UPDATE ON AIDS EPIDEMIC BY UNAIDS
Although there was no question that Africa had been hit the hardest by the HIV/AIDS pandemic, initiatives in countries like Zambia and Uganda –- countries with little in the way of resources but with active and early commitment to respond to the virus -- signaled that there was cause for hope, the Senior Epidemiologist of the Joint United Nations Programme on HIV/AIDS (UNAIDS) said at a Headquarters press briefing this afternoon. Mr. Bernhard Schwartlander, heading a diverse panel updating correspondents on the status and emerging global and regional trends of the virus, added that what was needed now was for the international community, particularly donors, to build on those positive efforts in other parts of the continent and around the world.
Mr. Schwartlander said that it had been 20 years since the first AIDS case had been described and diagnosed in the United States. Since that time,
22 million people had died worldwide, and there were now 36 million people living with the virus. He noted that the spread of the disease was not evenly distributed, hitting developing countries the hardest. Sadly, in some African countries four out of five people were now living with the disease, and in some cities on that continent, 50 per cent of adults were infected. The breadth of the pandemic would affect all aspects of society for many years to come. Latin America and the Caribbean had also been hard hit, he continued. There were an estimated 1.5 million in the region living with the disease.
Mr. Schwartlander said that one region generating particular concern was Eastern Europe. Using a map detailing a global view of HIV infections -– introduced late last week by UNAIDS Executive Director Dr. Peter Piot in connection with the launching of the agency’s report “Together we Can” –- he highlighted the “substantial” increase in infections over the last five years. He added that transmissions in the region tended to be focused on IV drug users, with a very specific pattern, jumping like brushfires from one high-risk sub-community to another.
For example, he said that Russia last year registered more new HIV infection cases than it had at any time throughout the disease’s 20-year history. That was specifically because it had been recently introduced into Moscow’s IV drug community. So, while overall national levels were still relatively low, “all the ingredients were there” -- including the parallel increase in reports of other sexually transmitted diseases -- for HIV to spread much more drastically in the region if swift action was not taken.
He then introduced the afternoon’s other speakers, Dr. Daniel Tarantola, Senior Policy Adviser to the Director-General of UNAIDS, and Dr. Helene Gayle, Director National Center for HIV, STD and Tuberculosis Prevention, US Centers for Disease Control and Prevention (CDC), who gave brief overviews of the situation in the Asia and Pacific region and the United States, respectively.
Dr. Tarantola said that while the special session would rightly focus on the devastating effects of the HIV/AIDS virus on the African continent, it would also provide the opportunity to look closely at Asia -– “a disaster in the making”. In that region, tracking the epidemic’s spread had been particularly difficult since the theatres of transmission had included all the groups identified as high
risk. At the same time, evidence showed that transmissions also frequently occurred from mother to child, and through unsafe blood and blood products.
This evinced a “mosaic of epidemics”, evolving in parallel. Looking beyond the bleak facts and figures, he noted that in Thailand, where the rate of infection had captured the attention of the international community for a number of years, behavioural change had reduced the number of newly acquired infections from some 140,000 annually to around 30,000. In China, he added, the prevalence rate was relatively low compared to some other countries, but the fast-rising rate of other sexually transmitted diseases meant that there were probably clouds on the horizon. In Cambodia, which had actively responded to the rapid spread of the virus, mainly through condom policies aimed at sex workers, there had been a dramatic decrease in infection rates. But while there was hope, there was also concern that the region could possibly be the site of the next major pandemic.
A correspondent asked what could be done about the attitude towards condom use in Muslim countries. Dr. Tarantola said that it was first important to note that there was not one approach to addressing the disease in all so-called Muslim countries. Indeed there were a variety of approaches, some very tolerant of condom use, particularly in the sex industry. He added that consideration of this issue during the special session would be crucial. “At least the debate is open,” he said. “It is truly time to discuss the words and concepts and principles that are being currently debated.”
Another correspondent wondered how the debate during the session about “vulnerable populations” would affect donor countries. Dr. Tarantola said that while it was good that the United Nations had decided to wake up and address vulnerable populations, it was also important to realize that those groups had not waited to be recognized. Indeed, they had been working and moving toward preventable behaviour for years. This was also true of countries that were less tolerant of vulnerability to HIV.
Dr. Gayle said that between 800,000 and 900,000 were living with HIV in the United States, including 300,000 of that number who had progressed to full-blown AIDS. While America could note some success, as the rate of new infections had decreased significantly from the early years of the epidemic -– from around 150,000 a year at that time to around 40,000 last year -– one had to agree that 40,000 new infections of what was considered a preventable disease was still too many. Further, she added that the country had been stable at that number of new infections for perhaps the last five years.
She went on to say that despite the decline in infection rates among gay and bisexual men, that group was still at the highest risk of contracting the disease. In recent years, the number of reported cases had risen dramatically among gay and bisexual men of colour. CDC studies now indicated that while about one in ten men in the age group were already infected with HIV, among African American and Latino men of that same age group, the number in some cities was as high as 30 per cent. Echoing the concerns of the other panellists, Dr. Gayle noted the corollary increase in other sexually transmitted diseases as a “worrisome” harbinger of things to come.
Dr. Gayle said that heterosexual transmission also continued to be a major factor in the spread of HIV in the United States, representing one third of all new infections. As with gay men and bisexual men, the most dramatic increase among women was among women of colour. She added that most women were infected through heterosexual contact. Injection drug use also played a major role in the spread of the disease, accounting for an estimated one in four new infections every year. Prevention efforts remained of critical importance in the United States, as well as making certain that infected persons had access to better treatment and therapy. It was hoped that with a more targeted and focused strategy, the number of new infections could be halved over the next five years.
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