HIV/AIDS epidemic is still in early stages.

• Author: Sarin, Radhika
• Position: Update

The scale of the AIDS epidemic is far beyond even the worst-case scenarios projected a decade ago, according to several new reports released at the 14th International AIDS Conference in Barcelona in July 2002. HIV/AIDS, now the world's fourth-largest killer and the leading cause of death in sub-Saharan Africa, is expected to kill 68 million people between 2000 and 2020 in the 45 most-affected countries, according to a report by UNAIDS. About 55 million of those deaths will take place in sub-Saharan Africa.

Contrary to earlier assumptions that HIV had reached "a natural limit" and had begun to level-off in hard-hit southern African nations, HIV prevalence (the percent of the population infected) in the region has increased. In Zimbabwe, the proportion of infected adults rose from a quarter of the population in 1997 to one-third by the end of 2001. Even in the world's most-affected country, Botswana, prevalence increased from 36 percent in 1999 to 39 percent in 2001.

New hotspots of the disease are emerging in Asia, reports UNAIDS. Large numbers of people are now infected in the populous nations of India and China, a fact that is masked by the countries' low rates of HIV prevalence (see World Watch January/February 2001). After a decade of negligible HIV rates, Indonesia is now seeing rising infection among high-risk populations.

The epidemic is growing most quickly in Eastern Europe and Central Asia. The number of reported cases has doubled every year since 1998 in Russia, where the epidemic is tied to economic hardships and rising unemployment, which have driven many young people to drug use and sex work. With public health services crumbling, sexually transmitted infections are on the rise, which also heightens the risk of contracting HIV.

One-third of the 1.5 million HIV-infected people in high-income countries are receiving antiretroviral treatment, while only 230,000 of the 38.5 million infected in low and middle-income countries have access to treatment. Consequently, AIDS-related mortality is far greater in poorer countries. A handful of Latin American, Caribbean, and Asian countries, however, have instated antiretroviral use. In 1996 Brazil established a legal right to free medication that has helped more than 100,000 NW-positive people receive treatment and reduced...