40 million and climbing

The rate of HIV infection worldwide is still on the rise, with Asia particularly at risk, the U.N. reports.

Published November 22, 2005 3:40PM (EST)

The HIV/AIDS pandemic is continuing its deadly spread across the globe, infecting 5 million more people last year and bringing the total living with the virus to over 40 million, the United Nations said Monday.

The Joint United Nations Program on HIV/AIDS (UNAIDS), in its latest update on the figures, tried to lighten the gloom by pointing to Kenya, Zimbabwe and some Caribbean countries, where there is some limited evidence that infection rates may be dropping slightly. But in the worst-hit regions, notably sub-Saharan Africa, the trend is steadily upward, and in India there are suggestions that the scale of infection could be worse than the official figures imply.

Peter Piot, executive director of UNAIDS, said it was encouraging that prevention efforts had led to gains in some countries. "But the reality is that the AIDS epidemic continues to outstrip global and national efforts to contain it."

At a press conference in New Delhi, India, he said Asia, which contains half of humanity, was particularly at risk. China and Burma, which he said had the worst epidemics in Asia, have been slow to acknowledge the scale of the problem. "In the world's most populous nation, China, the overwhelming majority of the population does not know how the virus is transmitted."

India, which has officially 5.1 million people living with HIV -- a number not far behind South Africa's -- announced earlier this year that new infections had fallen dramatically to 28,000 in 2004, from 520,000 in 2003, sparking disbelief among volunteer groups.

Piot said he had two concerns with India's data. One was that most of the sampling was done in rural areas when most of the affected population is in cities. The second was that in some states the surveillance of the disease was of "poor quality." "It does not make sense that migrants from a poor state like Bihar who live in Mumbai do not then infect their wives when they come home. Something is missing."

The UNAIDS report called for new efforts to prevent people from becoming infected, provoking protests from some activists who fear a slackening in the world's efforts to get drugs to all those who need them. Only 1 million are so far on the drugs, while 6 million will soon die without them. Three million people died of AIDS last year.

The World Health Organization, which set a target of 3 million on treatment by the end of this year, stressed that treatment is now essential to prevention work because people will not be tested for HIV and therefore will not change their behavior unless drugs are available. "We can now see the clear benefit of scaling up HIV treatment and prevention together and not as isolated interventions," said the WHO's director-general, Lee Jong-wook.

However, Piot said the emphasis on prevention after a few years of vociferous campaigning for drugs was deliberate because the balance had tipped too far the other way. "We're very concerned that prevention has slipped off the agenda," he said. "From the developed to the developing countries, whether you look at funding or intensity of programs, most attention is going to treatment. In the long run, that is really bad." He called for "a rapid increase in the scale and scope of HIV prevention programs."

The report shows that while projects with commercial sex workers in Thailand and India and drug users in Spain and Brazil have borne some fruit, the most intractable problems are in sub-Saharan Africa, where 77 percent of those infected are women. Their social status is very low, they have few rights, and they are unable to negotiate with men for safe sex.

Some programs to try to improve the standing of women have been started in Africa, said Purnima Mane, director of policy, evidence and partnerships at UNAIDS. "It saddens me to say that the results are very, very small scale. I often worry whether they will remain sustained because the prevalent norms are so much against gender equality."

In Kenya, Zimbabwe and Uganda, HIV prevalence rates, measured among pregnant women at antenatal clinics, have dropped, which is being attributed partly to changes in sexual behavior, with a greater use of condoms, but also to increases in death rates.

This article has been provided by the Guardian through a special arrangement with Salon. ) Guardian Newspapers Limited 2005. Visit the Guardian's Web site at http://www.guardian.co.uk.

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