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Just as clearly, experience shows that the right approaches, applied quickly enough with courage and resolve, can and do result in lower national HIV infection rates and less suffering for those affected by the epidemic. Globally, we have learned that if a country acts early enough, a national HIV crisis can be averted. It has also been noted that a country with a very high HIV prevalence rate will often see this rate eventually stabilise, and even decline. This indicates, among other things, that people are beginning to change risky behaviour patterns, because they have seen and known people who have been killed by AIDS. Fear is the worst, and last way of changing people's behaviour and by the time that this happens it is usually too late to save a huge number of that country's population.
Already, more than twenty million people around the world have died of AIDS-related diseases. In 2004, 3. 1 million men, women and children have died. Around twice the amount who have died until now - almost 40 million - are now living with HIV, and most of these are likely to die over the next decade or so. The most recent UNAIDS/WHO estimates show that, in 2004 alone, 4. 9 million people were newly infected with HIV. It is disappointing that the global numbers of people infected with HIV continue to rise, despite the fact that effective prevention strategies already exist. Africa It is in Africa, in some of the poorest countries in the world, that the impact of the virus has been most severe.
Altogether, there are now 16 countries in Africa in which more than one-tenth of the adult population aged 15 - 49 is infected with HIV. In seven countries, all in the southern cone of the continent, at least one adult in five is living with the virus. In Botswana, a shocking 37. 5 % of adults are now infected with HIV, while in South Africa, 20. 1 % are infected, up from 12. 9 % just three years ago. With a total of 5 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world.
Rates of HIV infection are still increasing in many countries in Sub-Saharan Africa, and an estimated 3. 1 million people in this region were infected in 2004, the most recent year for which data is available. This means that there are now an estimated 25. 4 million people here living with HIV/AIDS. In this part of the world, particularly, women are disproportionately at risk. As the rate of HIV infection in the general population rises, the same patterns of sexual risk result in more new infections simply because the chances of encountering an infected partner become higher. Sub-Saharan Africa has, relative to its population, by far the most severe HIV epidemic anywhere in the world, and has become the focal point of a number of initiatives to prevent the onward transmission of HIV and to provide antiretroviral medication to infected people, but these initiatives have yet to have a significant impact on death rates. Whilst West Africa is relatively less affected by HIV infection, the prevalence rates in some large countries are creeping up.
C^ote d'Ivoire is already among the 15 worst affected countries in the world; in Nigeria over 5 % of adults have HIV but the prevalence rate in other West African countries remains below 3 %. In Western Africa the epidemic displays a diversity not seen to such an extent in other parts of Africa. National prevalence rates can remain low, while infection rates in certain populations can be very high indeed. Infection rates in East Africa, once the highest on the continent, hover above those in the West of the continent but have been exceeded by the rates now being seen in the southern cone.
The prevalence rate among adults in Ethiopia and Kenya has reached double-digit figures and continues to rise. These rises are not inevitable. Uganda has brought its estimated prevalence rate down to around 5 % from a peak of close to 14 % in the early 1990 s with strong prevention campaigns, and there are encouraging signs that Zambia's epidemic may be following the course charted by Uganda. Yet, even in these countries, the suffering generated by HIV infections acquired years ago continues to grow, and a falling prevalence rate usually indicates that a high number of deaths have already occurred. Asia and the Pacific The diversity of the AIDS epidemic is even greater in Asia than in Africa. The epidemic here appears to be of more recent origin, and many Asian countries lack accurate systems for monitoring the spread of HIV.
Half of the world's population lives in Asia, so even small differences in the absolute numbers of people infected, can make huge differences in the infection rates. Around 1. 2 million people in Asia and the Pacific acquired HIV in 2004, bringing the number of people living with HIV to an estimated 8. 2 million. A further 540, 000 people are estimated to have died of AIDS in 2004. National adult prevalence is still under 1 % in the majority of this region's countries. That figure, though, can be misleading. Several countries in the region are so large and populous that the attention is only drawn to major urban areas, which may obscure serious epidemics in some smaller provinces and states.
