Aids Awareness

When AIDS first emerged, no-one could have predicted how the epidemic would spread across the world and how many millions of lives it would change. There was no real idea what caused it, and consequently, no real idea how to protect against it. Now, in 2004, we know from bitter experience that AIDS is caused by the virus HIV, and that it can devastate families, communities and whole continents. We have seen the epidemic knock decades off countries' national development, widen the gulf between rich and poor nations and push already-stigmatized groups closer to the margins of society. We are living in an 'international' society, and HIV has become the first truly 'international' epidemic, easily crossing oceans and international borders.

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. CÑ„te 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 1990s 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