December 1, 2004
AIDS advocates and health workers on Wednesday marked World AIDS Day by focusing on gender inequalities that can lead to an increased risk of HIV infection among women and girls, the AP/Long Island Newsday reports (AP/Long Island Newsday, 12/1). Nearly half of the 37.2 million HIV-positive adults ages 15 to 49 worldwide are women, and the number of HIV-positive women in all regions of the world has been increasing over the past two years, according to a report released last week by UNAIDS and the World Health Organization. According to the report, titled "AIDS Epidemic Update 2004," the total number of HIV-positive people in the world has risen from 38.1 million in 2003 to 39.4 million in 2004. More than three million people worldwide have died from AIDS-related illnesses in the past year. Over the past two years, the number of HIV-positive women in East Asia increased 56%, the largest increase in any region. In both Eastern Europe and Central Asia, the number of HIV/AIDS cases among women increased 48%, according to the report. In Africa -- the continent most-heavily affected by the disease -- women represent nearly 60% of HIV-positive people. In sub-Saharan Africa, where about 70% of the world's HIV-positive people live, about 75% of HIV-positive individuals ages 15 to 24 are women. UNAIDS Executive Director Peter Piot said that HIV/AIDS prevention programs in developing countries can be ineffective among women because women face poverty, sexual violence, limited educational opportunities and unequal access to medications (Kaiser Daily HIV/AIDS Report, 11/24).
Statements on HIV/AIDS Among Women
Piot said, "Violence against women cannot be tolerated at any level," adding, "The fear of violence prevents many women from accessing HIV information, from getting testing and seeking treatment. If we want to get ahead of the epidemic we must put women at the heart of the AIDS response." WHO Director-General Dr. Jong-Wook Lee said that to "ensure equitable access to prevention and treatment services for women and girls, it is important for countries to set their own national targets," adding, "The targets must match the proportion of men, women and children who are living with HIV and in need of treatment" (WHO release, 11/30). Richard Feachem, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said, "AIDS is increasingly taking on a woman's face," adding, "Millions of women are at risk from HIV while social, cultural and economic factors prevent them from protecting themselves against infection. The traditional prevention strategies are not effective in protecting these women. We must roll out large-scale prevention programs which reduce women's exposure to risk and allow them to protect themselves. The Global Fund will finance such programs in all countries which face large or growing epidemics" (Global Fund Web site, 12/1). HHS Secretary Tommy Thompson said that this year's World AIDS Day has a "special focus" on the "alarming impact of HIV/AIDS on women and girls," according to an HHS release. Thompson said, "Minority women are disproportionately impacted, comprising 80% of American women living with AIDS," adding, "In communities across this country, there are vibrant examples of HHS-supported programs targeted at women that are making a difference" (HHS release, 11/30).
U.S. "Losing Ground" in Fighting HIV/AIDS Among African Americans
The United States is "losing ground" in fighting HIV/AIDS among African Americans -- particularly African-American women -- who are disproportionately affected by the disease, according to Agence France-Presse (Agence France-Presse , 11/30). Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said that the proportion of AIDS cases among women in the United States has "risen dramatically," from 6% of cases in 1985 to 26% in 2002, with minority women -- especially African-American women -- being disproportionately affected, according to a NIAID release. Fauci said, "Of course, these numbers do not tell the full story: the scourge of HIV/AIDS in women cripples families, creates orphans and impairs the economic and social foundation of communities and nations," adding, "To stop the disturbing trend of an increasingly female HIV/AIDS pandemic, new ways of thinking are needed. Women must be empowered so that they are able to control their own lives and in particular their sexual relations" (NIAID release, 12/1). Sherry Kaplan, coordinator of the Center for Positive Connections in Miami, said, "It's a pretty bad situation," adding, "It's a tragedy that there is no wake-up call, that we have our own epidemic going on here in the U.S. and the money isn't coming in, that there is no proper education prevention." Kaplan said that a "more casual attitude" toward sex and the growing use of male erectile dysfunction drugs have contributed to the HIV/AIDS epidemic in the United States, according to Agence France-Presse. "Viagra is steering more infection because these men can now have sex and these (divorced and widowed) women don't know how to negotiate condom use, or they would never think that a man over 55 would give it to them," Kaplan said (Agence France-Presse , 11/30).
