New UNAIDS Report Warns AIDS Epidemic Still in Early Phase and Not Leveling Off in Worst Affected Countries

New York

-- A new report released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS), in advance of the XIVth International AIDS Conference in Barcelona, warns that the AIDS epidemic is still in an early phase. HIV prevalence is climbing higher than previously believed possible in the worst-affected countries and is continuing to spread rapidly into new populations in Africa, Asia, the Caribbean and Eastern Europe.

New data in the UNAIDS Report on the Global HIV/AIDS Epidemic indicate that theories that the epidemic might "level off" in heavily affected countries, due to a decline in the pool of people at risk, are being disproved as the epidemic continues to expand even in countries that already had extremely high HIV prevalence. In Botswana, the country with the highest HIV infection rates in the world, almost 39% of all adults are now living with HIV, up from less than 36% two years ago. In Zimbabwe, a country in which already one quarter of adults were HIV-positive in 1997, one-third were infected by the end of 2001. In five other countries, the HIV prevalence rate in adults now also exceeds 20%.

The UNAIDS report projects that, in the absence of drastically expanded prevention and treatment efforts, 68 million people will die because of AIDS in the 45 most affected countries between 2000 and 2020, more than five times the 13 million deaths of the previous two decades of the epidemic in those countries. In a number of southern African countries, where prevalence rates are highest, up to one-half of new mothers could die of AIDS. In South Africa alone, it is estimated that at the epidemic's peak there will be 17 times as many deaths among people aged 15-34 than there would have been without AIDS.

The report also indicates that, in many other parts of the world, HIV has moved beyond groups considered to be at highest risk of infection and is now spreading at an accelerated pace in the wider population:

• In China, where almost all cases of HIV/AIDS were previously transmitted through injecting drug use and unsafe blood practices, the epidemic is now spreading through heterosexual contact. In Guangxi province, HIV infection rates in studies among sex workers showed an increase from 0% in 1996 to 11% in 2000, indicating a strong advance in the sexual spread of the disease there. Countrywide, reported HIV infections rose nearly 70% in just the first six months of 2001.
• Infection rates are now rising rapidly among a number of populations in Indonesia, the world's fourth-most populous country, following a decade of consistently low infection rates there.
• In the Russian Federation and Eastern Europe, home to the fastest growing epidemic in the world, HIV is now moving from injecting drug users into the wider population. In Ukraine, almost 25% of new infections now occur through heterosexual contact.
• In parts of Western and Central Africa, where infection rates have been high but relatively steady, there is now evidence of rapidly accelerating HIV spread. In Cameroon, for example, the adult prevalence rate, which remained in the low single digits from 1988 through 1996, is now at almost 12%.

These data demonstrate that HIV/AIDS is spreading rapidly in parts of the world where the epidemic had seemed stable or was previously confined to groups at highest risk of infection," said Dr. Peter Piot, Executive Director of UNAIDS, presenting today's report at the 2002 session of the United Nations Economic and Social Council.

UNAIDS reports that, as the epidemic continues to spread in almost every part of the world, young people are at greatest risk for infection. Today, approximately half of all new adult infections are among young people aged 15-24. Almost 12 million young people are now living with HIV, and about 6,000 more become infected every day. At the same time, fourteen million children living today have lost one or both parents to AIDS, and this number will continue to grow rapidly, as the number of adults dying of AIDS rises over the coming years.

The unprecedented destruction wrought by the HIV/AIDS epidemic over the past 20 years will multiply several times in the decades to come, unless the fight against this disease is dramatically expanded," noted Dr Piot. "Nations with accelerating epidemics must move quickly to adopt proven responses from countries that have succeeded in turning the epidemic around."

