Globally, five million people became infected with HIV in 2003, the worst year so far in the burgeoning epidemic. Of these, 700,000 are children under the age of 15. The majority of these infections occurred in sub-Saharan Africa.
Speaking at a London press conference to launch the 2003 UNAIDS report on the global epidemic, Peter Piot of UNAIDS said that more people had become infected than ever before during 2003, and more people had died than ever before.
He also highlighted the severe lack of treatment available in the worst-affected countries. "Less than 2% of Africans who need it have access to the HIV treatment needed to save those individuals and their families, but also entire economies and systems." he said.
The epidemic appears to be most out of control in southern Africa – South Africa, Botswana, Namibia, Swaziland and Lesotho. Infection rates among pregnant women range from 23% in Namibia and South Africa to 39% in Swaziland and Botswana, with no sign of a leveling off in any country, with the exception of women aged 14-19 in South Africa.
Together with Zimbabwe and Zambia, these countries represent the current epicentre of the epidemic – the region of the world in which one in five of the adult population is HIV-positive. UNAIDS estimates that 30% of the world’s HIV-positive people can be found in southern Africa, despite the fact that less than 2% of the world’s population live in this region. Over five million of these people live in the Republic of South Africa, which this week confirmed that it will begin to implement an ambitious antiretroviral treatment programme.
"The current pace and scope of the world’s response to HIV/AIDS fall far short of what is required," state the report's authors. "The struggle against AIDS has reached a crossroads: either we inch along
making piecemeal progress, or we now turn the full weight of our knowledge, resources and commitment against this epidemic. The choice is clear."
Some encouraging data from Eastern and Central Africa suggest that the epidemic has leveled off or even declined in some countries. HIV prevalence has fallen to 8% among pregnant women in Kampala, the capital of Uganda, and has fallen to 11% in Addis Ababa, the capital of Ethiopia) from 24% in 1995.
But where prevalence remains stable, as in Zambia, this does not suggest that the epidemic is under control, says the UNAIDS report. In fact, it shows that the number of new infections each year in Zambia is roughly equal to the number of AIDS deaths – roughly 80,000 a year. Across the continent, HIV prevalence among pregnant women has remained stable for the past decade – with the exception of Uganda and Ethiopia, suggesting that prevention efforts are still having limited success.
A trend analysis of antenatal clinic sites in eight countries (between 1997 and 2002) shows HIV prevalence among pregnant women leveling off at almost 40% in Gaborone (Botswana) and Manzini (Swaziland), and at almost 16% in Blantyre (Malawi) and 20% in Lusaka (Zambia). Prevalence exceeded 30% in South Africa’s mainly urban Gauteng province (which includes Johannesburg), while median HIV prevalence in Maputo (Mozambique) was 18% in 2002.
Source: AIDS Epidemic Update, UNAIDS, December 2003.