The theme for the recent 11th International Conference on AIDS, held in Vancouver from July 7th through the 12th, 1996, was "One World. One Hope," to signify one global pandemic and the spirit of solidarity of a global community fighting together to control the HIV pandemic. This theme did permeate throughout the entire meeting, generating numerous optimistic scientific reports and a general feeling that the therapeutic advances and some of the prevention successes were indeed having some effect on the pandemic. However, it was equally clear that the burden of the HIV pandemic is shifting almost entirely to Third World countries that will not be able to afford to sustain any of these new advances without international help. Consequently, an unequal partnership in the burden of AIDS became more apparent, and as a result, the "One World. One Hope," became divided into "Two Worlds: One With Hope and One With 90% of All the Cases."
Some of the most sobering statistics provided at the meeting were from the newly formed UNAIDS, the joint United Nations Program on HIV/AIDS. It is now estimated that 21.8 million adults and children worldwide are living with HIV/AIDS, of whom 20.4 million (94%) live in the developing world. Close to 19 million adults and children (86% of the world's total) are living with HIV/AIDS in sub-Saharan Africa and in southeast Asia. Of the adults 12.2 million (58%) are male, and 8.8 million (42%) are female. In 1995 alone 2.7 million new adult HIV infections occurred, averaging 7,500 new infections each day. Of these about one million, an average of nearly 3,000 new infections per day, occurred in Southeast Asia, and 1.4 million infections (close to 4,000 new infections per day) were in sub-Saharan Africa. The industrialized world, in contrast, accounted for 55,000 new HIV infections in 1995, or 2% of the global total. Approximately 500,000 children were born with HIV infection in 1995; of these 67% were in sub-Saharan Africa, 30% in southeast Asia, and 2 to 3% in Latin America and the Caribbean.
From the beginning of the pandemic until July 1996, an estimated 27.9 million people worldwide were estimated to be infected with HIV. The largest number of HIV-infected individuals are in sub-Saharan Africa, totaling 19 million (68% of the total), and in southeast Asia, totaling 5 million (18% of the global total). The relatively new epidemic in southeast Asia has escalated with frightening speed. In just the last five years, the number of HIV-infected people in Southeast Asia is twice the total number of all infected people in the entire industrialized world.
More than 6 million adults have developed AIDS from the beginning of the pandemic to July 1996, and of these 4.5 million (75%) were in sub-Saharan Africa, 7% in Latin America and the Caribbean, and 12% in North America, Europe, and Oceania. In Southeast Asia, where the pandemic gained intensity more recently, the number of AIDS cases still remains low, a statistic which makes it more difficult to convince policy makers that a silent HIV epidemic is rapidly spreading through their populations. Of the 1.6 million children with AIDS in the world, the majority, 1.4 million (85%), are in sub-Saharan Africa. To date approximately 6 million people (4.5 million adults and 1.5 million children) are estimated to have died from AIDS worldwide.
In summary, the HIV/AIDS pandemic is now composed of distinct epidemics, each with its own future and force, disproportionately impacting on the developing world. As the meeting progressed, it became clear that in the world of AIDS there are really two worlds. One world is comprised of industrialized nations where the epidemic has stabilized and where enormous advances in therapeutics have resulted in increased survival and increased quality of life. The second world is comprised of developing countries, primarily in sub-Saharan Africa, Southeast Asia, and parts of Latin America, where the epidemic is still a runaway train, going downhill and gaining speed. In this world few of the therapeutic advances have any real meaning since no one can afford these drugs. At an annual estimated cost of $15,000 per person for therapeutic intervention, there is little chance that residents of a small African village will be the fortunate recipients of these emerging "successes." One conservative estimate is that the cost of drug therapy for 21.8 million HIV-infected people would be 200 billion dollars a year.
From my perspective the "one hope" for the "one world" of AIDS still lies in the development and implementation of a safe and effective vaccine that will provide immunity to all of the 10 different subtypes of HIV infection. A plenary debate between Drs. John Moore of the Aaron Diamond Institute and Edward Mbidde of Uganda clearly underscored the urgency for more fundamental research and vaccine development, but at the same time emphasized the need to advance forward with Phase III efficacy trials, even if only partially effective, in the hope of trying to prevent further spread of HIV infection, particularly in developing countries.
*Adapted from: Global AIDS Policy Coalition, Harvard School of Public Health, 1/18/96