AIDS’ Global Spread Staggers Researchers

More than 68 million people will die of AIDS in the next two decades unless massive intervention efforts are begun immediately, according to a grim new UNAIDS report issued Tuesday.

About 22 million people have already died of AIDS worldwide and another 40 million are now HIV-positive, but the numbers are going to grow much higher than was previously believed possible “if we continue with prevention and treatment at the levels they are now,” said Dr. Peter Piot, the executive director of UNAIDS, a joint United Nations program on AIDS and HIV.

“It’s clear to me we are only at the beginning of the AIDS epidemic in historical terms,” he said.

The report marks the first time in at least 10 years that the agency has issued such a global projection of deaths. In the early 1990s, many experts, in fact, thought the epidemic was at or nearing its peak, but in hindsight it is clear they underestimated the virulence of the disease.

As AIDS experts from around the world prepare to gather in Barcelona, Spain, next week for the 14th International AIDS Conference, the continued spread of the virus in the most severely affected countries, and its explosion in several new regions, has staggered those who track its progression, said UNAIDS epidemiologist Neff Walker.

While the rate of new infections and deaths has leveled off in the United States and Europe, the gulf between wealthy countries and the developing world has been growing ever wider.

Four years ago, experts--basing their predictions on experience with epidemics of other diseases--had thought the virus had reached a saturation point in the most severely affected countries such as Botswana and Zimbabwe and that infection rates would level off.

“We have grossly, grossly underestimated how bad this was going to be,” Piot said. The continued spread of the virus has the potential to depopulate some countries.

In Botswana, 39% of adults are now HIV-positive, compared with less than 36% two years ago, and researchers do not foresee a leveling off of the infection rate. Because of AIDS, life expectancy in Botswana has dropped below 40 for the first time since 1950.

In Zimbabwe, one-third of all adults are now infected, compared with one-quarter in 1997. In five other African countries, the HIV prevalence rate is also more than 20%.

In several sub-Saharan countries, half of all new mothers could die of AIDS, according to experts.

Meanwhile, researchers fear a repeat of the sub-Saharan experience in countries such as China and Russia, which have hitherto had little experience with the problem. In the Russian Federation, for example, new cases of HIV infection have been nearly doubling every year. In the Ukraine, 25% of new cases now result from heterosexual contact. “It’s the fastest growing epidemic in the world,” Piot said.

The number of new infections in China grew 70% during the first six months of 2001. UNAIDS experts predicted last week that the number of HIV-positive people in China would grow from the current estimated 1.5 million to 10 million by 2010. That, the report said, would put the country “on the verge of a catastrophe that could result in unimaginable suffering, economic loss and social devastation.”

To forestall this global viral explosion in just the middle- and low-income countries will require $10 billion a year from wealthy countries and the affected nations themselves for prevention and treatment, Piot said, and “that is a conservative estimate.” But currently, the total spending is less than $3 billion per year.

“It’s not asking for the moon,” Piot added. “By any standards that are used for breaches in security, that’s peanuts.”

Even if the money becomes available, AIDS workers will have their hands full. A separate UNICEF report issued Tuesday said that the vast majority of the world’s youth have no idea what AIDS is or how it is transmitted, much less how to protect themselves from it.

Nonetheless, another U.N. report to be issued today is expected to say that the number of new cases could be cut by nearly two-thirds through a massive prevention effort.

Researchers take heart from experiences in the handful of countries that initiated prevention programs several years ago.

In Uganda, which has the most ambitious prevention program in Africa, the prevalence of HIV infections among adults has fallen from 8.3% in 1999 to 5% at the end of 2001. Zambia has also seen successes: HIV prevalence among young women dropped from 28% in 1996 to 24% in 1999 in cities, and from 16% to 12% in rural areas.

The government of Poland has mounted a strong effort to successfully curtail the epidemic among injection drug users and prevented it from gaining a foothold in the wider population.

Strides are also being made in treatment, but they are modest. The cost of so-called triple therapy--using three different classes of drugs to block HIV replication--has fallen as low as $1 per person a day for certain generic drugs, compared with a yearly cost of $12,000 to $15,000 for brand-name drugs in the United States.

But even that reduced rate is beyond the means of most developing countries, where health budgets are often in the range of 5 cents per person a year.

The number of people receiving drug treatment in sub-Saharan Africa increased tenfold over the last two years, but it is still only about 30,000. Worldwide, UNAIDS estimates that less than 4% of the people who could benefit from drug treatment are now receiving it.

On a positive note, Piot said, “political commitment has grown hugely in the past two years.” Nearly 100 countries have national AIDS strategies and dozens have established AIDS commissions.

“I used to go into these countries and be diverted to health ministers” and lower-level officials, he said. “Now presidents and prime ministers want to meet.”

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A Disease Unchecked

Here are the estimated numbers of AIDS deaths and existing cases worldwide by region as of 2001.

HIV/AIDS deaths* Living with HIV/AIDS**

Sub-Saharan Africa 18.3 million 28.5 million

South & Southeast Asia 1.97 million 5.6 million

Latin America 630,000 1.5 million

North America 485,000 950,000

Western Europe 225,000 550,000

Caribbean 232,000 420,000

North Africa & Middle East 124,000 500,000

East Asia & Pacific 100,000 1 million

Eastern Europe &

Central Asia 53,000 1 million

Totals 22.1 million 40 million

*Estimated adult and child deaths because of HIV/AIDS from start of epidemic to end of 2001.

**Adults and children estimated to be living with HIV/AIDS as of the end of 2001.