HIV/AIDS Poses Threat Equal to Nuclear Terrorism, U.N. Report Says
HIV/AIDS poses a threat to international security and stability "on a par with" nuclear terrorism, and the pandemic has the ability to "claim tens of millions of lives worldwide in a matter of months," according to a report commissioned by U.N. Secretary-General Kofi Annan that was released on Tuesday, Agence France-Presse reports. The report says that in the age of globalization and mass travel, developed countries ignore HIV/AIDS and other infectious diseases "at their own peril," according to Agence France-Presse. The security of developed countries could be "held hostage" by the ability of resource-poor countries to contain HIV/AIDS and emerging diseases, the report says. The report calls for a U.N. Security Council special session to address HIV/AIDS as a "threat to international peace and security," according to Agence France-Presse. "Some believe that HIV/AIDS is a horrible disease, but not a security threat," the report says, adding that the threat posed by the disease should be considered equivalent to nuclear proliferation, terrorism and inter-state conflict (Agence France-Presse , 11/30).
Epidemics in India, China, Russia Near "Tipping Point," UNAIDS Says
The HIV/AIDS epidemics in India, China and Russia are "perilously close to a tipping point" and bear "alarming similarities to the situation we faced 20 years ago in Africa," Piot said on Tuesday, according to the Washington Post. Piot said that the HIV/AIDS epidemics in those three countries could transform "from a series of concentrated outbreaks and hot spots into a generalized explosion across the entire population -- spreading like a wildfire from there." In his "unusually ominous and concrete" warning on Tuesday, Piot said that HIV/AIDS epidemics in India, China and Russia could threaten the global economy and international security, according to the Post. In addition, he said that if "Africa-scale" epidemics emerge in the three countries, resources needed to provide antiretroviral drugs to African countries could "easily diminish, perhaps even vanish." Piot said that China currently has an HIV prevalence of 0.1%, compared with an overall prevalence of 7.5% in sub-Saharan Africa. Although India has an "extremely low prevalence," the country has 5.1 million HIV-positive people, second only to South Africa, where 5.3 million HIV-positive people live. There are approximately 860,000 people living with HIV/AIDS in Russia, according to the Post. Although the epidemics in the three countries are "confined almost entirely to high-risk groups," the number of HIV-positive people will rise "exponentially" when the epidemics break out into the general population of heterosexual adults, according to the Post. "The tipping point is not a hypothetical construct," Piot said, adding, "In South Africa, it took five years for prevalence rates to move from 0.5% to 1%. Then, in only seven years, it jumped from 1% to 20%." U.S. Ambassador Randall Tobias, head of the State Department's Office of the Global AIDS Coordinator, said that the three countries have the "capacity to do a great deal for themselves" to fight HIV/AIDS, adding, "We need to encourage the leadership and make sure that each of those countries is doing everything it can to put this issue at the very top of the agenda." Tobias said that the three countries should work to reduce stigma surrounding HIV/AIDS, according to the Post. None of the three countries are included in the President's Emergency Plan for AIDS Relief (Brown, Washington Post, 12/1).
HIV/AIDS in Africa
In examining the HIV/AIDS epidemic in Africa, it "most often seems AIDS is winning," according to Reuters/Philadelphia Inquirer (Nyambura, Reuters/Philadelphia Inquirer, 12/1). The "real hurdle" in fighting the disease in Africa is "translating awareness into behavior change, and the effort often runs up against longstanding and strongly held cultural values," according to the Christian Science Monitor. "If the same market researchers who are selling Coke were charged with selling safer sex, they'd probably have thrown up their hands by now because it's a much more complicated thing," Neill McKee, coauthor of the book "Strategic Communication in the HIV/AIDS Epidemic," said. The "cultural stumbling blocks" to preventing the disease's spread in Africa include gender inequality, a reluctance to openly discuss sex and an acceptance of married men having multiple sex partners, according to the Monitor. Suzanne Leclerc-Madlala, head of anthropology at South Africa's University of KwaZulu-Natal, said that African men -- who have faced a history of colonialism, racism and poverty -- do not want to give up their power over women, according to the Monitor. "I don't think we're putting enough emphasis on changing men's behavior," Leclerc-Madlala said. Results of the "ABC" prevention strategy -- meaning Abstinence, Be faithful, use Condoms -- have been "mixed" in Africa, according to the Monitor. The ABC approach helped lower HIV/AIDS prevalence in Uganda from 13% in the early 1990s to 4.1% today, but condom use is increasing only in some African countries, and extramarital sex is not declining, according to the Monitor (Crawley, Christian Science Monitor, 12/1). President Festus Mogae of Botswana on Wednesday marked World AIDS Day by calling on Botswana's people to "abstain or die," according to Reuters. Mogae, who noted that 37% of Botswanan adults are HIV-positive, said, "We don't seem to be getting on top of it," adding, "We have to say things like 'abstain or die'" (Beck, Reuters, 12/1). British Prime Minister Tony Blair said that the world should not "despair" about helping Africa fight HIV/AIDS, according to the Associated Press. "Part of the problem is that I think people get fatigued and tired with looking at Africa because it all seems so hopeless," Blair said, adding, "It isn't. There are things that can be done and there are real success stories" (Higgins, Associated Press, 12/1).
