Five Million New HIV Cases, Three Million AIDS-Related Deaths in 2003, UNAIDS/WHO Update Says
Five million new HIV cases occurred and three million people died of AIDS-related causes throughout the world in 2003, according to the annual "AIDS Epidemic Update" on the state of the global AIDS epidemic released on Tuesday by UNAIDS and the World Health Organization, Reuters Health reports (Gale, Reuters Health, 11/25). The report, which was released in advance of World AIDS Day on Dec. 1, says that there are 40 million people living with HIV/AIDS worldwide in 2003, Reuters reports (Reaney, Reuters, 11/25). In general, the report's statistical estimates are lower than figures predicted in the 2002 report, but the actual number of people living with HIV/AIDS has not decreased, the Wall Street Journal reports. UNAIDS and WHO used revised data collection and statistical sampling methods to "correc[t]" last year's estimate of 42 million, according to the Journal (Chase, Wall Street Journal, 11/26). The "continuous improvements" in research methods mean that comparisons with previous estimates could be "misleading," according to the report ("AIDS Epidemic Update 2003," December 2003). The HIV/AIDS pandemic "shows no sign of abating," UNAIDS Executive Director Peter Piot said, according to the New York Times (Altman, New York Times, 11/26). Approximately 14,000 people were infected with HIV each day in 2003, and more than 95% of new HIV cases occurred among people who live in low- or middle-income countries, according to the report ("AIDS Epidemic Update 2003," December 2003).
Sub-Saharan Africa "continues to bear the brunt" of the HIV/AIDS epidemic, with 3.2 million new HIV infections and 2.3 million AIDS-related deaths in 2003, the San Francisco Chronicle reports (Russell, San Francisco Chronicle, 11/26). Southern Africa comprises 30% of the people living with HIV/AIDS in the world, but the region represents less than 2% of the global population, Reuters reports (Reuters, 11/25). One in five adults are living with HIV/AIDS in Southern Africa, which is the highest prevalence in the area since the beginning of the epidemic, according to UNAIDS (UNAIDS/WHO release, 11/25). Botswana and Swaziland have the highest HIV prevalence rates in Africa, with about 40% of people between the ages of 15 and 49 testing HIV-positive, the Washington Post reports (Brown, Washington Post, 11/26). Women in sub-Saharan African countries are particularly affected, with women between the ages of 15 and 24 up to 2.5 times more likely to be HIV-positive than men ages 15 to 24, according to the report. In addition, many countries in the region have high AIDS-related mortality and high rates of infection, "creating a cycle of illness and death due in great part to the almost complete absence of large-scale HIV prevention or antiretroviral treatment programs," according to a UNAIDS/WHO release (UNAIDS/WHO release, 11/25). Piot said, "The epidemic continues to deepen, to expand, and it is tightening its grip on Southern Africa and threatening Southeast Asia."
India, Russia, China
Piot said that he was concerned about the spread of HIV throughout China, India and Russia, the Boston Globe reports (Donnelly, Boston Globe, 11/26). Although India's three million to six million people living with HIV/AIDS is "relatively low" compared with its population size, the low prevalence "masks epidemics in several regions" of the country, the Post reports. In five Indian states, which are larger than many countries, more than 1% of pregnant women are HIV-positive. In addition, HIV prevalence among sex workers is high, with approximately 50% of sex workers in Mumbai testing HIV-positive (Washington Post, 11/26). The report also says that up to 75% of injection drug users in the country test HIV-positive (San Francisco Chronicle, 11/26). In Russia, which has approximately one million HIV-positive people, the "epidemic is growing at a fearsome rate," the report says. Piot said that he was concerned because the Russian government has not made the political commitment to fighting the epidemic that other countries have made. Piot added that Russia has included in its budgets "only a few million dollars for AIDS and still deals with it at the level of a deputy minister of health" (New York Times, 11/26). In China, HIV/AIDS has appeared first among sex workers and injection drug users, the Post reports. The report shows that 80% of injection drug users in Xinjiang province and 20% of drug users in Guangdong province are HIV-positive. In addition, thousands of Chinese people contracted HIV during the 1990s from unsterile equipment used during blood collection, according to the Post (Washington Post, 11/26).
