Five million new HIV cases were reported worldwide last year -- the most cases reported in any single year since the beginning of the epidemic -- according to the 2004 UNAIDS Report of the Global AIDS Epidemic (PDF; 15Mb) released by UNAIDS in advance of the XV International AIDS Conference, the AP/CNN.com reports (AP/CNN.com, 7/6). The report, which illustrates the most recent global HIV/AIDS trends, for the first time includes revised HIV prevalence for previous years based on improved methodology and more comprehensive country surveillance data (UNAIDS release, 7/6). For countries with generalized epidemics -- where HIV prevalence among pregnant women exceeds 1% -- overall HIV prevalence is calculated from data on women tested through prenatal care centers. The data then is adjusted and updated based on studies of HIV prevalence in specific populations. Countries with low-level or concentrated epidemics -- in which transmission is assumed to occur mainly among men who have sex with men and sex workers and their clients -- estimates are made for each group and then combined to obtain an estimate of the total number of HIV-positive people. However, many countries have started large-scale household surveys, which can offer more precise estimates than prenatal testing data. In addition, many countries have generated more precise data after attending workshops run by UNAIDS, UNICEF, the World Health Organization and CDC. Therefore, the changes in the 2003 data largely reflect improvements in the validity of the estimates, according to UNAIDS (Kaiser Daily HIV/AIDS Report, 6/30). The report shows that the number of people living with HIV increased from 35 million in 2001 to 38 million in 2003. The report also shows that nearly three million people died from AIDS-related causes in 2003 (UNAIDS release, 7/6). Additionally, almost 50% of new HIV cases worldwide were among people ages 15 to 24, and women comprised almost 50% of people living with HIV, the report says (Bloomberg News, 7/6).

Africa
Sub-Saharan Africa remains the most affected region in the world with approximately 25 million people living with HIV/AIDS, Reuters reports (Reaney, Reuters, 7/6). According to the report, an increase in AIDS-related deaths and a continued increase in the number of new HIV cases have led to a stabilization of HIV prevalence in the region. The region -- which accounts for 10% of the world's population but more than 65% of the world's HIV/AIDS cases -- saw three million new HIV cases and 2.2 million deaths in 2003. The report says that there is "no such thing as the 'African' epidemic" because the continent has "tremendous diversity ... in the levels and trends of HIV infection." For example, six countries have adult HIV prevalence rates below 2%, compared with six other countries with prevalence rates greater than 20%, and Botswana and Swaziland have HIV prevalence rates above 35%, according to the report. In addition, women are more likely than men to become infected with HIV at an early age. The country ratios of young HIV-positive women to young HIV-positive men range from 20 women for every 10 men in South Africa to 45 women for every 10 men in Kenya and Mali (UNAIDS executive summary, 7/6).

Asia
Asia accounts for 60% of the world's population and has experienced some of the "sharpest" increases in numbers of HIV cases, the report says, Reuters reports. Asia has 7.4 million HIV-positive people, which could have "global implications," according to Reuters (Reuters, 7/6). In Asia, the epidemic is still "largely concentrated" among injection drug users, men who have sex with men, commercial sex workers, and clients of sex workers and their sexual partners, according to the report. The report says that HIV prevention programs aimed at these groups are "inadequate, partly because of stigma and discrimination." Although some Asian countries -- including Thailand and Cambodia -- have launched efforts to fight HIV/AIDS among those high-risk groups, "there is no room for complacency," the report says, concluding that if other Asian countries "fail to target populations at higher risk, the epidemic will affect much greater numbers of people in the general population" (UNAIDS executive summary, 7/6). UNAIDS Executive Director Peter Piot said, "Asia is now where Africa was 15 years ago," adding, "The growth of the epidemic is going to depend to a large extent on how the countries react. Will they wait, like Africa, until there is massive mortality because the epidemic is largely invisible, or will they act now?" (Reuters, 7/6).

Eastern Europe, Central Asia
The report also says that Eastern Europe and Central Asia are seeing "fast growing" epidemics, BBC News reports (BBC News, 7/6). The report shows that about 1.3 million people in the region are living with HIV/AIDS, compared with 160,000 HIV-positive people in 1995. In addition, more than 80% of HIV-positive people in the region are younger than age 30 (AP/CNN.com, 7/6). The most affected countries in the region are Estonia, Latvia, the Russian Federation and Ukraine; however, Belarus, Kazakhstan and Moldova also are experiencing increases in numbers of HIV cases. The driving force behind the epidemic in the region is injection drug use, particularly in Russia (UNAIDS executive summary, 7/6).

Latin America, Caribbean
There are about 1.6 million HIV-positive people in Latin America. The epidemic is mainly concentrated among high-risk groups, including injection drug users and MSM, the report says. In addition, the report says that low national prevalence in some countries is obscuring serious epidemics. For example, in Brazil -- the most populous country in the region -- national prevalence is "well below 1%," but prevalence levels among injection drug users are above 60%, the report says (UNAIDS release, 7/6). In the Caribbean, HIV transmission primarily occurs through heterosexual intercourse and is centered on commercial sex workers and their clients. Haiti faces the largest epidemic in the region and has a prevalence rate of 5.6% -- the highest HIV prevalence outside of Africa (AP/CNN.com, 7/6).

Funding
Funding for HIV/AIDS programs worldwide increased to approximately $5 billion in 2003 from $300 million in 1996, Bloomberg News reports. However, the amount of funding available is less than 50% of what will be needed in 2005 by developing countries for prevention and treatment programs, according to the report, which calls for $12 billion by 2005 (Bloomberg News, 7/6). Although the Global Fund to Fight AIDS, Tuberculosis and Malaria, the U.S. President's Emergency Plan for AIDS Relief and other bilateral efforts have pledged more than $2 billion to increase access to antiretroviral treatment in 34 countries by the end of 2005, $3.5 billion still is needed. The report says that although more funding is available, many heavily affected countries are facing "serious bottlenecks" that are blocking "effective spending," including a lack of human and institutional capacity; stigma and discrimination; inadequate political commitment; "slow transfer of funds" from national to local and community levels; insufficient accounting; and inconsistent funding processes among donors, according to the UNAIDS executive summary (UNAIDS executive summary, 7/6). Piot said, "Despite increased funding, political commitment and progress in expanding access to HIV treatment over the past two years, the AIDS epidemic continues to outpace the global response" (BBC News, 7/6). He added, "The virus is running faster than all of us" (AP/CNN.com, 7/6). The report concludes, "Today we are faced with life and death choices. Without major action, the global epidemic will continue to outstrip the response. But there is an alternative: together we can forge policies grounded in science, not political rhetoric, and embark boldly on ... an agenda for future action based on innovative approaches" (UNAIDS report, 7/6).

NPR's "Morning Edition" on Tuesday included an interview with Piot about the study (Inskeep, "Morning Edition," NPR, 7/6). The complete segment is available online in RealPlayer.

To mark the release of the 2004 UNAIDS report, the Kaiser Family Foundation on Tuesday released two new fact sheets. The first fact sheet, titled "The Global HIV/AIDS Epidemic," contains the most recent data about the impact of the epidemic by geographic region and on women and young people. The second fact sheet, titled "The Global Impact of HIV/AIDS on Youth," shows the most recent data on the impact of HIV/AIDS among young people, particularly those between the ages of 15 and 24. The fact sheet focuses on factors that make adolescents more vulnerable to HIV, key parts of prevention programs aimed at young people and treatment programs.

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