Twenty Years of AIDS Ravages Societies, Young and Old, Around the World

As activists around the globe mark World AIDS Day on Saturday, the virus is estimated to have infected 60 million people, killing 22 million of them. The disease has orphaned about 13 million children.

In the United States and Western Europe, the disease, once a death sentence, has been transformed into a chronic, survivable illness by costly medications. However, treatment appears to have damaged incentives for prevention, and new infections have begun to grow again in the developed world. "We never really turned back the epidemic," said Neff Walker, an epidemiologist at UNAIDS. "It just keeps going on."

Walker and other experts worry about the spread of the disease through the huge population of China and about the rapidly rising infections in Southeast Asia and Eastern Europe. "Everyone feels like the worst is still to come," Walker said. In the Ukraine, an estimated 240,000 people had HIV in 1999. Up to 80 percent were drug users infected by dirty needles. Today, "the situation continues to worsen," said Nina Horehiliad of Ukraine's Center on AIDS.

In sub-Saharan Africa, home to 70 percent of the world's AIDS infections, hospitals are filled, cemeteries are packed with the bodies of 20- and 30-year olds, and grandparents are raising orphaned children. In most countries on the poorest continent, the infected have no hope of getting AIDS medications. "I don't think we know what we are dealing with because the knife is coming down, and it's a silent one," Jenny Marcus, coordinator of Community AIDS Response. "People are just quietly disappearing." In South Africa, where 4.7 million people are infected, AIDS has orphaned 420,000 children, thousands of whom are living in households headed by children.

Scientists are hoping to develop an AIDS vaccine to create a firewall of immunity around the world's infected populations, but even with recent encouraging developments, it could be years before a vaccine is widely distributed.

Signs of hope exist, however. New infections among young people are decreasing in Uganda, Zambia, Tanzania, South Africa, Cambodia and the Bahamas, according to UNAIDS. In Botswana, where an estimated 35 percent of adults are infected -- the highest rate in the world -- the government announced plans to provide AIDS medication to every infected person. A grant of $100 million from the Bill Gates Foundation and the pharmaceutical giant Merck and Co. will support that effort.

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