AIDS Epidemic Continues to Grow, U.N. Reports

Three million people died of AIDS last year and almost 5 million became infected with HIV -- more than in any previous year, according to a United Nations report issued Tuesday.

Worldwide, the number of people living with HIV, the virus that causes AIDS, stands at about 38 million, despite efforts to control it, the report said.

The “most frightening” numbers come from Eastern Europe and Asia, UNAIDS chief Dr. Peter Piot said. Those regions account for one in four new infections, largely as a result of growing numbers of injection drug abusers.

“Overall, the world is failing in its response to AIDS and the commitments that were made,” Piot said. “The virus is running faster than all of us.”

The cost of responding to the crisis is also growing, he said, rising to $12 billion per year from the $10 billion previously estimated. However, funding is about $6 billion per year, half the needed amount but a fifteenfold increase from the resources available when UNAIDS was established in 1996.

“There is finally some money to work with,” Piot said. “There is definitely some progress, but not enough.”

Piot noted that the number of people being treated for HIV infection has doubled in the last two years. Even so, fewer than one in 10 people in developing countries have access to the drugs necessary to keep the virus in check.

Perhaps even more troubling, he said, is that only 20% of people worldwide are reached by HIV prevention programs. The percentage is lower in Russia, Asia, the Middle East and North Africa, where the emerging epidemic is concentrated in groups that are highly stigmatized -- primarily drug abusers and homosexuals.

Governments in those regions fail to see that prevention efforts are “harm reduction for the entire nation,” Piot said.

The report was released Tuesday in anticipation of the 15th International AIDS Conference, which will be held next week in Bangkok, Thailand.

The estimate of 38 million HIV-positive people worldwide is the highest total yet in the epidemic.

A previous report put the total at 40 million, but it has been reduced by a more precise estimate of cases in rural areas of sub-Saharan Africa, said Kathleen Cravero, deputy executive director of UNAIDS.

That region has about 10% of the world’s population but 70% of its HIV-positive people, the report said. The number has held steady at about 25 million, but that stability is deceptive, Piot said. Stabilization means that “for every person who is dying, someone new is being infected,” he said. “And the number dying is increasing.”

In Africa, the majority of the infected are women, Piot said. Globally, women make up about half of the HIV-positive, but in Africa, they are 60%. Among teenagers there, he added, girls are three to six times as likely as boys to be infected as a result of what he called “intergenerational sex.”

Teenage girls in the region often have their first sex “with men who are five to 15 years older than them, if not more. It is often nonconsensual, or in return for something, such as food or a CD. This introduces extremely high-risk situations to girls, who are already more vulnerable,” Piot said.

South Africa still has the largest single group of infected people at 5.3 million, but India is close behind with 5.1 million and gaining, the report said. Piot and others have warned that India will soon overtake South Africa, but Indian officials said Tuesday that the government has the situation under control.

“There is no galloping HIV epidemic across India and there is no evidence of an upsurge in HIV prevalence in any state in the country,” Meenakshi Datta Ghosh, project director of the National AIDS Control Organization, said at a news conference there after the report’s release.

He said the number of new infections had dropped to 520,000 last year from 610,000 in the previous year.

But critics charge that India vastly underestimates the number of people who are infected and many people do not know they carry the virus.

Overall, 1.1 million people became infected in Asia last year, according to UNAIDS. In most countries the prevalence is at or below 1%, the level at which control becomes much more difficult and expensive, Cravero said.

“We have a real window of opportunity in Asia, but if we don’t take it, it will close forever,” she noted. In China, for example, the number of HIV-positive could grow to 10 million by 2010 if preventive action is not taken immediately, the report said.

In the U.S., 950,000 people are living with HIV, according to the report, up from 900,000 in 2001. Half of the new infections are among African Americans.

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HIV and AIDS

In 2003, an estimated 4.8 million people became infected with HIV, the virus that causes AIDS. About 37.8 million people worldwide are living with HIV.

Estimates of HIV and AIDS cases at the end of 2003.

North America: 1 million

Caribbean: 430,000

Latin America: 1.6 million

North Africa & Middle East: 480,000

Western Europe: 580,000

Sub-Sahran Africa: 25 million

Eastern Europe & Central Asia: 1.3 million

East Asia: 900,000

South & Southeast Asia: 6.5 million

Oceana: 32,000

Sources: Associated Press; U.N. Program on HIV/AIDS (UNAIDS)