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Countries like Thailand and Uganda which had been lauded as success stories in the battle against AIDS are witnessing a resurgence in HIV infection rates, as the number of infections are rising in almost every region of the world. However, in other nations, a decline in infection rates is being seen, as well as positive trends in young people's sexual behaviour, according to the 2006 AIDS Epidemic Update
With 2.9 million deaths and 4.3 million new HIV infections in the past year, the AIDS epidemic is continuing to grow, with worrying evidence of a resurgence in infection rates in some countries that were previously stable or declining, according to the latest United Nations data.
2006 AIDS Epidemic Update, compiled by the World Health Organisation (WHO) and UNAIDS, the joint UN programme on HIV/AIDS, which is based on disease surveillance from around the world, was released on November 21. The report says an estimated 4.3 million new HIV infections this year (in the range of 3.6 million and 6.6 million) were reported in 2006, 400,00 more than in 2004. About 40% of new infections were among people aged between 15 and 24 years, says the report.
Somebody is infected with the HIV virus every 8 seconds, equivalent to 11,000 infections worldwide every day, while another 8,000 infected people die, the two agencies said. "Evidence shows again that the global epidemic is growing in all areas," said Peter Piot, executive director of UNAIDS.
About 39.5 million people worldwide (34.1-47.1) are now said to be living with the disease (2.6 million more than in 2004). Of these cases 37.2 million are adults, 17.2 million of them women. Two hundred and thirty million of the HIV/AIDS cases are children.
In 2006, 2.9 million (2.5 million-3.5 million) died of AIDS-related illnesses. More than 2.1 million of these, or 65%, occurred in sub-Saharan Africa, which is still the epicentre of the HIV/AIDS epidemic. “In sub-Saharan Africa, the worst affected region, life expectancy at birth is now just 47 years, which is 30 years less than most high-income countries,” the WHO’s acting director-general Anders Nordström said.
Adults accounted for 2.6 million, and children, for 380,000 of the 2.9 million AIDS related deaths, the report said.
Among positive trends noted by the report are a decline in infection rates in some countries, changes in young people’s sexual behaviour , and increased access to treatment and prevention programmes. But in many countries prevention programmes are not reaching those most at risk, such as young people, women and girls, men who have sex with men, sex workers and their clients, injecting drug users and ethnic and cultural minorities.
In North America and Western Europe, prevention programmes have often not been sustained and new infection rates have remained the same. In low and middle-income countries, there are only a few examples of rate reductions. Some countries that had earlier shown successes in reducing new infections, such as Uganda, have either slowed or are now experiencing increasing infection rates.
New data showed erratic condom use in Uganda and more men having sex with more than one partner, as well as evidence of rising HIV prevalence in some rural areas, according to Karen Stanecki, UNAIDS senior epidemiologist. "In Thailand, another one of our past success stories, the number of new infections continues to drop but the epidemic is changing and countries such as Thailand and Uganda need to take into account the fact that epidemics do change over time," Stanecki said.
“This is worrying, as we know increased HIV prevention programmes in these countries have shown progress in the past, Uganda being a prime example,” UNAIDS executive director Peter Piot said. “This means that countries are not moving at the same speed as their epidemics. We need to greatly intensify life-saving prevention efforts while we expand HIV treatment programmes.”
Increased prevention programmes focused on reaching those most at risk of infection are making inroads, according to the report. Positive trends in young people’s sexual behaviour -- increased use of condoms, delay of sexual debut, and fewer sexual partners -- have taken place over the past decade in many countries with generalised epidemics. Declines in HIV prevalence among young people between 2000 and 2005 are evident in Botswana, Burundi, Côte d’Ivoire, Kenya, Malawi, Rwanda, Tanzania and Zimbabwe.
In other countries, even limited resources show high returns when investments are focused on those most likely to be exposed. In China, some programmes for sex workers have seen marked increases in condom use and decreases in the rate of sexually-transmitted infections. Programmes with injecting drug users also show progress in some regions.
