the first clinical evidence of AIDS was reported two decades ago, HIV/AIDS
has spread to every corner of the world. Still rapidly growing, the epidemic
is reversing development gains, robbing millions of their lives, widening
the gap between rich and poor, and undermining social and economic security.
- An estimated 36.1
million people are living with HIV. In 2000, about 5.3 million people
around the world became infected, 600 000 of them children.
- Since the epidemic
began, AIDS has killed a total of 21.8 million people—almost three times
the population of Switzerland. In 2000 alone, AIDS claimed three million
- Sub-Saharan Africa
is by far the worst affected region in the world. An estimated 25.3
million Africans were living with HIV at the end of 2000. By that time,
a further 17 million had already died of AIDS—over three times the number
of AIDS deaths in the rest of the world.
- On the continent,
two million more women than men carry HIV. Some 12.1 million children
have lost their mother or both parents to the epidemic. By the end of
2000, an estimated 1.1 million children under 15 were living with HIV,
largely due to mother-to-child transmission.
- Uganda remains
the only African country to have turned a major epidemic around. Its
extraordinary effort of national mobilization pushed the adult HIV prevalence
rate down from around 14% in the early 1990s to 8% in 2000. Elsewhere
in East Africa—Djibouti, Ethiopia and Kenya, for example—prevalence
rates are still in double digits. In West Africa, Senegal has managed
to slow transmission, but prevalence in populous Nigeria now stands
- In several southern
Africa countries, at least one in five adults is HIV-positive. Adult
prevalence rates rise as high as 20% in Namibia and Zambia, 24% in Lesotho,
25% in Swaziland and Zimbabwe, and almost 36% in Botswana.
- Countries such
as Botswana and South Africa have redoubled their efforts to contain
the epidemic, but it will take years for this to bear fruit. In 2000,
the HIV prevalence rate among pregnant women in South Africa rose to
its highest level ever: 24.5%, bringing to 4.7 million the estimated
total number of South Africans living with the virus.
Latin America and
- Almost 1.8 million
people in this region are living with HIV/AIDS, including the 210 000
adults and children who became infected in 2000. At 5%, Haiti has the
highest HIV adult prevalence rate in the world outside sub-Saharan Africa.
The rate in five other Caribbean countries hovers around 2% of the adult
population. However, Brazil’s emphatic efforts seem to be containing
a potentially major heterosexual epidemic in that country.
- The spread of HIV
is driven by a combination of factors, including unsafe sex between
men and women (the main mode of transmission in the Caribbean and much
of Central America). In Brazil, Costa Rica and Mexico, infection rates
peak among men who have sex with men, while in Argentina, Brazil and
Uruguay, injecting drug users account for a large share of infections.
Throughout the region, however, heterosexual transmission is becoming
an increasingly important factor in the epidemic.
Asia and the Middle
- Some 6.4 million
people in Asia carry the virus and determined steps are needed to prevent
a massive increase in their numbers. China seems especially prone to
an epidemic because of the recent steep rise in sexually transmitted
infections and the large-scale transmigration of people (spurred by
- An estimated 780
000 people became infected in South and South-East Asia in 2000, with
HIV prevalence exceeding 1% in Cambodia, Myanmar and Thailand. Because
of India’s vast population, its low prevalence rate (0.7%) nonetheless
translates into 3.7 million people living with HIV/AIDS—more than in
any other country besides South Africa.
- In North Africa
and the Middle East, infections are rising off a low base. Across the
region, there were an estimated 80 000 new infections in 2000, bringing
to some 400 000 the number of people living with HIV/AIDS. Localized
studies in Algeria, for instance, reveal prevalence rates of about 1%
among pregnant women.
Central and Eastern
- Infection rates
are climbing alarmingly in Eastern Europe and Central Asia, where overlapping
epidemics of HIV, injecting drug use and sexually transmitted infections
are swelling the ranks of people living with HIV/AIDS. Most of the quarter
million people who became infected in 2000 were men. In some parts of
the region, more HIV infections occurred in 2000 than in all previous
- New epidemics have
emerged in Estonia and Uzbekistan, while, in Ukraine, more than 250
000 people were living with HIV/AIDS by 2000. In 1986, only a few cities
in what is today the Russian Federation reported HIV cases; today, almost
all its regions harbour the virus. Although the epidemic is still concentrated
among injecting drug users and their sexual partners, growing prostitution
and high levels of sexually transmitted infections could, in a climate
of jolting social change, cause it to spread rapidly into the general
- The notion that
the epidemic is a thing of the past in high-income industrialized countries
is unfounded. Almost 1.5 million people live with HIV in those regions,
many of them productively, thanks to pervasive antiretroviral therapy.
But that achievement is shadowed by the fact that prevention efforts
are stalling in most industrialized countries.
- Infection rates
in some American cities are again rising among men who have sex with
men; one urban United States study has revealed a HIV prevalence of
7.2% in this group. Also reported are sharp increases in sexually transmitted
infections among men who have sex with men in Amsterdam—an indication
that unsafe sex threatens to become the norm again. There are signs
that unsafe sex between men might be a growing factor in Eastern Europe's
- In some countries,
the epidemic is shifting towards more vulnerable people—especially ethnic
minorities who, because they face discrimination and social exclusion,
appear to face disproportionate risks of infection. They are also more
likely to be missed by prevention campaigns and deprived of access to
treatment. HIV prevalence rates among injecting drug users give special
cause for alarm: 18% in Chicago and as high as 30% in parts of New York.
By contrast, needle and syringe exchange schemes in Australia are slowing
the increase in prevalence among injecting drug users.
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