Money, Treatment, Prevention
Even with the report's "grim picture," there are "signs of progress," Piot said, according to the Los Angeles Times. HIV prevalence in Uganda and in Rwanda's and Ethiopia's capital cities has declined, which is "very encouraging," according to Piot. In addition, more political leaders in Africa are discussing the pandemic publicly, and more HIV-positive people are receiving treatment than in previous years, the Times reports. Spending on HIV/AIDS prevention and treatment programs throughout the world also increased 50% in 2003 to $4.7 billion, according to the Times (Mestel, Los Angeles Times, 11/26). Piot said that the report offers "hope" because more money is being spent on treatment, adding, "There is now movement to roll out this treatment on a very large scale" (Reuters, 11/25). For example, the South African Cabinet on Nov. 19 approved a plan for a national HIV/AIDS treatment program, including the distribution of free antiretroviral drugs through service points in every health district within one year and in every local municipality within five years. The program aims to treat 1.2 million people -- or about 25% of the country's HIV-positive population -- by 2008 (Kaiser Daily HIV/AIDS Report, 11/21). But Piot said that funding is "still half of what is needed to mount an effective response," adding, "We are now moving ahead, and the glass is now half full or half empty" (Los Angeles Times, 11/26).
Three by Five
WHO officials are set to release details of implementation for a plan to provide three million people with antiretroviral treatment by 2005, Reuters Health reports (Reuters Health, 11/25). WHO Director-General Jong-Wook Lee on Sept. 22 during a U.N. General Assembly special session on HIV/AIDS in New York City announced WHO's commitment to the "three by five" plan and declared the lack of access to antiretroviral drugs a global health emergency (Kaiser Daily HIV/AIDS Report, 10/3). Lee said that the group will present information on the program next week to coincide with World AIDS Day, adding, "This represents an unprecedented drive to increase the number of people receiving treatment. For 'three by five' to succeed, however, and for treatment access to increase further in the future, the international community must continue to increase its financial and logistical support" (UNAIDS/WHO release, 11/25).
Piot said, "This crisis will get worse and worse. We have to look far beyond medical solutions. [HIV/AIDS] is going to be a fundamental political problem," adding, "Either we inch along making piecemeal progress, or we now turn the full weight of our knowledge, resources and commitment against this epidemic" (New York Times, 11/26). Dr. Jack Chow, assistant director-general for HIV/AIDS, tuberculosis and malaria at WHO, said, "In two short decades, HIV/AIDS has tragically become the premier disease of mass destruction. The death odometer from HIV/AIDS is now at 8,000 a day and accelerating" (Reuters, 11/25). Eric Goosby, medical director of Pangaea Global AIDS Foundation, said, "In the next three to five years, the biggest wave [of HIV infection] will hit the beach. The only thing that will stop it is treatment" (Sternberg, USA Today, 11/26). The International AIDS Vaccine Initiative said in a release that the "best way to curb the number of new infections is to accelerate the development of a preventive AIDS vaccine." Dr. Seth Berkley, president and CEO of IAVI, said, "For two decades running we still have not broken the cycle of new infections" (IAVI release, 11/25). AIDS Project Los Angeles Executive Director Craig Thompson said, "These data portray the devastating impact of a powerful, unyielding foe" that has "never stopped starting." He added, "Future generations will look back and judge us on our ability to accept the moral responsibility presented by the ongoing AIDS epidemic. The window of opportunity is just beginning to open globally. Inaction and fear will force it shut" (APLA release, 11/25).
NPR's "All Things Considered" on Tuesday examined the report and compared the factors contributing to the AIDS epidemics in South Africa and India. The segment includes comments by several UNAIDS advisers (Wilson, "All Things Considered," NPR, 11/25). The segment is available online in RealPlayer.
A kaisernetwork.org "Ask the Experts" webcast featuring Piot is available online. The interview, which was conducted by Kaiser Family Foundation Senior Visiting Fellow Jackie Judd, a former correspondent with ABC News, was taped on Nov. 18.