Why We Should Care: AIDS Around the World

. . . In North America and Western Europe

As new infections continue to occur and new antiretroviral therapies keep people with HIV alive longer, the proportion of the population living with HIV has actually grown in these regions. Correspondingly, the number of AIDS-related deaths has declined. Despite the availability of drug therapies in these industrialized countries, HIV is still a challenge.

• In most countries in this region, the number of new HIV infections has remained relatively constant in recent years, with an estimated 1.5 million people living with HIV at the end of 1999.

• Previous trends toward safer sexual behavior among homosexual populations are being reversed; experts speculate this may be because of complacency due to drug therapies.

• In 1999 in North America, 44,000 new HIV infections were reported; in Western Europe, 30,000.

A wife in Tanzania cares for her husband who is sick with AIDS. WHO photo by L.Gubb

. . . In Sub-Saharan Africa

Sub-Saharan Africa is still the "global epicenter" for AIDS and HIV, with close to 70% of the world's HIV-positive people living in this region that is home to just 10% of the world's population. At the start of the 21st century, over 24 million people in sub-Saharan Africa are estimated to be living with HIV or AIDS. Almost 13.7 million here have already died of AIDS.

• About 90% of reported AIDS cases in this area are attributed to heterosexual transmission.

• For every 10 African men, 12 or 13 African women are now infected.

• Life expectancy at birth in South Africa is set to drop from a high of 59 years in the early 1990s to just 45 years by 2010 because of AIDS.

• In 1999, 90% of all HIV infected children (14 or younger) born to women with HIV were living in sub-Saharan Africa.

. . . In North Africa and The Middle East

Less is known about the HIV/AIDS epidemic in North Africa and the Middle East than in other parts of the world. The generally conservative social and political attitudes and traditions in many of the countries in these regions present challenges to HIV/AIDS awareness and prevention efforts among their populations.

• By the end of 1999, there were an estimated 220,000 people living with HIV/AIDS in this region.

• Injection drug use is now the most common cause of AIDS in many countries of this region, accounting for two-thirds of all reported AIDS cases in Bahrain and 50% in the Islamic Republic of Iran.

• In Egypt, one AIDS case out of 10 is among injection drug users.

Thai sailors, Bangkok, Thailand. In all cultures, men who live apart from their families, such as in the military, are at greater risk of infection from unprotected sex with multiple partners. WHO photo by G. Diez

. . . In Asia and The Pacific

HIV came relatively late to Asia, giving the region the opportunity to learn from successful prevention efforts in other countries. However, experts expect Asia to become the epicenter of the epidemic within the next 15 years.

• Across the continent as a whole, 6.5 million people were living with HIV by the end of 1999. The high rates of HIV infection are attributed primarily to the sharing of equipment for injection drug use and to the commercial sex industry.

• The sex industry in China is growing; there are now up to 4 million prostitutes in the country.

• In Vietnam, HIV prevalence increased five-fold among female sex workers from 1994-1998.

• In Guandong province in China, cases of HIV attributed to injection drug use rose from virtually nothing in 1998 to 11% by 1999.

• In China an estimated half million people in a population of over a billion are HIV-positive.

• In India it is now estimated that about 4 million are infected with HIV.

• Strong prevention programs have reduced the rate of infection in some countries such as Thailand, where decreases in HIV infection have been seen.

Young men with AIDS in a Warsaw, Poland, hospital. In Eastern Europe, economic crises, war, displacement of populations and disruption of families have created ideal conditions for the spread of HIV. PAHO/WHO photo by G. Diez

. . . In Eastern Europe

Many countries in Eastern Europe have reported dramatic growth in HIV infections since the early 1990's. The world's steepest HIV curve in 1999 was recorded in the newly independent states of the former Soviet Union. The number of Eastern Europeans estimated to be living with the HIV virus today is 70 times greater than in the early 1990s. Injection drug use is the major mode of transmission.

• HIV infections in the former Soviet Union have doubled in the past two years.

• In 1999, HIV infections in Central and Eastern Europe rose by a third, reaching a total of 360,000.

• Almost 90% of all AIDS cases reported in 1998 and 1999 in the entire Eastern European region were in Ukraine.

"Pegação" is an AIDS prevention program for young male prostitutes in Rio de Janeiro, Brazil. WHO photo by A. Waak

. . . In Latin America and The Caribbean

The HIV/AIDS epidemic in the Americas consists of a mosaic of epidemics. In Latin America, 0.57% of adults aged 15 to 49 were living with HIV in early 2000. Nearly four times that number is estimated to be infected in the Caribbean, the second worst affected area in the world next to sub-Saharan Africa. In Latin America, the principal modes of HIV transmission are unprotected sex between men and IV drug use, but the epidemic is increasing in the heterosexual population, as demonstrated by rising rates of infection in women and their infants.

The epidemic in the Caribbean is mainly heterosexual, with the vast majority infected during unprotected sex, primarily among young people. Some social and cultural factors tend to inhibit prevention efforts -- factors such as beliefs about birth control (including condom use) and male sexual attitudes.

• HIV is severely affecting the populations of several Caribbean countries. For example, 13% of pregnant women in Haiti and 7% in Guyana tested positive for HIV in 1996. In the Caribbean, AIDS is the leading cause of death among 15 to 45 year olds.

• In Mexico, unprotected sex between men continues to drive the epidemic, with 14.2% of this group infected. The male-to-female ratio among the HIV-infected remains high at just over 7:1.

• In Brazil, 60% of those living with HIV are in Sao Paulo and Rio de Janeiro. The epidemic has shifted from primarily men who have unprotected sex with men and IV drug users to heterosexuals.

• Drug injecting is a major source of HIV infection in Argentina and Uruguay.