PRESS BRIEFING BY UNAIDS EXECUTIVE DIRECTOR

The bad news was that the HIV/AIDS epidemic was still at the early stage of its expansion and the good news was that efforts to stem it were not business as usual, Dr. Peter Piot, the Executive Director of UNAIDS, said today upon the release of a new report on the issue.

He was introduced by Therese Gastaut, Director, Public Affairs Division, who said the Headquarters briefing for correspondents was being held to launch the UNAIDS report as part of the high-level segment of the 2002 Economic and Social Council (ECOSOC) session, focusing on health and education as the engine of development.  Ms. Gastaut also introduced the Director of UNAIDS New York, Desmond Johns.

Dr. Piot went on to say that the report was the standard or reference on the state of AIDS in the world.  It contained country-by-country estimates on a number of indicators vital to understanding both the epidemic and the response.  It was a collective work of the United Nations Secretariat and eight co-sponsors of UNAIDS, and it was being published one year after the special session of the General Assembly on HIV/AIDS in New York.

[The eight United Nations co-sponsors are:  United Nations Children's Fund (UNICEF); United Nations Development Programme (UNDP); United Nations Population Fund (UNFPA); United Nations International Drug Control Programme (UNDCP); United Nations Educational, Scientific and Cultural Organization (UNESCO); World Health Organization (WHO); International Labour Organization (ILO); and the World Bank].

The first major finding was that AIDS continued its relentless expansion, and from a historic perspective, "we are only at the beginning of this epidemic -– this epidemic which is already the largest epidemic in human history", he said.  That was clear in Asia, where HIV was starting to spread in very large countries.  That was also clear in Eastern Europe and Central Asia.  In the most affected region in the world, southern Africa, the level of infection continued to increase.  For example, in Zimbabwe, where two years ago about one in four adults were HIV positive, that was one in three today.

In Botswana, the most affected country in the world, 39 per cent of the adults were affected -- up from 36 per cent two years ago, he said.  So, despite assumptions by scientists that the epidemic would soon reach a natural saturation level, "to say the least, we're not there yet", he said.  That was the most surprising finding and a cause for major concern.  The report also provided many examples of the devastating impact of AIDS on every walk of life and every aspect of society.  That was a major cause of suffering for individuals and their families, and also drove households into poverty. 

He said that AIDS affected all aspects of social and economic development.  For example, last year, approximately 1 million children in Africa lost teachers to AIDS.  There were examples like that from every country and every sector of society.  In the 45 most affected countries where HIV prevalence was over 1 per cent, at the current level of effort, if that continued, 68 million people would die from AIDS over the next 20 years.  That was on top of the 25 million who had already died in the last two decades.

In South Africa, there would be 17 times as many deaths occurring over the next decade as would have occurred without AIDS, he said.  Yesterday, the World Food Programme (WFP) launched its appeal to help the victims of the famine and drought in southern Africa.  The data clearly showed that AIDS had exacerbated the impact of the drought and famine. 

Another major finding, he continued, was the first-ever estimates of the number of people with HIV who were being treated around the world by region.  An estimated 730,000 people were currently receiving treatment and, of those, approximately 500,000 were living in high-income countries.  In those high-income countries, last year, some 25,000 people died of AIDS.  In Africa, only 30,000 people were being treated out of a total of 28.5 million infected.  Last year, there were 2.2 million deaths there.

On a more positive side, he said, over the last two years it had become clear that the world was finally waking up.  A number of indicators suggested that it was not business as usual any longer in many countries where national AIDS commissions had been established.  Also, there had been many commitments on behalf of regional political bodies.  There was empirical evidence that success was possible in the fight against AIDS, such as in countries like Cambodia, Thailand, Zambia, Uganda and Brazil, which had seen a decrease in new infections.

If a country like Cambodia, which was one of the poorest in the world following decades of genocide, was able to bring down the number of new infections, other countries should be able to do that too.  Another indicator of a new phase concerned funding for AIDS programmes in low- and middle-income countries, which had increased six-fold since 1999.  Low- and middle-income nations needed $10 billion per year to prevent the spread of HIV, treat the infected, and care for the orphans.  "We are not there yet", he said. 

With $2.8 billion being spent this year on AIDS programmes in those countries, there was still a huge gap, he said.  To fill that gap, the domestic budgets of affected countries and donor money would have to increase by 50 per cent every year until 2005 to reach that $10 billion goal. 

