Number of New HIV Cases Increases Worldwide, Many Concentrated in Asia, UNAIDS Report Says
The 2004 UNAIDS Report of the Global AIDS Epidemic released by UNAIDS on Tuesday in advance of the XV International AIDS Conference illustrates "daunting trends" and an increasing "need for assistance" in the world's fight against the pandemic, the Boston Globe reports (Donnelly, Boston Globe, 7/7). According to the report, which for the first time includes revised HIV prevalence for previous years based on improved methodology and more comprehensive country surveillance data, five million new HIV cases were reported worldwide last year -- the most cases reported in any single year since the beginning of the epidemic. The report shows that the number of people living with HIV increased from 35 million in 2001 to 38 million in 2003. The report also shows that nearly three million people died from AIDS-related causes in 2003. In addition, almost 50% of new HIV cases worldwide were among people ages 15 to 24, and women comprised almost 50% of people living with HIV, the report says (Kaiser Daily HIV/AIDS Report, 7/6).
Although sub-Saharan Africa remains the most affected region in the world with about 25 million HIV-positive people, the report shows that Asia could "face an AIDS catastrophe" if the region does not make bigger strides in combating the disease, the Financial Times reports (Dyer/Marcelo, Financial Times, 7/6). Asia, which accounts for 60% of the world's population, has 7.4 million HIV-positive people and has experienced some of the "sharpest" increases in numbers of HIV cases, the report says. In Asia, the epidemic is still "largely concentrated" among injection drug users, men who have sex with men, commercial sex workers and clients of sex workers and their sexual partners, according to the report (Kaiser Daily HIV/AIDS Report, 7/6). However, the Asian epidemic is "fast moving into the general population," Kathleen Cravero, deputy executive director of UNAIDS, said. The report shows that of the five million new HIV cases reported in 2003, nearly 1.2 million occurred in Asia, the New York Times reports. In addition, China, Indonesia and Vietnam account for 50% of the Asian population and are seeing "rapidly ... expanding" epidemics, the report says. HIV epidemics are "much harder to stop" after HIV prevalence begins to exceed 1% -- the prevalence level that most epidemiologists use to define a generalized HIV epidemic -- than before prevalence reaches 1%, according to Cravero, the Times reports. Because "many countries [in Asia] have prevalence rates less than 1%, and some are hovering around 1%," there is a "small window of opportunity" to curb the spread of HIV in Asia, Cravero said. "If we miss it, it will slam shut forever," and "we will see an epidemic the likes of which we never imagined," Cravero said, adding, "You either drive [the Asian HIV/AIDS epidemic] down now through maximum scaling up of prevention or you spend exponentially more money and energy trying to drive it down" (Altman, New York Times, 7/7).
India has 5.1 million people living with HIV, up from about four million in 2002, according to the Globe (Boston Globe, 7/7). The epidemic in India, which now ranks second behind South Africa for the most HIV/AIDS cases in the world, stems from "widespread ignorance" about HIV, according to the Chicago Tribune. In addition, the "down low" phenomenon -- in which men have sex with men but do not mention their male relationships to their female sex partners, friends or family members -- is an "emerging concern," the Tribune reports. NIH National Institute of Allergy and Infectious Diseases Director Anthony Fauci said that although only a small percentage of the India's population of one billion is HIV-positive, "you're talking tens of millions of additional infections" if the number of cases doubles or triples, the Tribune reports. He added that he is concerned that "several Asian countries [have] a gross underestimate, not only of what is actually going on but what the potential is" for the HIV/AIDS epidemic, adding, "You have the potential for an explosion that, given the numbers of people who live in Asia, could potentially dwarf what we're seeing in Africa" (Graham, Chicago Tribune, 7/7). However, the Indian government has said that the rate of increase in the number of HIV cases in 2003 "had slowed" compared with statistics for 2002, according to the Financial Times. India's National AIDS Control Organization Director Meenakshi Datta Ghosh said, "There is no galloping AIDS epidemic in India" (Financial Times, 7/6).
Prevention, Treatment Among Women
To help curb the spread of HIV in Asia and elsewhere, countries must "vastly increase" prevention and treatment efforts, Cravero said, according to the Times. However, prevention and treatment programs in Asia "largely miss" women and girls, who often do not have the option of abstaining from sex and have "little control" over whether their partners use condoms or remain faithful, according to Cravero, the Times reports (New York Times, 7/7). However, the epidemic's "feminization" is most apparent in sub-Saharan Africa, where 57% of HIV-positive adults are women and 75% of young people living with HIV are female, the report says, according to AFP/Yahoo! News. In the region's "male-dominated culture," women are the caregivers and therefore "bear the largest AIDS burden," the report says, according to AFP/Yahoo! News (AFP/Yahoo! News, 7/6). UNAIDS Executive Director Peter Piot said that the "ABC" model of prevention -- Abstinence, Be faithful, use Condoms -- is "pretty irrelevant" for women in Africa. Many women in the region face "violent, nonconsensual sex," according to the Mail & Guardian (Mail & Guardian, 7/7). He added that teenage girls in the region often have their first sexual experience with a man who is five to 15 years older, which "introduces extremely high-risk situations to girls, who are already more vulnerable" (Maugh, Los Angeles Times, 7/7). Cravero said, "Most of the women and girls, as much in Asia as in Africa, don't have the option to abstain [from sex] when they want to," adding, "Women who are the victims of violence are in no position to negotiate anything, nevermind faithfulness and condom use" (Nakashima, Washington Post, 7/7). Piot said that "[t]o ensure women become less infected, we have to target men," adding, "We are getting into a need for quite fundamental and long-ranging behavior change. We have to change norms in society" (Mail & Guardian, 7/7). NBC's "Nightly News" on Tuesday reported on the study. The segment includes comments from Dr. Wafaa El-Sadr, a professor of epidemiology at Columbia University's Mailman School of Public Health and Piot (Bazell, "Nightly News," NBC, 7/6). The complete segment is available online in Windows Media.