For the first time, HIV infection rates are showing widespread signs of stagnating or declining in some of the hardest-hit urban areas in sub-Saharan Africa, according to new U.S. analysis. U.S. and UN officials have found a decline or leveling off of HIV rates in cities in 11 countries, greatly expanding earlier reports that the virus is in retreat in Uganda and among young people in Zambia. But analysts say the rates are still disturbingly high and that they are unsure whether to attribute the relative stability or decrease in HIV cases to improved prevention efforts, changes in sexual behavior, or more ominously, an upswing in the numbers of people dying.

Peter Piot, head of UNAIDS, said he believes that in cities such as Addis Ababa, Ethiopia, and Lusaka, Zambia, the decline in cases among those ages 15-19 "means that likely we are seeing the impact of prevention efforts there." But the leveling off or decline of HIV rates may also be because the pandemic has matured and now is killing people at an accelerated pace.

A U.S. Agency for International Development study of data found that urban areas in Rwanda, Ethiopia, Tanzania and Uganda have had steady declines in HIV prevalence. It showed the virus was leveling off in cities in Zimbabwe, Malawi, Zambia, Kenya, Ivory Coast, Republic of Congo and Senegal. But the study showed several urban areas where HIV continues a long-term increase, including cities in South Africa, Namibia, Nigeria, Mozambique and Cameroon. AIDS specialists say the data show the value of studying regions within countries as opposed to national rates, which they say often mask important pandemic trends.

"I am constantly struck now driving on roads in urban Africa, and seeing a large clutch of schoolchildren by the side of the road ... and then you realize you're driving past a cemetery," said Stephen H. Lewis, UN special envoy for HIV/AIDS in Africa. "... These kids are spending so much time in funerals, and that must be -- in the strongest ways imaginable -- changing them."

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