November 24, 1999
More African Women Have AIDS Than Men
Issue in Depth: The AIDS Epidemic
Join a Discussion on The AIDS Epidemic
By LAWRENCE K. ALTMAN
IDS has long been considered primarily a men's disease. But on Tuesday the United Nations reported for
the first time that more women than
men were infected with the AIDS
virus in Africa, the site of the vast
majority of such infections in the
In a report released in advance of
World AIDS Day on Dec. 1, the United Nations said that of the 22.3 million adults in sub-Sahara Africa infected with H.I.V., the AIDS virus,
12.2 million, or 55 percent, are women.
This is the first time that data
have been available to make such a
comparison, officials said.
United Nations officials said the
precise reasons for the shift were
unclear, though they noted that
H.I.V. was spread in Africa primarily through heterosexual intercourse.
The virus passes more easily from
men to women than from women to
"Ten years ago, it was hard to
make people listen when we were
saying AIDS wasn't just a man's
disease," said Dr. Peter Piot, head of
UNAIDS, which joins a number of
United Nations agencies, including
the World Health Organization. Dr.
Piot (pronounced PEE-yot) spoke to
reporters by telephone from London.
Infection rates among women are
much lower in the United States and
other developed countries than in
Africa. But more women, primarily
in minority groups, are becoming
infected through heterosexual sex in
this country, Dr. Piot said.
The new evidence that Africa has 6
infected women for every 5 infected
men comes from a number of studies
in several African countries, UNAIDS said. Many AIDS experts have
assumed that more women were infected than men in Africa. But documentation was not possible because
much of the data was not broken
down by sex, Dr. Bernhard Schwartlander, an epidemiologist for the
agency and a principal author of the
report, said in an interview.
Another factor in the shifting demographics in Africa, the report said,
is the different age patterns of H.I.V.
infection in men and women. Studies
in several countries have found that
African girls 15 to 19 are 5 to 6 times
as likely to have the virus as boys
their own age. Men tend to be more
promiscuous, and "older men, who
often coerce girls into sex or buy
their favors with sugar-daddy gifts,
are the main source of H.I.V. for the
teenage girls," the report said.
To reduce the risk to women, Dr.
Piot said, health workers need to
devise strategies to change men's
actions, starting with sex education
among boys. Another goal is to reduce the cost of female condoms, so
they can be used more widely.
Although Africa is by far the continent most affected by the virus, with
nearly 70 percent of the infected people in the world living in the countries below the Sahara, AIDS remains an unabated epidemic in
many countries. This year, an estimated 5.6 million adults and children
became infected with the virus,
bringing to more than 50 million the
worldwide total since the AIDS epidemic was first recognized in 1981.
Thirty-three million infected people
are alive today. But AIDS has killed
16 million; 2.6 million of them died in
1999, a record for any year.
"AIDS remains a fatal disease"
despite the availability of newer
combinations of drugs, Dr. Piot said,
and "the threat of H.I.V. has not
diminished in any country."
How high will the number of AIDS
cases reach worldwide? Dr.
Schwartlander said the answer
would depend on the number of infections in Asia, a number that cannot
be determined now. Because the factors that influence changes in sexual
behavior are difficult to predict and
because risk factors like injecting
drugs vary, he said, UNAIDS cannot
predict when AIDS will peak.
Even if prevention programs completely stopped new infections,
deaths would increase for years, because third world countries cannot
afford drugs to fight the virus, and
their health systems are overwhelmed by related illness.
The steepest curve in rising infection rates in 1999 was in the newly
independent states of the former Soviet Union, where drug use by injection is increasingly common among
unemployed people and schoolchildren. In the Russian federation,
nearly half of all reported cases of
H.I.V. infection since the start of the
epidemic were recorded in the first
nine months of 1999 alone.
In Moscow, three times as many
cases were reported in the first nine
months of 1999 as in all previous
years combined. Towns around Moscow have even sharper increases,
with more than five times as many
infections in the first nine months of
1999 as in previous years combined.
H.I.V. rates in adults are about 2
percent in the Caribbean, the highest
outside sub-Sahara Africa, where it
is 8 percent.
"AIDS has emerged as the single
greatest threat to development in
many countries of the world," Dr.
Life expectancy in southern Africa, which climbed to 59 in the early
90's from 44 in the early 50's, is
expected to drop back to 45 in 10
years. Fewer than 50 percent of the
South Africans now alive can expect
to reach 60, compared with 70 percent for developing countries and 90
for industrialized countries.
A survey of commercial farms in
Kenya found that illness and death
now rivaled old-age retirement as
the leading reason why employees
left work. Some life insurance companies have found that a third or
more of deaths are related to H.I.V.,
even in plans that require a negative
test as a condition of acceptance.
UNAIDS noted some bright spots.
Strong prevention efforts have had
sustanined success in lowering or
stabilizing rates in the Philippines,
Thailand and a few other countries.
Dr. Piot said that political efforts
were increasing in a number of countries, but that it took five years before statistics showed improvement.
Dr. Seth Berkley, head of the International AIDS Vaccine Initiative,
said, "A vaccine is the world's best
hope for ending the pandemic."
The New York Times