Half of those with HIV are women
UN cites sharp rise in heterosexual cases
By John Donnelly, Globe Staff, 11/27/2002
Driving the increase among women is the explosive rise in heterosexual transmission in sub-Saharan Africa, the report said. An estimated 58 percent of HIV-infected adults in the region are women.
''The face of AIDS is clearly a female face in sub-Saharan Africa,'' said Peter Piot, executive director of the Joint United Nations Program on HIV/AIDS, which is known as UNAIDS. ''We are far away from the gay white man disease it used to be in the 1980s.''
Piot said that heterosexual transmission is on the rise on every continent, posing a greater risk of rapidly spreading disease because the population of heterosexuals is far larger than the population of gay men and intravenous drug users.
The report, by UNAIDS and the World Health Organization, also cited an increase in heterosexual transmission throughout Europe and in Central Asia, although in those places gay men and male drug users still make up a majority of cases.
Source: UNAIDS report
Globe Staff Graphic
Next: A global view of AIDS
Still, for the first time, a survey of 15 Western European countries last year found that more HIV cases were transmitted by heterosexual contact than by sharing dirty needles or by homosexual contact.
Estimates of heterosexual transmission in the rich European countries were relatively small: 2,947 cases overall in 2001, compared with three times that number every day this year in sub-Saharan Africa. But AIDS specialists said those figures should underscore the importance of safe-sex practices for heterosexual partners worldwide.
In the United States, HIV, the virus that causes AIDS, is still transmitted largely through drug use and gay sex. But the Centers for Disease Control found that heterosexual cases now account for a third of all new infections nationally. In addition, a CDC study of 25 states found that heterosexual transmission is becoming more frequent, and African-American women accounted for 50 percent of all new heterosexual HIV diagnoses from 1998 to 2000.
The global report estimated that 42 million people are now living with HIV or AIDS, that 5 million will be newly infected in 2002, and that 3.1 million will die this year from AIDS.
The UNAIDS estimates represent a small overall increase from last year, but the report makes clear that the numbers won't remain static. In the coming few years, according to the report, the death toll is expected to rise substantially unless health systems in the poor world are substantially improved and those living in poverty are given access to antiretroviral drugs.
''The AIDS death toll on the [African] continent is expected to continue rising, before peaking around the end of this decade,'' the report said. ''This means that the worst of the epidemic's impact on those societies will be felt in the course of the next decade and beyond.''
In four southern African countries, the report noted, HIV infection has ''risen higher than thought possible,'' exceeding 30 percent among adults age 15 to 49. They are Botswana (38.8 percent), Zimbabwe (33.7 percent), Swaziland (33.4 percent), and Lesotho (31 percent).
The report also highlights the fact that 90 percent of Africans are not infected, indicating that much is at stake in preventing the further spread of AIDS. Four recent studies of young people in sub-Saharan Africa provide evidence that prevention is beginning to show results for young women.
In Addis Ababa, the capital of Ethiopia, infection rates among women ages 15 to 24 who attend antenatal clinics dropped from 24.1 percent in 1995 to 15.1 percent in 2001. In South Africa, HIV prevalence rates for pregnant women under 20 fell from 21 percent in 1998 to 15.4 percent in 2001. Similiar trends have been seen in Zambia and Uganda.
Piot and Bernhard Schwartlander, the WHO's top AIDS epidemiologist, both noted that the numbers of young women infected heterosexually are daunting.
''The reasons more women are becoming infected - among teenage girls it's about twice as frequently as boys - is one, that they have sex with older men who are more likely to be infected,'' Piot said. ''And second, they are biologically more vulnerable to infection with HIV because of immature cervixes'' and the high incidence of sexually transmitted sores that give an easier entry for the virus, he said.
The report also found that the fastest-growing AIDS epidemic was in Eastern Europe and the Central Asian republics, where intravenous drug use was the predominant transmission method.
In some places that had almost no AIDS, the epidemic seemed to take root overnight. Uzbekistan, for instance, reported 620 new infections in the first six months of 2002, or six times the number of new infections from the same time period a year earlier.
Such an increase ''gives us clearly the message that no society is immune and can be safe'' from AIDS, Schwartlander said. ''In Central Asia, AIDS was largely unknown. In less than a decade, the situation has changed drastically.''
UNAIDS has projected that there would be more than 40 million new infections worldwide by 2010, a far smaller estimate than one released this year by the US National Intelligence Council. That US intelligence report forecast that five countries alone - Nigeria, Ethiopia, China, India, and Russia - could have between 80 million and 110 million cases by the end of the decade.
Schwartlander said that interventions and a large increase in funding could help prevent millions of infections.
At the White House yesterday, a group of protesters made the same argument, if in more confrontational manner. Police arrested 31 people for refusing to move from a White House gate, where they left behind body bags representing the mounting death toll from AIDS. One who was arrested and later released, Paul Davis, called on President Bush to ''initiate a bold new plan to fight AIDS.''
The activists want the administration to commit an additional $2.5 billion to combat AIDS; the administration now spends about $1 billion. The White House has held several meetings recently discussing new AIDS initiatives in advance of Bush's planned trip to Africa in mid-January.
John Donnelly can be reached at email@example.com.
This story ran on page A1 of the Boston Globe
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