San Francisco Chronicle
November 26, 2003    p. A2

AIDS epidemic's
unrelenting siege

40 million infected
with HIV; 3 million
deaths this year

By Sabin Russell

    Amid hopeful signs that world resources are beginning to mobilize against AIDS, the disease continues to infect an estimated 5 million people a year and is out pacing efforts to contain it, global health authorities said Tuesday.
    Worldwide, more than 40 million people are infected with HIV, the virus that causes AIDS, and 3 million die of it every year.
    "The epidemic continues to expand. It is tightening its grip on southern Africa, and is threatening south Asia," warned Dr. Peter Piot, executive director of UNAIDS, the Joint United Nations Program on HIV/AIDS.
    "The good news," Piot added during a telephone press conference from London, "is that this has been a fairly good year, in terms of global response."
    In its annual assessment of the epidemic released Tuesday, UNAIDS noted that AIDS spending in poor and middle-income countries this year rose 50 percent to $4.7 billion, from $3.1 billion last year.
    Unfortunately, spending levels are roughly half what experts say is needed today to reverse the tide of the global epidemic, which has killed an estimated 20 million people since it first surfaced in 1981.
    Although afflicted nations are spending greater shares of their own resources on AIDS, up to 80 percent of the cost of fighting the epidemic in Africa and parts of Asia will have to come from wealthier nations, the agency contends.
    Using what it said are improved scientific tools, UNAIDS set the total number of people living with HIV this year at 40 million. That figure is actually lower than last year's estimate of 42 million, but scientists now acknowledge the older number was likely wrong, with actual infections last year closer to 39 million. By this new standard, the epidemic is in fact still growing.
    Sub-Saharan Africa, with 3 million new infections this year and 2.3 million deaths, continues to bear the brunt of the global pandemic.
    "Swaziland has now joined the Botswana league, with a 39 percent prevalence," Piot said. In both nations, nearly 4 in 10 adults are now believed to be HIV positive.
    Piot cited as a positive step the growing willingness among African leaders to discuss openly the epidemics afflicting their countries. But he criticized Russia for failing to face up to the AIDS problem in that nation, where the disease is spreading as fast as anywhere in the world.
    There is also mounting worry that the disease has gained a foothold in some parts of India, the world's second-most-populations nation. The overall rate of HIV infection in India is less than 1 percent, but that still translates into more than 4.6 million people because of the sheer size of that country's population. Within India, infection rates among prostitutes in certain districts exceed 50 percent, and prevalence among injecting drug users is as high as 75 percent.
    "My biggest concern in Asia is India," Piot said.
    But he also suggested there has been a change for the better in international attitudes toward the crisis. "When global leaders meet, they talk AIDS," said Piot, noting that President Bush and British Prime Minister Tony Blair set aside their discussions on Iraq to discuss AIDS strategy during the President's recent visit to the United Kingdom.
    At the approach of World AIDS Day on December 1, the Bush administration is dispatching Secretary of Health and Human Services Tommy Thompson on a week-long fact-finding trip to Africa. Thompson will lead a delegation that includes business leaders, top officials of the National Institutes of Health and the Centers for Disease Control and Prevention, as well as Ambassador Randall Tobias, the president's newly named coordinator for his $15 billion overseas AIDS initiative. The tour includes stops in Rwanda, Kenya, Uganda and Zambia, all countries that are slated to receive funding under the president's plan.
    Calling the trip "historic," Thompson said one of its aims is to educate business leaders about the scope of the AIDS problem in Africa, and perhaps persuade them to contribute to the Global Fund to Fight AIDS, Tuberculosis and Malaria, the UN-inspired program for which he serves as chairman.
    Thompson warned that, with some African nations having 30 percent or more of their populations infected, "it is only a matter of time before a country becomes so destabilized, it might fall ....This is a problem the world community needs to be cognizant of."

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