Global AIDS Statistics Revised Sharply Higher

Even while new cases of AIDS are declining in the United States and Western Europe, the pandemic is spreading throughout parts of the rest of the world much faster than previously believed, according to new statistics from the United Nations and the World Health Organization.

Epidemiologists now believe that 16,000 people are becoming infected with the AIDS virus every day, nearly double the previous estimate of 8,500, according to a UNAIDS report issued Wednesday in Geneva.

Worldwide, more than 30 million people are HIV-positive or have AIDS, including one in every 100 sexually active people. In sub-Saharan Africa, one in every 13 sexually active adults is HIV-positive, and in certain countries, such as Botswana, the figure soars to 30% of the adult population.

“The more we know about the AIDS epidemic, the worse it appears to be,” said Dr. Peter Piot, executive director of UNAIDS, the Joint United Nations Programme on HIV/AIDS. “We are now realizing that rates of HIV transmission have been grossly underestimated--particularly in sub-Saharan Africa, where the bulk of infections have been concentrated to date.”

UNAIDS estimates that 2.3 million have died of AIDS this year, a 50% rise over 1996. Nearly half the 1997 deaths have been of women, and 460,000 have been of children under 15. The full impact of the epidemic in terms of AIDS deaths is just beginning to hit, Piot said.

Although new AIDS cases declined 6% in the United States last year, Wednesday’s report is important to Americans because “it helps us to estimate the magnitude of the problem we see coming down the pike,” said Thomas Coates, director of the new UC San Francisco AIDS Research Institute.

The pandemic also “hurts us economically,” he said. “These are our trading partners. These are our markets. They are places we need to be concerned about for our own self-interest. It affects us and them economically in very adverse ways, because it cuts out the productive part of the population.”

The new numbers are higher for two reasons--the increasing rate of transmission and better data on the incidence of the disease in many developing countries.

“It now appears that previous calculations grossly underestimated the rate of [HIV] transmission, particularly in sub-Saharan Africa, where the bulk of infections are concentrated,” the report says. The revised data indicate 5.8 million new infections each year, which are expected to bring the total number of HIV/AIDS cases existing in 2000 to 40 million.

Researchers had arrived at previous estimates by extrapolating data from Uganda, which has a comparatively modern records system for infectious disease. Most other African countries have very poor record-keeping.

But Uganda has had a successful anti-AIDS campaign emphasizing condom use and sexual restraint. Infection rates were beginning to level off there, and new infections were dropping in younger people. When Ugandan figures were extrapolated to the subcontinent, it looked as though the AIDS problem was beginning to be controlled.

But data from other countries hinted that this was not the case. So this year, a team of UNAIDS and WHO epidemiologists collected statistics from 50 countries that had been covered only by regional estimates. In a technique call “sentinel surveillance,” they anonymously tested a sample of women visiting prenatal clinics.

Because child-bearing is nearly universal among fertile women in these countries, the technique is believed to provide good data about the incidence of diseases. Additionally, well-recognized epidemiological techniques can be used to estimate HIV prevalence in men.

The higher numbers are “not surprising,” said Dr. Roger Detels, a UCLA School of Public Health epidemiologist. “We’re aware that [HIV] has taken hold in several countries, such as China, where it hasn’t been fully recognized.”

Even though there has been encouraging news in the United States recently, he added, “the emphasis really needs to be on prevention [in developing nations]. The strides that have been made in treatment will have very little impact on those countries because they cannot afford them.”

“Sadly,” Coates said, “this epidemic is totally unnecessary. The developed world now contributes $400 million to $500 million annually to prevention in developing countries. If we were to increase that four to five times, the epidemic could be controlled.”

The most important contributions, he said, would be marketing strategies for condoms, effective treatment of sexually transmitted diseases, sex education for the young and clean needles for people who inject drugs. “Most infections are among young people, and most of them could be avoided,” he said.

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AIDS Hot Spots

Adults and children now estimated to be living with HIV/AIDS and the increase or decrease since late 1996:

North America: 860,000 (+110,000)

Caribbean and Latin America: 1.61 million (+40,000)

Western Europe: 530,000 (+20,000)

Eastern Europe & Central Asia: 150,000 (+100,000)

N. Africa & Middle East: 210,000 (+10,000)

Sub-Saharan Africa: 20.8 million (+6.8 million)

South & Southeast Asia: 6.0 million (+800,000)

East Asia & Pacific: 440,000 (+340,000)

Australia & New Zealand: 12,000 (-1,000)

Global total: 30.6 million (+8 million)

Source: United Nations

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Why the Increase?

* The rate of transmission is increasing.

* Researchers were able to obtain better data on the incidence of the disease in many developing countries.

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OTHER FINDINGS

* There are 16,000 new infections a day

* More than 8 million children have lost their mothers to AIDS.