Two years ago, during the hugely successful International AIDS Conference in Durban, South Africa, the congress was abuzz with the sense that the worst was apparently over for Africa as far as the AIDS pandemic was concerned.
Models of how many patients the virus could infect -- as high as 35 percent of adults in the nation of Botswana -- indicated the peak had been reached, and although the situation in the sub-Saharan area was grave, recovery might be on the horizon.
Today, at the just completed 14th International AIDS Conference in Barcelona, Spain, researchers said they now realize the epidemic has, in fact, worsened in Africa. New new studies foreshadow the expanding epidemic spreading into Eastern Europe, the Caribbean and the massive populations of India and China -- where in numbers alone, the epidemic could double in size in just a few years.
"We made a lot of mistakes in calculating the extent of the epidemic and how it could grow," admitted Dr. Stephano Vella, the outgoing president of the International AIDS Society, the organization that sponsored the Durban and Barcelona meetings. "We've been surprised by these new figures."
Compiled by the Joint United Nations Programme on AIDS, the new statistics show even though no one thought the situation in Botswana could get worse, it had. Latest figures estimate 39 percent of the adults are infected in the country.
"The figures from Botswana are really troubling," said Dr. Eugene McCray, director of the global AIDS program of the National Center for HIV, STD and TB Prevention of the Centers of Disease Control and Prevention, Atlanta.
Most upsetting, of all the nations in Africa, Botswana has considerable resources -- it is a leading world exporter of diamonds, major portions of its population have access to reasonable medical treatment, anti-AIDS messages are supported by top officials and the country is awash in condoms to prevent transmission of the disease.
"Despite all this," McCray told United Press International, "the rates in Botswana went up."
Another piece of bad news arrived via reports from West Africa. For years, that area of the continent had been assumed to have a stable epidemic with infection rates in the 3 percent to 5 percent range.
In 2001, the rates have jumped to double digits in Cameroon and the Central African Republic. An estimated 9.7 percent of adults in Cote d'Ivoire and 6.5 percent in Nigeria are infected -- and Nigeria is the most populous nation in Africa, so that translates to 3.5 million people.
"We don't know why the numbers have jumped so quickly in West Africa," McCray said. He suggested it may be due to previous underreporting. Vella said displacement due to regional conflicts could have played a role as well.
In Africa, the epidemic continues to be spread by heterosexual contacts -- with more and more women becoming infected rather than equal numbers of both sexes. In Eastern Europe and the republics that used to make up the Soviet Union, the epidemic is being spread through injecting drug users.
In China, drug use and supplies of tainted blood have delivered AIDS with sudden impact. In India, another area where sexual contact spreads the disease, researchers cite dense slum brothels of the urban centers of the country as the incubator of the outbreak that has now spread to villages.
"AIDS is everywhere in India," Vella said. "It will be a catastrophe. The numbers of people are immense."
World Bank officials predict that without major intervention in India more than 13 million people could be infected with the virus that causes AIDS by 2010.
McCray said new studies have shown that in places such as China where the epidemic has found a solid foothold, the risk of rapid spread is great, in part due to almost complete lack of knowledge about the disease and how is passes from one person to another in the most vulnerable populations.
The UNAIDS figures predict by the year 2020, AIDS will claim the lives of 68 million more people in the 45 countries of the world where the disease is most prevalent, mainly in the nations of Africa. The disease has already killed more than 20 milion people worldwide.
Dr. Ron Valdiserri, deputy director of the National Center for HIV, STD and TB Prevention, said although some people were surprised by the numbers, "most epidemiologists were not. We have seen infection rates greater than the rate in Botswana." He noted in the 1980s, the infection rate among gay men in San Francisco reached more than 60 percent."
The concern about China and India, Valdiserri said, "is that we know that once AIDS is introduced into an area that the spread of it can be explosive." But "these predictions are not inevitable. If we provide more focused attention on scaling up prevention programs as well as scaling up treatment access we could change the pattern," he said.
Two years ago, Vella noted, the Global Fund to Fight AIDS, Tuberculosis and Malaria did not exist. Now it is beginning to use the $2.8 billion already promised by the world's wealthy nations to begin a series of treatment programs in the hardest hit areas.
"This is nothing like enough," said Richard Feachum, head of the global fund, which is a United Nations agency. Estimates are that $10 billion a year will be needed to fight the disease on a worldwide scale.
Valdiserri said the CDC is working in China and India to try to check the epidemic before it goes out of control. He said a few steps are showing promise including efforts by commercial sex workers in India to negotiate with male clients to use condoms to prevent AIDS transmission.
"I think that we have seen in Barcelona a number of proposals and ideas that taken together could impact and slow the epidemic," Valdiserri said. "If we don't take these steps, the epidemic will become that freight train racing out of control down the tracks."