Britain Pledges to Increase HIV/AIDS Vaccine Research
British Chancellor of the Exchequer Gordon Brown on Wednesday announced that Britain will increase funding for HIV/AIDS vaccine research and will guarantee that the country will buy "large stocks" of a vaccine if one becomes available to ensure that there is a "ready-made" market for a vaccine, London's Independent reports. Brown said that Britain would work with the world community to increase the current $600 million spent on HIV/AIDS vaccine research and will work with other developed countries to establish an "advance purchase scheme," which would agree to buy millions of doses of an HIV/AIDS vaccine to ensure a global market. Although the scheme would cost Britain $382 million per year, government ministers said that the initiative would save millions more dollars that are currently being spent to treat the disease in developing countries. In addition to Brown's announcement, Gareth Thomas, British international development minister, called on the European Commission to spend more than the $26 million it currently spends on HIV/AIDS vaccine research, according to the Independent. "We want the commission to do more to provide funding for an AIDS vaccine," Thomas said, adding, "During our E.U. presidency next year, we will continue to focus on prevention and look at how we can build up the work on an AIDS vaccine as well as promoting cooperation between Europe and the U.S." (Russell, Independent, 12/1).
European Commission Warns of Rising Number of HIV-Positive Europeans
The European Commission on Tuesday "sounded the alarm" over the increasing number of Europeans who are contracting HIV through unprotected sex, according to Reuters (Reuters, 11/30). European Union data show that the number of HIV/AIDS cases in the E.U. has doubled since 1996, with the "most drastic" increases occurring in the Baltic states of Latvia, Lithuania and Estonia (Agence France-Presse , 11/30). "A big factor behind rising infection rates appears to be that many young people are either unaware of, or choose to ignore, advice about safe sex," Markos Kyprianou, the European Union's top health official, said, adding, "Teenagers and people in their early 20s are too young to remember the safe sex campaigns of the 1980s and early 1990s. ... Urgent action is needed to avert a public health disaster" (Reuters, 11/30).
British Public Shows Lack of HIV/AIDS Knowledge, Poll Shows
A new survey of public opinion in Britain shows a lack of knowledge of HIV/AIDS issues and a "lack of sympathy" for people living with the disease, according to London's Guardian. The survey of 2,000 adults was commissioned by Marie Stopes International and Interact Worldwide. The survey showed that 20% of British residents believe that it is HIV-positive people's "own fault" that they contract the virus; 26% said they felt they have a right to know who is HIV-positive in their community; 17% said they would "worry" if their doctor had treated HIV-positive people; and 60% said they would have more sympathy for someone infected with HIV through a blood transfusion rather than through unprotected sex, according to the Guardian. In addition, 54% of respondents said that men who have sex with men are at high risk of HIV infection, but only 26% said that heterosexuals were at high risk. "This is particularly shocking as it shows that people are making judgments and assigning 'blameworthiness' in their response to the disease," Patricia Hindmarsh of Marie Stopes said, adding, "AIDS doesn't discriminate -- people do." Ros Davies, CEO of Interact Worldwide, said, "The results show that many respondents are not aware that this is an issue for everyone," adding, "They still perceive HIV/AIDS as a disease affecting only minority groups -- gay men, drug users and prostitutes" (Boseley, Guardian, 12/1).
UNAIDS Executive Director Peter Piot on Tuesday appeared on kaisernetwork.org's live "Ask the Experts" program to answer questions about the HIV/AIDS pandemic. Piot also reviewed the recently released "AIDS Epidemic Update 2004" and discussed this year's World AIDS Day theme. To view the webcast, go to kaisernetwork.org/ask/hivaids/30nov04.
Additional information on World AIDS Day -- including webcasts; access to studies and key facts; and links to resources and organizations around the world -- can be found online on kff.org.
Reprinted with permission from kaisernetwork.org. You can view the entire Kaiser Daily HIV/AIDS Report, search the archives, or sign up for email delivery at www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily HIV/AIDS Report is published for kaisernetwork.org, a free service of the Kaiser Family Foundation, by The Advisory Board Company. © 2004 by The Advisory Board Company and Kaiser Family Foundation. All rights reserved.