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The AIDS epidemic is far larger than previously believed and showed no signs of stabilization at the end of 1997, according to a recent report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) [1]. According to these revised estimates, some 30.6 million people globally are now infected with the human immunodeficiency virus (HIV) that causes AIDS, and 11.7 million have died of the disease – 2.3 million in 1997 alone. This estimate of the number of people infected with the virus is almost 30 percent higher than the previous year’s estimate, reflecting new ways of extrapolating from figures at the country level rather than the regional level. Roughly 5.8 million people are believed to have become infected with HIV in 1997. Of these new infections, more than 40 percent occurred among women, and more than 50 percent occurred in young adults aged 15 to 24.
The disparities in disease between rich and poor countries are vast and growing. According to the new report, more than 90 percent of all HIV-infected people live in developing countries, and most of them do not know they are infected; thus they are not taking precautions to prevent the spread of the disease. Infection rates are soaring in sub-Saharan Africa, the world’s poorest region, whereas in the wealthy regions of Western Europe and North America, rates are slowing dramatically. In Western Europe, according to the latest data, the number of new cases declined roughly 30 percent between 1995 and 1997. What is more, many of those in wealthy countries who are infected with HIV have access to antiviral drugs that delay the disease’s progress; these expensive drugs are largely unavailable in poor countries (and to the poor in wealthy countries).
The AIDS epidemic has been particularly devastating in sub-Saharan Africa, where fully two thirds of the total number of people infected with the virus now reside. Although Africa has long been the region with the highest total number of people infected, experts at the World Bank had thought the epidemic was leveling off [2]. The latest UNAIDS/WHO estimates challenge those claims, asserting that 7.4 percent of the adult population, aged 15 to 49, is now infected. In the worst-hit areas, the rate is far higher. In Botswana, for instance, nearly 30 percent of the adult population is believed to be infected, double the number from just 5 years ago.
The AIDS epidemic is newer in Asia than in Africa, and many Asian countries have not yet developed comprehensive surveillance systems. Available data suggest that although HIV-infection rates are generally still low, the number of people infected is enormous because the region is so large. In India, for example, less than 1 percent of the adult population is believed to be infected, but that translates into 3 million to 5 million people. The nascent epidemic in China continues to spread through drug use in the south and prostitution in the east. In Southeast Asia, although the picture is bleak in Cambodia and Vietnam, Thailand has successfully decreased the number of new infections as a result of its sustained condom use campaigns and other educational efforts.
In Latin America and the Caribbean, infection rates are relatively low, and the disease has been concentrated mainly among homosexual men and intravenous drug users. It now appears to be spreading among poor and less educated parts of the population, as well as among women. According to UNAIDS/WHO, a major opportunity exists in this region to slow the spread of AIDS, but it will require special attention to the prevention needs of poor and socially marginalized people.
In Eastern Europe and the former Soviet Union, HIV is spread primarily through intravenous drug use. Experts caution that infection rates may soon rise significantly – a soaring number of cases of sexually transmitted diseases suggest an increase in unprotected sexual activity in this region.
In the wealthier countries, by contrast, aggressive prevention and treatment strategies have led to a declining number of AIDS cases, especially among homosexual men. In the United States, the latest estimates indicate the first-ever annual decrease in new AIDS cases – 6 percent in 1996. Among some disadvantaged groups in the United States, however, AIDS is still on the rise. In 1996, new AIDS cases rose by 19 percent among African-American heterosexual men and by 12 percent among African-American heterosexual women. In the Hispanic community, the number of cases rose 13 percent among men and 5 percent among women in just 1 year. These disparate trends reflect, in part, differing access to expensive antiviral drugs and a lower level of success of prevention efforts targeted to minority communities.
1. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), Report on the Global HIV/AIDS Epidemic (UNAIDS/WHO, Geneva, 1997).
2. The World Bank, Confronting AIDS: Public Priorities in a Global Epidemic (Oxford University Press, New York, 1997), p. 13.