AIDS in a new millennium: a grim picture with glimmers of hope
When AIDS emerged from the shadows two decades ago, few people could predict how the epidemic would evolve, and fewer still could describe with any certainty the best ways of combating it. Now, at the start of a new millennium, we are past the stage of conjecture. We know from experience that AIDS can devastate whole regions, knock decades off national development, widen the gulf between rich and poor nations and push already-stigmatized groups closer to the margins of society.
Just as clearly, experience shows that the right approaches, applied quickly enough with courage and resolve, can and do result in lower HIV infection rates and less suffering for those affected by the epidemic. An ever-growing AIDS epidemic is not inevitable; yet, unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. This may sound dramatic, but it is hard to play down the effects of a disease that stands to kill more than half of the young adults in the countries where it has its firmest hold – most of them before they finish the work of caring for their children or providing for their elderly parents. Already, 18.8 million people around the world have died of AIDS, 3.8 million of them children. Nearly twice that many – 34.3 million – are now living with HIV, the virus
The most recent UNAIDS/WHO estimates show that, in 1999 alone, 5.4 million people were newly infected with HIV.
Africa: the enormous challenges of a long-lasting epidemic
The African countries south of the Sahara have some of the best HIV surveillance systems in the world. They provide solid evidence that the HIV infection rate has stabilized at a relatively low level in Senegal and that the extremely high rates in Uganda have been reduced. However, in most sub-Saharan countries adults and children are acquiring HIV at a higher rate than ever before: the number of new infections in the region during 1999 was 4.0 million. This acceleration effect is yet another challenge posed by long-standing epidemics. 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.
Altogether, there are now 16 countries 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 35.8% of adults are now infected with HIV, while in South Africa, 19.9% are infected, up from 12.9% just two years ago. With a total of 4.2 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world. While West Africa is relatively less affected by HIV infection, the prevalence rates in some large countries are creeping up. Côte d’Ivoire is already among the 15 worst-affected countries in the world; in Nigeria, by far the most populous country in sub-Saharan Africa, over 5% of adults have HIV. The prevalence rate in other West African countries remains below 3%. 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 inexorable. Uganda has brought its estimated prevalence rate down to around 8% from a peak of close to 14% in the early 1990s with strong prevention campaigns, and there are encouraging signs that Zambia’s epidemic may be following the course charted by Uganda (see Box 1, page 10). Yet, even in these countries, the suffering generated by HIV infections acquired years ago continues to sectors of the economy stagger under the burden.
Just as clearly, experience shows that the right approaches, applied quickly enough with courage and resolve, can and do result in lower HIV infection rates and less suffering for those affected by the epidemic. An ever-growing AIDS epidemic is not inevitable; yet, unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead. This may sound dramatic, but it is hard to play down the effects of a disease that stands to kill more than half of the young adults in the countries where it has its firmest hold – most of them before they finish the work of caring for their children or providing for their elderly parents. Already, 18.8 million people around the world have died of AIDS, 3.8 million of them children. Nearly twice that many – 34.3 million – are now living with HIV, the virus
The most recent UNAIDS/WHO estimates show that, in 1999 alone, 5.4 million people were newly infected with HIV.
Africa: the enormous challenges of a long-lasting epidemic
The African countries south of the Sahara have some of the best HIV surveillance systems in the world. They provide solid evidence that the HIV infection rate has stabilized at a relatively low level in Senegal and that the extremely high rates in Uganda have been reduced. However, in most sub-Saharan countries adults and children are acquiring HIV at a higher rate than ever before: the number of new infections in the region during 1999 was 4.0 million. This acceleration effect is yet another challenge posed by long-standing epidemics. 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.
Altogether, there are now 16 countries 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 35.8% of adults are now infected with HIV, while in South Africa, 19.9% are infected, up from 12.9% just two years ago. With a total of 4.2 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world. While West Africa is relatively less affected by HIV infection, the prevalence rates in some large countries are creeping up. Côte d’Ivoire is already among the 15 worst-affected countries in the world; in Nigeria, by far the most populous country in sub-Saharan Africa, over 5% of adults have HIV. The prevalence rate in other West African countries remains below 3%. 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 inexorable. Uganda has brought its estimated prevalence rate down to around 8% from a peak of close to 14% in the early 1990s with strong prevention campaigns, and there are encouraging signs that Zambia’s epidemic may be following the course charted by Uganda (see Box 1, page 10). Yet, even in these countries, the suffering generated by HIV infections acquired years ago continues to sectors of the economy stagger under the burden.