Aids Alert International-HIV worldwide shows no slowing in infections, deaths
More sub-Saharan African women are infected with HIV than men
If there was a billboard that highlighted the number of HIV infections worldwide, it would now read 50 million infected, including 16.3 million dead.
HIV has infected a population that is nearly the size of the United Kingdom, says Peter Piot, MD, PhD, executive director of UNAIDS of Geneva, Switzerland. Piot presented the grim update at a special international telephone briefing held by UNAIDS and the World Health Organization (WHO) of Geneva in late November in conjunction with World AIDS Day.
An estimated 5.6 million people became infected with HIV in 1999. Of these, more than half a million were children, according to UNAIDS statistics. (See global summary chart, p. 2.)
| Global Summary of the HIV/AIDS Epidemic December 1999 |
| People newly infected with HIV in 1999 |
| Total — 5.6 million |
| Adults — 5 million |
| Women — 2.3 million |
| Children <15 years — 570,000 |
| Number of people living with HIV/AIDS |
| Total — 33.6 million |
| Adults — 32.4 million |
| Women — 14.8 million |
| Children <15 years — 1.2 million |
| AIDS deaths in 1999 |
| Total — 2.6 million |
| Adults — 2.1 million |
| Women — 1.1 million |
| Children <15 years — 470,000 |
| Total number of AIDS deaths since the beginning of the epidemic |
| Total — 16.3 million |
| Adults — 12.7 million |
| Women — 6.2 million |
| Children <15 years — 3.6 million |
| Source: Joint United Nations Programme on HIV/AIDS. AIDS epidemic update: December 1999. Geneva: 1999, pp. 1-24. |
Plus, more women are infected with HIV than men in southern Africa.
"This year, we have new and overwhelming evidence that infected women far outnumber men in sub-Saharan Africa by two million," Piot says. "Studies that we have supported show that African girls are five to six times more likely to be infected than boys of the same age."
On the positive side, some nations that have focused on HIV prevention strategies, such as Thailand and the Philippines, have experienced a leveling off or decline in HIV infections, Piot says.
UNAIDS has made it a top priority that national leaders recognize the HIV problem and target young people with prevention efforts, he adds.
"We have to be very realistic that it's not feasible to just have one approach like advertising or condoms or so on," Piot says. "We need a combination of school education and using media and pop stars and all that, together with making sure condoms are there and affordable."
The major factor influencing the HIV epidemic is individual behavior, particularly among young people, says Bernhard Schwartlander, MD, head of the UNAIDS epidemiology team in Geneva.
About 50% of all new infections worldwide occur in people in the 15-24 age group. That's the age group when most people first become sexually active, and it's the age group most prone to injecting drug use. So countries like Argentina that target HIV prevention programs to that age group have a smaller HIV epidemic than other nations that fail to make that commitment to prevention strategies and education, Piot says.
"We have seen in some countries substantial behavior changes in the youngest population, 25-year-olds, and hope they will carry on as they grow older," Schwartlander says. "That will have an impact on the epidemic in these countries."
Piot and Schwartlander say it's not possible to predict where the epidemic is heading now that it's taken hold in Asian countries, such as India, where there are enormous populations at risk for the disease. (See story on how the epidemic is progressing in various regions of the world, p. 2.)
"What's happening in India and China with populations together of two billion is a question that will drive the epidemic in the future, and it's impossible to say where it's going to peak," Schwartlander says.
However, Africa's epidemic could peak at 50 million infected people within the next few years, Piot notes. "What you're seeing today is more than the worst-case scenario."
The HIV epidemic can gain little more ground once it has penetrated 20% to 30% of a population, as it has in some African nations, Schwartlander says.
Sub-Saharan Africa has an estimated 23.3 million people who have HIV infection or AIDS, which accounts for nearly 70% of the world's total HIV cases in a region that has only 10% of the world's population.
"These numbers are unbelievably high, and if you had asked us 20 years ago, we would never have believed we would reach those levels," he adds.
Epidemiologists do not think HIV infection rates will reach 20% to 30% penetration in China or India, Schwartlander says. "But even if you reach one-quarter of that, you can estimate what that would mean in terms of the total epidemic."
The sub-Saharan African region also has a higher ratio of infected women than men. Studies suggest there are 12 or 13 African women infected for every 10 African men. UNAIDS and WHO estimate that at the end of 1999 there were 12.2 million women and 10.1 million men ages 15-49 who were living with HIV in sub-Saharan Africa.
This trend means HIV/AIDS organizations and public health officials need to focus on educating men about prevention efforts and offer women more options for protecting themselves from infection, Piot says.
"We need to empower women and make sure far more female-controlled efforts are available, and that's why we're trying to push the female condom, and everywhere we've done that it's been a success," Piot adds. "But there's a lack of funding, and that makes it less effective."
Meantime, HIV epidemiologists need better tools to measure the disease's spread. For example, until recently, UNAIDS had no data on how many women vs. men were infected with HIV, Piot says.
UNAIDS bases prevalence estimates on data collected through HIV sentinel surveillance, and estimates of HIV-related deaths are derived indirectly from mathematical models that are based on HIV prevalence data.
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