Although national adult HIV prevalence in India, for example, is below 1 %, five states have an estimated prevalence of over 1 % among adults. In most Asian countries the epidemic is centred among particular high-risk groups - men who have sex with men, injecting drug users, sex workers and their partners. The epidemic has already spread beyond these groups, however, into the general population. Some Asian countries, such as Thailand, have responded rapidly to the epidemic with extensive campaigns to educate the public and prevent the spread of HIV - and have appeared to show some success.
Other very populous regions, such as China, have only recently admitted that the spread of HIV threatens their populations, and as a result, their prevention work s lagging behind the spread of the virus. Unless rapid and effective action is taken in this part of the world, then the size of the epidemic to come will dwarf the many deaths that have already occurred. However, the epidemic in Asia has ample room for growth. The sex trade and the use of illicit drugs are extensive, and so are migration and mobility within and across borders. The fluidity in international markets and especially the lack of economic stability in Asia has erupted into non-stop movement within countries and among countries, mirrored in the growing prevalence of HIV.
India, China, Thailand and Cambodia, to name only a few, have highly mobile populations within their borders, with people moving from state to state and from rural to urban areas. In China, permanent and temporary migrants may total as many as 120 million people. Eastern Europe & Central Asia The AIDS epidemic in Eastern Europe & Central Asia shows no signs of declining. Some 210, 000 people were infected with HIV in 2004, bringing the total number of people living with the virus to around 1. 4 million, and AIDS claimed 60, 000 lives in the past year.
Eastern Europe is home to the fastest growing arm of the global HIV epidemic. In any country with unsafe drug-injecting practises, a fresh outbreak of HIV is liable to occur at any time. This is especially true of the countries in Eastern Europe where the HIV epidemics are still young and have so far spared some cities and sub-populations. In the Russian Federation, a new outbreak of HIV among injecting drug users (IDUs) in the Moscow region in 1999, resulted in the reporting of more than three times as many new cases in that year as in all the previous years combined.
The route of heroin smuggled into the West crosses through a number of Eastern European countries, and it's path is marked by a high concentration of IDUs, and a high HIV prevalence. Worst affected are the Russian Federation, Ukraine, and the Baltic states (Estonia, Latvia, and Lithuania), but HIV continues to spread in Belarus, Moldova and Kazakhstan, while more recent epidemics are now evident in Kyrgyzstan and Uzbekistan. It is now estimated that around 860, 000 people aged 15 - 49 are living with HIV in the Russian Federation, although reporting of HIV cases is at best patchy in many areas. The epidemic in Eastern Europe is driven by injecting drug use, and the criminalization of this practise makes it difficult to gain an accurate picture of the proportion of drug users who are HIV+. Caribbean HIV is ravaging the populations of several Caribbean island states. Indeed some have worse epidemics than any other country in the world outside sub-Saharan Africa.
In the most affected countries of the Caribbean, the spread of HIV infection is driven by unprotected sex between men and women, although infections associated with injecting drug use are common in some places, such as Puerto Rico. Haiti, where the spread of HIV may well have been fuelled by decades of poor governance and conflict, is the worst affected nation in the region. In some areas, 13 % of anonymously tested pregnant women were found to be HIV-positive in 1996. Overall, around 8 % of adults in urban areas and 4 % in rural areas are infected.
HIV transmission in Haiti is overwhelmingly heterosexual, and both infection and death are concentrated in young adults. It is estimated that nearly 200, 000 Haitian children had lost one or both of their parents to AIDS by the end of 2001. Haiti has been traumatized by decades of almost continual mass-unemployment, brutal governments, and conflict. With this as a background, the spread of HIV has largely been undisturbed.
The danger is that Haiti will eventually solve it's social issues, only to find that HIV has already devastated the population. The heterosexual epidemics of HIV infection in the Caribbean are driven by the deadly combination of early sexual activity and frequent partner exchange by young people. In Saint Vincent and the Grenadines, where the prevalence of sexually transmitted diseases is high for the region, a quarter of men and women in a recent national survey said they had started having sex before the age of 14, and half of both men and women were sexually active at the age of 16. In a large survey of men and women in their teens and early twenties in Trinidad and Tobago, fewer than a fifth of the sexually active respondents said they always used condoms, and two-thirds did not use condoms at all. A mixing of ages, which has contributed to pushing the HIV rate in young African women to such a high levels, is common in this population too. Will...
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