The HIV epidemic is still in its early phase and there could be 68 million HIV-related deaths between 2000 and 2020 unless prevention and treatment programmes to combat the disease are expanded drastically, the United Nations Programme on HIV/AIDS (UNAIDS) is warning. Such a level of AIDS related mortality would represent a three-fold increase on the 21 million deaths attributed to AIDS in the 20 years before 2000.
In a new report published in advance of the XIV International AIDS Conference which opens in Barcelona on 7 July, UNAIDS is also warning that theories that HIV might “level off” in countries with high prevalence rates are being disproved. The Report on the Global HIV/AIDS Epidemic, highlights Botswana, which has the highest HIV infection rates in the world with almost 39% of all adults now HIV-positive, up from less than 36% two years ago. In Zimbabwe, HIV prevalence has increased from a quarter of the adult population on 2000 to a third by late 2001 and three other southern African countries have HIV prevalence rates in adults above 20%.
UNAIDS is also projecting that 50% of South African new mothers could die because of HIV, and that mortality amongst 15-34 year olds will be 17 times higher because of AIDS.
HIV spreading in new areas
The spread of HIV in other parts of the world, notably China, the Far East and Eastern Europe has prompted UNAIDS to warn that even though 40 million people are currently infected with HIV worldwide, the HIV epidemic is still in its early phase. A 70% increase in cases of HIV in China in the first six months of 2001 is highlighted by the report, as is a rapid increase in HIV cases in Indonesia, the world’s fourth most populous country. In the Russian Federation and Eastern Europe injecting drug use and heterosexual sex have led to the fastest growing HIV epidemic in the world. Parts of Africa which previously had low rates of HIV infection, are now seeing the rapidly accelerating spread of the disease, with explosions in the HIV epidemic noted in Cameroon, and predicted for Ethiopia.
Young people are bearing the brunt of infections, with approximately 50% 0f all new cases of HIV in people aged 15-24. Almost 12 million young people are thought to be infected with HIV, and 14 million children have lost one or both parents due to AIDS. UNAIDS are predicting that “this number will continue to grow rapidly, as the numbers of adults dying of AIDS rises over the coming years.”
The UNAIDS report also accuses governments and individuals in western industrialised countries of becoming complacent about the threat posed by AIDS, noting that the "rising incidence of...sexually transmitted infections among men who have sex with men...confirms that more widespread risk-taking is eclipsing the safer sex ethic promoted so effectively for much of the 1980s and 1990s." A syphilis outbreak amongst gay men in Los Angeles in 2001 is cited as evidence that "safe sex was on the decline in the city."
Less than 4% have access to HAART
Noting that less than 4% of people infected with HIV in the developing world had access to HAART, Dr Peter Piot, director of UNAIDS said, “access to adequate care and treatment is a right not a privilege” adding “real progress has been made in lowering the price on antiretroviral therapy in the developing world, far greater action is needed by both governments and the private sector to ensure that treatment reaches those in greatest need. The cost of treatment must continue to fall, and governments in both the developing world and donor countries must create sustainable funding streams to provide treatment while strengthening the healthcare infrastructure.”
Successful prevention efforts
However, on a more optimistic note, the UNAIDS report highlights the successful slowing of the spread of HIV in some countries, suggesting that “the world is finally waking up to what it takes to bring [HIV] under control” and that “political commitment has grown hugely in the past two years…grounded in the increasing involvement of community and religious organisations, businesses, individuals and activists.”
Highlighted for praise are Zambia which has managed to reduce HIV prevalence amongst women in both urban and rural areas, and Poland ,which unlike much of eastern Europe succeeded in curtailing the HIV epidemic amongst injecting drug users and preventing it from spreading to the sexually active population.
Uganda is praised as “Africa’s greatest success story in the fight against AIDS.” At the end of 2001 adult HIV prevalence had fallen from 8.3% in 1999 to 5%. The South African government’s HIV awareness campaigns with young people are also singled out for praise, the report noting increased rates of safer sex amongst the young. In June, it was suggested that HIV prevalence amongst pregnant women in South Africa may have levelled off at 25%, with statisticians noting a slight fall in new cases of HIV detected in under 25s.
More funds and political will needed
Although UNAIDS praises a six-fold increase in donations to fight HIV since 1998, it highlights that total donor funding of $3 billion in 2002 is $7 billion short of what will be needed by 2005 to fund HIV prevention, care and treatment projects in low and middle income countries.
Calling for more money and enhanced political will, Peter Piot said “it is possible to make progress against HIV/AIDS…In order to overcome this epidemic on a global scale, the international community must muster even greater political commitment, action, and above all, resources.”