AIDS Explodes In Asia, E Europe

by Sanjay Suri

(IPS) LONDON -- Moves to fight AIDS have been failing overall with five million more infections reported last year, UNAIDS executive director Peter Piot announced July 6.

"It is a failure of reaching infected people, and of treating them," Piot said while releasing the UNAIDS annual report. The report was released ahead of the 15th international AIDS conference to be held in Bangkok July 11-16.

Apart from five million new infections, three million died of AIDS related causes last year, Piot said. Both the infections and the deaths were the highest reported for a single year.

"We are now entering the globalization phase of the epidemic," Piot said. "So far the epidemic has been largely in sub-Saharan Africa. But now one in four new infections is being reported in Asia, and the fastest growing epidemic is in Eastern Europe."

AIDS is also becoming more and more an issue for women, Piot said. In 1981 AIDS was a phenomenon among white middle-class homosexual men. "Now half of all people infected with HIV are women," Piot said. "In Africa it is 60 percent and increasing."

The number of people living with HIV has grown from 35 million in 2001 to 38 million last year, says the fourth global report on AIDS produced by UNAIDS.

That number is down from earlier figures of around 40 million. "But that is because of more accurate estimates and better reporting," Piot said. There is little doubt that the incidence is rising, even though estimates of the numbers infected have been lowered.

If there is some good news, it is that the epidemic is stabilizing in Africa, Piot said. In East Africa particularly there is a decline in infections among the young, mostly in urban centers.

There have been successes elsewhere, too. Infections have been reduced in Thailand from 140,000 in 1991 to 21,000 last year. But Asia presents a mixed picture, he said.

The largest study of sexual behavior carried out in India has shown a "disconnect between the surface and what is happening below," Piot said. The report says about 5.1 million people in India are living with HIV -- one in seven HIV-positive people worldwide.

The spread of the infection calls for new leadership, Piot said. That calls for confronting the disease, and also for the allocation of bigger budgets to fight it. An example, he said, was Uganda "where it became very bad for the career of any official not doing enough to fight AIDS." AIDS is "the largest epidemic in human history" and there is "need for leadership everywhere to fight it."

But despite such instances of isolated success as Uganda and Thailand, "only one in five persons who needs access to prevention, such as education, condoms and clean needles has it," Piot said. "This is the Achilles' heel of the global response."

Over the last two years the number of people with access to antiretroviral treatment has doubled to about 440,000, Piot said. But that access has grown mostly in Latin America, and is "shockingly low in Africa."

The development of "so-called" generic drugs in China, India and Brazil has brought down the cost of antiretrovirals by 90 percent, Piot said. But in two cases such generic drugs had to be withdrawn following intervention by the World Health Organization (WHO), he said. There can be no compromise on the quality of treatment offered, he said.

Piot pointed to several factors behind the spread of the infection. In Africa, he said, a primary factor was "inter-generational sex" that was often "not consensual, in all its variations." That meant that in southern Africa the first sexual experience of a girl was often with a man five to 15 years older than she.

In many countries a teenage girl is five times more likely to pick up an HIV infection than a teenage male, he said. "To help the women we have to target the men. We need a fundamental behavioral change."

The best promise for helping women is research on the development of microbicides -- a gel or cream that women can apply on their bodies to prevent spread of HIV infection.

Several companies are working to develop microbicides. British minister for the Department for International Development (DfID) Hilary Benn who also addressed the meeting said five British companies have taken developments of microbicides into clinical trials this year. The trials appear more promising than the development of a vaccine.

Another way of preventing the further spread of infections would be to counter the legacies of colonialism and apartheid regimes, Piot said.

The spread of HIV is not necessarily related to poverty -- in Botswana, one of the more prosperous countries in southern Africa, 40 percent of adults are HIV-positive.

"But in many countries including South Africa the organization of labor means long periods spent away from families and that has consequences in terms of the need for sexual expression, whether it is among themselves or with commercial workers."