November 26, 2002
According to the new report, the African famine is a clear example of how the impact of HIV/AIDS reaches beyond the loss of life and health care costs traditionally associated with disease. More than 14 million people are now at risk of starvation in Lesotho, Malawi, Mozambique, Swaziland, Zambia, and Zimbabwe. All six of these predominantly agricultural societies are battling serious AIDS epidemics, with more than 5 million adults currently living with HIV/AIDS in these countries, out of a total adult population of some 26 million. These six countries also have a total of 600,000 children under 15 living with HIV. The new report details how the impact of AIDS in farm communities has greatly decreased the capacity of these communities to survive the famine.
"The famine in southern Africa brings the world face-to-face with the deep and devastating impact of AIDS," said Dr Peter Piot, Executive Director of UNAIDS. "What we are seeing today in a number of countries of sub-Saharan Africa is an HIV epidemic that is overwhelming the coping resources of entire communities. We must act now, on a much larger scale than anything we have done before, not only to assist those nations already hard-hit, but also to stop the explosive growth of AIDS in the parts of the world where the epidemic is newly emerging."
The report shows a rapidly expanding epidemic in new areas. The world's fastest growing HIV/AIDS epidemic is located today in Eastern Europe and the Central Asian Republics. In 2002, there were an estimated 250,000 new infections there, bringing the total for the region to 1.2 million people living with HIV/AIDS. In some countries, the epidemic's growth is startling; in Uzbekistan, for example, there were almost as many new infections reported in the first six months of 2002 as in the entire previous decade.
Several countries in Asia and the Pacific, including China, Indonesia and Papua New Guinea, may also face huge growth in their epidemics. UNAIDS warns that 11 million more people will acquire HIV in Asia by 2007, unless concerted and effective action is taken to increase access to HIV prevention and care in the region, where the epidemic is still in its early phases.
"We know there is a point in every country's AIDS crisis where the epidemic breaks out from especially vulnerable groups into the wider population," says Dr Gro Harlem Brundtland, Director-General of the World Health Organization. "This is a critical moment of opportunity and danger. Unless we see national prevention initiatives championed by the highest level of government, the growth in infections can be unstoppable. We are at this critical moment today in a number of countries in Eastern Europe, central, south and eastern Asia."
Globally, the report finds that 42 million people are now living with HIV, 5 million were newly-infected in 2002, and 3.1 million people were killed by AIDS this year. In sub-Saharan Africa, the epidemic continues to expand. An estimated 3.5 million new infections occurred in 2002, and 2.4 million Africans died of the disease. In Asia, 7.2 million people are now living with HIV.
Today's report details the manner in which HIV/AIDS is fuelling other crises, most notably the famine in southern Africa. There, AIDS is combining with other factors -- including droughts, floods and in some cases short-sighted national and international policies -- to cause a steady fall in agricultural production and to cut deep into household income.
AIDS-related deaths in a farm household cause crop output to plummet -- often by up to 60%. A 2002 study in central Malawi, for example, has shown that about 70% of surveyed households had suffered labour losses due to sickness. Household incomes also shrink, leaving people with less money to buy food.
The report indicates that 7 million agricultural workers in 25 African countries have died of AIDS since 1985. In 2001 alone, AIDS killed nearly 500,000 people in the six predominantly agricultural countries threatened with famine, most of who were in their productive prime.
"The famine is a tragic example of how this epidemic combines with other crises to create even greater catastrophes," noted Dr Piot. "What is happening today in southern Africa illustrates that AIDS cannot be addressed in isolation. Reponses to AIDS must take into account that the epidemic has an impact in every economic and social sector."
Injecting drug use is the main mode of HIV transmission in Eastern Europe, as well as in several countries in Asia, the Middle East and North Africa.
"Unsafe injecting drug use drives very rapid expansion of the epidemic," noted Dr Brundtland, "but it does not take long before the sexual partners of injecting drug users become part of a steadily widening epidemic."
Indonesia, where injecting drug use was virtually unknown ten years ago, is seeing a sharp rise in injecting drug use -- and with it, the risk of a major AIDS epidemic. The country now has as many as many as 200,000 injecting drug users-and rates of HIV infection are rocketing among them. Data indicate that up to 50% of injecting drug users in Jakarta may be HIV-positive, compared to 0% in 1998. This route of transmission could account for more than 80% of the country's HIV infections in the year ahead.
The report cites evidence from Brazil that prevention efforts, including drug treatment and needle exchange, can lower HIV prevalence among injecting drug users. But it warns also that such "targeted" interventions alone will not halt the epidemic. More extensive HIV/AIDS programmes that reach the general population are essential.
"It is critical that drug users, and other groups who are particularly vulnerable to infection, gain access to prevention services," said Dr Brundtland. Programmes targeted to these very vulnerable populations, as well as national initiatives that reach in particular young people, must be urgently scaled up.
The report identifies several successes in the fight against AIDS. Evidence from South Africa and Ethiopia indicates that the awareness campaigns and prevention programmes that have been launched in recent years are starting to have an impact, particularly among young people. In South Africa, the number of pregnant women under age 20 who are HIV-positive fell to 15.4% in 2001, compared to 21% in 1998. In Ethiopia, the HIV rate also appears to be in decline among young inner-city women in the capital, Addis Ababa.
These trends follow the reporting of similar findings in Zambia. Uganda also continues to demonstrate success in 2002 in reducing new HIV infections in several parts of the country.
In Asia, rates of HIV infection are levelling off in Cambodia, the country in the region with the highest proportion of adults living with HIV. This trend is again a direct result of a sustained national prevention programme. In a significant success, Cambodia reports that HIV infections among sex workers declined from 42% in 1998 to 29% in 2002. The decline was most dramatic among sex workers under the age of 20. In the Caribbean region, there are signs that the epidemic may be stabilizing in the Dominican Republic.
"There is strong evidence from around the world that the AIDS epidemic does yield, in some cases dramatically, to determined human intervention," concluded Dr. Piot. "We can prevent 29 million new HIV infections this decade if we implement a full prevention package globally by 2005. Over the past two years the international community has come to recognize what is needed, in terms of resources and political leadership, to combat the pandemic. But we cannot say that in either category we are anywhere near where we need to be to have a significant impact on the epidemic."
UNAIDS calculates that effective prevention and care programmes in low- and middle-income countries will require US$10.5 billion by 2005. Funding needs will then rise significantly so that by 2007 some US$15 billion a year will be needed to successfully combat AIDS -- and that level would have to be maintained for at least a decade thereafter.
For more information, please contact Anne Winter, UNAIDS, (+41 79) 213 4312 (mobile), Dominique de Santis, UNAIDS, Geneva, (+41 22) 791 4509, Andrew Shih, UNAIDS, New York, (+ 1 212) 584 5012, or Chris Powell, WHO, Geneva, (+41 22) 791 2888 or (+41 79) 217 3425 (mobile). You may also visit the UNAIDS Home Page on the Internet for more information about the programme (www.unaids.org).