Less Than 4% of Those in Need in the Developing World Have Access to Antiretroviral Treatment

A new analysis of access to treatment shows that of the 6 million people in the developing world in need of antiretroviral drug therapy, just 230,000, less than 4%, were receiving antiretroviral drugs at the end of 2001. In high-income countries, where an estimated 500,000 people were receiving antiretroviral treatment, 25,000 people died of AIDS in 2001. In Africa, however, where only some 30,000 of the 28.5 million people infected were receiving antiretroviral treatment, AIDS killed 2.2 million people.

Access to adequate care and treatment is a right, not a privilege," said Dr. Piot. "Although real progress has been made in lowering the price of antiretroviral therapy in the developing world, far greater action is needed by both governments and the private sector to ensure that treatment reaches those in greatest need. The cost of treatment must continue to fall, and governments in both the developing world and donor countries must create sustainable funding streams to provide treatment while strengthening the healthcare infrastructure.

Although access to treatment is still limited in Africa, some nations in Latin America and the Caribbean have begun closing the HIV treatment gap with high-income countries. Eleven countries in the region now have policies and laws that guarantee antiretroviral therapy for their HIV-positive citizens, although this does not mean that all in need receive treatment yet. Across Latin America and the Caribbean, about 170,000 people now receive antiretroviral treatment, the majority in Brazil. As these countries work to expand treatment access, other related services, including treatment for opportunistic infections, counseling, and social support are also improving. Countries are indeed recognizing that access to antiretroviral therapy generates vast collateral benefits, as well.

A New Era Is Opening Up

According to the UNAIDS report, despite the continuing rapid expansion of the epidemic, the world is finally waking up to what it takes to bring it under control. Political commitment has grown hugely in the past two years; almost 100 countries now have national AIDS strategies in place and dozens of countries have established national AIDS commissions. This growing political engagement is also grounded in the increasing involvement of community and religious organizations, businesses, individuals and activists.

Several nations have achieved new successes in slowing the spread of HIV within their borders, and in some cases have made progress to expand access to HIV treatment for those infected, providing models for action for other nations:

• Despite massive socioeconomic challenges, Zambia may become the second African country (after Uganda) to reverse a widespread epidemic. HIV prevalence is falling among young women there -- from 28% in 1996 to 24% in 1999 in cities, and from 16% to 12% in rural areas -- and both men and women in Zambia's cities report safer sexual behaviour.
• HIV prevalence continues to drop in Uganda, Africa's greatest success story in the fight against AIDS. At the end of 2001, adult HIV prevalence had fallen to 5%, down from 8.3% in 1999.
• By mounting a strong national response, the Polish Government has successfully curtailed the epidemic among injecting drug users and prevented it from gaining a foothold in the wider population.
• Strong political commitment and large-scale prevention programmes in Cambodia have helped lower rates of HIV infection, reflected in the decrease in HIV prevalence among pregnant women from 3.2% in 1996 to 2.7% in 2000.
• Government-supported youth prevention efforts in South Africa have led to high levels of HIV/AIDS awareness and appear to be increasing safer sexual practices among sexually active young people.

In another positive development, donor funding earmarked for fighting the epidemic has increased 6-fold since 1998. Many nations, including some of the world's poorest, have significantly increased their AIDS budgets. But measured against the enormous need, today's funding still falls far short. Current commitments, from heavily affected countries themselves, donor countries, international organizations and the private sector, will provide about US$3 billion in 2002. Low- and middle-income countries will require US$10 billion annually to combat AIDS by 2005.

The success around the globe on preventing infection, and treating those already infected, demonstrates that it is possible to make progress against HIV/AIDS," said Dr. Piot. "But so far, these countries are the exception, and not the rule. In order to overcome this epidemic on a global scale, the international community must muster even greater political commitment, action, and above all, resources."

For more information, please contact Anne Winter, UNAIDS, Geneva, (+41 22) 791 4577, Dominique De Santis, UNAIDS, Geneva, (+41 22) 791 4509 or Andrew Shih, UNAIDS, New York, (+1 212) 584 5024. You may also visit the UNAIDS Home Page on the Internet for more information about the programme.

Click here to read the report (PDF).