In Portugal, HIV diagnoses among drug injectors were almost one-third lower in 2005, compared with 2001, following special programmes focused on HIV and drug use.
The report outlines how women and girls need increased attention. In sub-Saharan Africa, women continue to be more likely than men to be infected with HIV, and in most countries in the region they are also more likely to be the ones caring for those infected.
There is increasing evidence of outbreaks among men who have sex with men in Cambodia, China, India, Nepal, Pakistan, Thailand and Vietnam as well as across Latin America. But most national programmes fail to address the specific needs of these people, the report notes. The overlap between injecting drug use and sex work in Latin America, Eastern Europe and particularly Asia is also not being addressed.
In Latin America, the Caribbean, the Middle East and North Africa, weak surveillance often means that people at highest risk -- men who have sex with men, sex workers and injecting drug users -- are not adequately reached through prevention and treatment strategies because not enough is known about their particular situation.
The report also says that levels of knowledge about safe sex and HIV remain low in many countries, as well as perceptions of personal risk. Even in countries where the epidemic has a very high impact, such as Swaziland and South Africa, a large proportion of the population do not believe they are at risk of becoming infected. “Knowing your epidemic and understanding the drivers of the epidemic, such as inequality between men and women and homophobia, is absolutely fundamental to the long-term response to AIDS. Action must not only be increased dramatically, but must also be strategic, focused and sustainable to ensure that the money reaches those who need it most,” says Dr Piot.
Other key findings of the AIDS Epidemic Update are:
- The number of people living with HIV increased in every region of the world, in the past two years. The most striking increases have occurred in East Asia and in Eastern Europe and Central Asia, where the number of people living with HIV in 2006 was over one-fifth (21%) higher than in 2004.
- Sub-Saharan Africa remains the most affected region in the world. Two-thirds of all people living with HIV live in this region -- 24.7 million people in 2006. Almost three-quarters of all adult and child deaths due to AIDS occurred in sub-Saharan Africa -- 2.1 million of the global 2.9 million deaths due to AIDS.
- Globally, and in every region, more adult women (15 years or older) than ever before are now living with HIV. The 17.7 million women living with HIV in 2006 represent an increase of over 1 million compared with 2004.
- Access to treatment and care has greatly increased in recent years. Through the expanded provision of antiretroviral treatment, an estimated 2 million life-years were gained since 2002 in low and middle-income countries.
- Worldwide, however, less than 1 in 5 people at risk of becoming infected with HIV has access to basic prevention services. Across the world, only 1 in 8 people who want to be tested are currently able to do so.
- There are more new HIV infections every year than AIDS-related deaths, and as more people become infected with HIV more people will die of AIDS-related illnesses.
- According to the latest UNAIDS/WHO ‘3 by 5’ data, over 1.6 million people living with HIV were receiving ARV therapy in low and middle-income countries, as of June 2006. This represents more than a four-fold increase since December 2003. Overall, antiretroviral therapy coverage in low and middle-income countries increased from 7% at the end of 2003 to 24% in June 2006.
The report recommends:
- Scaling up available prevention strategies in 125 low and middle-income countries would avert an estimated 28 million new infections between 2005 and 2015, or 50% of infections that are projected to occur during this period. This would save US$ 24 billion in associated treatment costs. Simultaneous scaling up of both prevention and treatment would avert 29 million new infections by the end of 2020.
- In 2005, a total of US$ 8.3 billion was estimated to be available for AIDS funding; this figure is estimated to rise to US$ 8.9 billion in 2006 and US$ 10 billion in 2007. But it falls short of what is needed -- US$ 14.9 billion in 2006, US$ 18.1 billion in 2007 and US$ 22.1 billion in 2008.
- As for treatment and care, about 55% of these resources will be needed in Africa, 20% in Asia and the Pacific, 17% in Latin America and the Caribbean, 7% in Eastern Europe and 1% in North Africa and the Near East.
InfoChange News and Features, November 2006
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