Turning to a question about the difference between HIV and AIDS, Dr. Piot explained that HIV was the abbreviation for the human immunodeficiency virus.  Someone who had the virus was infected with HIV, but did not have clinical signs of immunodeficiency.  The virus destroyed the immune system, and beyond a certain point, an infected person became vulnerable to all sorts of opportunistic infections, which would cause no or little harm to a person with a normal immune system, but could kill a person with a depressed immune system.  AIDS was the ultimate, clinical severe stage of the HIV infection.

A correspondent noted that last year when the Global Fund was launched the Secretary-General had said it would require $7 billion to $10 billion per year over a decade.  Dr. Piot had said that the world could not absorb that much right away, but would have to do so incrementally.  The correspondent asked him to describe the capacity today.

Dr. Piot said that by 2005, programme capacity should be at its peak, in terms of the $10 billion goal.  The total actual spending for AIDS this year would be approximately $2.8 billion.  The Global Fund had approved roughly $600 million in projects for a two-year period, which also included programmes for tuberculosis and malaria; about $400 million plus was going to AIDS programmes.  That was the first round.  Today, the Fund called for proposals for a second round, which would be discussed at the Board meeting in November.  Less than one year after the Secretary-General's call for action and the formal establishment of the Fund in January, there was a long journey ahead through institutions.  Fiduciary mechanisms had to be set up in countries.

Asked how recent the figures were for China and whether there had been a dramatic change this year, he said the figures for China and for all other countries were from December 2001.  The estimates were officially reported figures, he added.  They were very solid for the smaller countries and for Africa.  For countries like China and India, he was still struggling with the fact that the denominator was huge and the AIDS phenomenon, by any standard, was still fairly rare.  In China, an estimated 1 million people were infected with HIV.

Responding to a question about why Cambodia had been cited as a success story, he said that was surprising, because it was a very poor country and the very fabric of society had been destroyed by war.  But, he had seen how the Prime Minister and the King had taken the lead in the fight against AIDS.  So, that was not only a matter of the doctors dealing with AIDS, it had become the business of society, from the monks in the temples to businesses and schools.  Indeed, the AIDS fight had become a core element of reconstruction there.

He was not talking about sophisticated technology with respect to AIDS prevention, he added.  In that regard, journalists could save more lives than doctors could.  AIDS prevention was about communication, information, education, and values.  And, that was what had happened in Cambodia, although it still struggled with insufficient funds.

In those countries that had succeeded in reducing the number of new infections, it had become clear that it took about four to five years from the initiation of nationwide prevention efforts and a measurable, reliable decline in the number of new infections, he replied to a further question.  That had been observed in Thailand, Uganda, and Zambia.  A critical mass of safer sexual behaviour needed to build throughout a population before the numbers went down.  He expected results in some African countries over the next few years, but the situation was bound to get worse before it got better.

Asked whether the projection of 68 million deaths over the next 20 years were new numbers and whether they represented a marked increase over expectations, he said that those were new numbers.  He had not undertaken that exercise before.  Until now, he had been producing short-term predictions.  Now, he was trying to predict where the epidemic was headed in the longer term, using various scenarios, including constant efforts and increased efforts and investments.

He added that he was surprised that it was that high.  He would have expected to have seen more impact from the prevention efforts.  At current efforts, if business as usual continued, that would be the result.  The weakest part of the prediction concerned Asia.  Just a 1 per cent difference in the infection rate in China or India, or well over 10 million people, made an

enormous difference.  He could not make those predictions on a 10- or 20-year basis.

Replying to a question about infection in the broader population, he said that in the early days in a country where HIV spread, it was always the most vulnerable people who were infected first –- homosexual men and intravenous drug users.  In Thailand, the infection had spread first among those involved in the sex industry.  Today, most infections were occurring outside commercial sex participants.  He was also seeing that trend in Russia, where the spread was taking place among heterosexuals.  In China, the situation was still in the "early days".

He said that there had been a 90 per cent decline over the last two years in the cost of anti-viral drugs to treat HIV/AIDS, in response to another question.  That was the result of voluntary price reductions by research companies, generic competition, pressure from activists and the Secretary-General, himself, who had met several times with heads of the large pharmaceutical companies.  He would not call that collaboration or cooperation, but competition.

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