AIDS Alert International: UNAIDS/WHO Report Highlights Epidemic Resurgence
January 1, 2007
AIDS Alert International
UNAIDS/WHO Report Highlights Epidemic Resurgence
The AIDS global epidemic continues to grow, and some countries are seeing a resurgence of infection rates, according to the annual epidemic update by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) in Geneva, Switzerland.
"This year's report gives us some cause for concern," says Paul de Lay, MD, director of the department of evaluation at UNAIDS. De Lay and other UNAIDS/WHO experts spoke in November 2006, as part of a media teleconference in preparation for World AIDS Day 2006.
"The evidence is showing that not only is the global epidemic growing, but there are also worrying trends where some countries are seeing a resurgence of infection rates," de Lay says. "These are countries which had been stable or declining, previously."
For example, in Uganda, while the epidemic has overall stabilized at a national adult prevalence of 6.7 percent in 2005, there now is evidence of an increase in HIV infection in some rural areas, according to the "AIDS Epidemic Update, December 2006," published by WHO/UNAIDS.
One study of 25 villages found that HIV prevalence rose from a low of 5.6 percent in men and 6.9 percent in women in 2000 to 6.5 percent in men and 8.8 percent in women in 2004.1
"We're seeing a decline in the intensity of prevention programs," de Lay says. "There's a complacency that surrounds this disease and a decrease in some of the resources that are allocated."
Also, there is less political commitment in some of these countries, and that results in increased risk behavior, de Lay says.
For instance, in Uganda, investigators have found that there is decreasing condom use in casual sexual encounters and increasing numbers of casual partners, he adds.
Also, there has been a resurgence of the epidemic among men who have sex with men (MSM) in Europe, UNAIDS officials say.
On a positive note, there have been improvements in sexual behavior among young people in some African countries, indicating that HIV prevention programs are making a difference when targeted to youths, sex workers, and injection drug users (IDUs), de Lay says.
"These examples tell us that even limited resources can give high returns when investigators are focused on reaching people most at risk and are adapted to changing national epidemics," de Lay adds.
For example, in Kenya, where an estimated 1.3 million people are HIV infected, there has been a declining HIV prevalence among adults since the late 1990s. It fell from 10 percent to 7 percent between the late 1990s and 2003, and it has fallen to about 6 percent in 2005.1
At some antenatal sites, infection rates among pregnant women have fallen dramatically from 25 percent in 1998 to 8 percent in 2004, and at other sites, HIV prevalence declined from 15 percent in 2001 to 4.3 percent in 2004.1
"In several countries, Kenya, Zimbabwe, Burkina Faso, there continue to be signs of declining rates of HIV new infections related to condom use and delayed sexual debut," de Lay says.
Kenya had major HIV prevention efforts launched in 2000, and studies show that young people are delaying their first sexual experience, increasing condom use, and fewer adults have multiple sexual partners.1
The "AIDS Epidemic Update" report also notes that other factors have influenced this decline in prevalence, including increasing AIDS mortality and a saturation of HIV infection among the people most at risk.1
Across Africa, women are more likely than men to be infected with HIV, and they're more likely to be the ones caring for people infected with HIV, says Karen Stanecki, PhD, chief of epidemiology for UNAIDS and a co-author of the global report. Stanecki also spoke at the media teleconference.
"Even in countries where the epidemic has had a very high impact, such as Swaziland and South Africa, general awareness is still woefully low," Stanecki says. "At least 2 million South Africans living with HIV do not know that they are infected and believe they face no danger of becoming infected."
The epidemic has reached its highest number with an estimated 39.5 million people living with HIV infection, the report says.
There were 4.3 million new HIV infections in 2006, and 2.8 million of these were in sub-Saharan Africa, meaning 65 percent of new infections were in this part of the world. Also, WHO/ UNAIDS estimates that 2.9 million people died in 2006 of AIDS-related illnesses.
In Asia, South and Southeast Asia have the highest infection rates of that region, Stanecki says.
"There are signs of serious epidemic among men who have sex with men (MSM) that are becoming uncovered in Cambodia, China, India, Nepal, Pakistan, Thailand, and Vietnam," Stanecki says.
Also, married women in Asia increasingly are at risk, she says.
"In fact, for example, in 2005, about one-third of new infections in Thailand were in married women, who were probably infected by their spouses," Stanecki says.
The most striking increases in the epidemic are in Eastern Europe and Central Asia, where in 2006 there were 270,000 new infections, she says.
"The Russian Federation and Ukraine account for about 90 percent of the HIV infections in the region," Stanecki says. "Almost one-third of newly diagnosed HIV infections in the region are among young people, ages 15 to 24, and 80 percent of the people living with HIV in Russia are between the ages of 14 and 30."
Unprotected sexual intercourse and injection drug use are the biggest risk factors in that region, Stanecki notes.
While scientific evidence shows that harm reduction programs could impact IDU populations and the spread of HIV, these are not being used as much as they could be in Eastern Europe and Central Asia, where IDU populations are driving the HIV epidemic, says Kevin De Cock, MD, another teleconference speaker and the director of the department of HIV/AIDS of WHO.
"The proportion of injection drug users in the world who have access to harm reduction and prevention services is still woefully inadequate," De Cock says.
There are examples of scale-up of these prevention measures in China, and Vietnam plans to implement in 2007 a progressive harm-reduction program, he adds.
In China, there are an estimated 650,000 people living with HIV at the end of 2005, and the country's IDU-related HIV epidemic has grown alarmingly, with 44 percent of those infected having an injection drug use risk factor.1
Half of IDUs are infected with HIV in parts of Xinjiang, Yunnan, and Sichuan provinces. And HIV prevalence has risen among IDUs in southwest Sichuan province. While China has launched needle-exchange programs in 18 provinces, with 92 operating in 2006, some harm- reduction projects continue to encounter resistance at the provincial government levels.1
In Viet Nam, HIV has reached into all 64 provinces and all cities, and the number of people living with HIV has doubled since 2000, reaching 260,000 in 2005. About 40,000 people in Viet Nam are infected with HIV each year, and most of these people have the risk factors of IDU and sex work.1
As of June, 2006, WHO/UNAIDS estimates that 1.65 million people, almost one-quarter of those who are need it, are receiving antiretroviral therapy worldwide, De Cock says.
"I think in the future, we will be hearing more about estimates of death and how we think that treatment is impacting on mortality," De Cock says. "We have not yet seen declines in mortality across the developing world the way we have in Europe or North America."
The biggest challenge for the international health community is the weakness of health systems in the most heavily infected countries, especially in sub-Saharan Africa, where there is a weakness in human resources, infrastructure, laboratory capacity, procurement and supply systems, and more, De Cock notes.
Reference:
- AIDS epidemic update, December 2006. Report from the Joint United Nations Programme on HIV/AIDS and the World Health Organization: 1-96.
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