In North America, Western Europe, Australia, and some Latin American countries like Brazil, availability of antiretroviral therapies and health care have slowed the progression from HIV to AIDS. In the US alone, the number of deaths from AIDS between 1996 to 1999 decreased by more than 40%, largely because of antiretroviral therapies.

Countries where good education, prevention, and care programs are available often experience lower rates of infection with HIV. In many developing countries, the lack of antiretroviral treatments and access to health care allows for the unrestrained progression of the disease. As a result, the number of AIDS cases in many developing nations has increased dramatically. If antiretroviral therapies are not provided for HIV-positive individuals, many more regions will experience devastating increases in the rates of AIDS-related mortality in the future. Treatment of HIV-positive pregnant women must also be addressed to decrease infection rates among newborn children.

Sub-Saharan Africa: Sub-Saharan Africa has witnessed the largest number of new infections, although regional infection rates have begun to increase less rapidly. For example, there were 3.8 million new infections in 2000, compared to 4 million new infections in 1999.

Prevention measures in sub-Saharan countries like Uganda have reduced the infection rates of individual nations. The decreases in these nations balance the increasing infection rates in other areas of the continent. As a result, the overall regional infection rate appears to be more stable.

Infection rates may also be stabilizing because the pandemic has already affected many in the population. As a result, fewer people are at risk of becoming newly infected with HIV.

Asia: The pandemic in some Asian nations is growing as a result of the sex trade, illicit drug use, and extensive migration across borders. In addition, the safety of donated blood supplies and blood products is of increasing concern.

• Researchers estimate that the number of AIDS cases in China is growing by nearly 30% each year, and as many as 10 million Chinese will be living with HIV/AIDS by 2010.

• In India, the number of new infections is doubling every 14 months. As a result, India will soon overtake South Africa as the nation with the most people living with HIV/AIDS.

The Caribbean: The AIDS pandemic has hit the Caribbean harder than anywhere outside of sub-Saharan Africa. Two percent of the population has HIV or AIDS, and the number of AIDS cases is doubling every two to three years. As a result, AIDS has become the leading cause of death in the Caribbean for those between the ages of 15 and 45.

Columbian girls gather to learn more about HIV/AIDS. Photo: Armando Waak, PAHO

Young boys in Puerto Cumarebo, Venezuela. Photo: Armando Waak, PAHO

HIV transmission often occurs through unprotected sexual contact. The percentage of young women whose first sexual experiences are with older men is of increasing concern. Females 15 to 24 years old have infection rates two to four times higher than females in other age groups and three to six times higher than males of the same age. Homophobia and stigma may have driven some homosexual men to adopt heterosexual lifestyles. As a result, HIV transmission between homosexual and heterosexual populations has increased.

Fear, denial, and misinformation have influenced the growth of the pandemic. People are reluctant to receive education, testing, or treatment because of the stigma surrounding AIDS. Acknowledging HIV infection may result in violence, rejection from family and friends, job loss, expulsion from school, loss of housing, and denial of medical care.

Eastern Europe and Central Asia: The dramatic increases in HIV infections in these regions are fueled by economic instability, which in turn has contributed to the growth of the commercial sex and drug industries. Evidence indicates that the pandemic is also beginning to spread through heterosexual populations as a result of sexual transmission.

• In the Russian Federation, the number of reported HIV cases rose from 10,000 in January 1999 to approximately 130,000 in July 2001. Estimates indicate that as many as 620,000 HIV cases remain unreported.

• Improved documentation may help to account for the increase in reported HIV and AIDS cases in countries like the Czech Republic, Slovenia, and Ukraine.