among donor countries is the key to saving lives in developing countries,” said Peter Piot, who added, “we have fought hard to raise the money, now we must work as hard to spend it wisely.”
However, one resource which is particularly underfunded is condoms. Currently the supply of condoms is 40% short of what’s currently needed, and by 2015 an estimated 19 billion condoms a year will be needed to prevent the spread of HIV and other sexually transmitted infections.