NEW YORK, July 2 (UPI) -- United Nations officials predicted Tuesday that by the year 2020, as many as 68 million people will die from AIDS in the 45 most affected nations -- five times the number of people already killed by the worldwide epidemic.
Twenty years since it was first identified as a health threat, doctors said the epidemic -- despite already killing 13 million people and infecting an additional 40 million men, women and children -- is still in its early stages.
"Effective responses to this epidemic are possible," said Dr. Pete Piot, executive director of UNAIDS, the Joint United National Programme on HIV/AIDS, "but only when they are politically backed and full scale, and that unless more is done today and tomorrow, the epidemic will continue to grow."
The report -- a litany of bad news -- describes the extent of infection with the human immunodeficiency virus, the retrovirus that causes AIDS:
--In southern Africa, about 40 percent of pregnant women are infected with HIV. Neff Walker, senior epidemiologist for UNAIDS, told UPI "Our previous estimates were off by 30 to 50 percent. We thought that the epidemic in parts of Southern Africa had peaked, but it didn't turn out that way." He said the epidemic continues to grow and continues to confound the best estimates of researchers.
--In Botswana, where 36 percent of adults were infected with HIV two years ago, the rate rose to 39 percent in 2001. About 60 percent of women 25-29 years old are infected in Gaberone, the capital city.
--In West Africa, an apparent stability in the prevalence of HIV infection has turned around -- in the wrong direction. In Cameroon, the rate, which remained around 5 percent from 1988 to 1996, is now approaching 12 percent.
--Belief that major Asian populations would be free of the epidemic have been shattered with rising infection rates in Indonesia and China.
--Hopes that the epidemic would be confined to marginalized segments of the drug injecting populations of Eastern Europe and Central Asia have proved illusory as the epidemic is spreading into heterosexual populations.
Piot said that in 2001, UNAIDS estimated 5 million people were newly infected with HIV -- including 2 million women and 800,000 children under the age of 15. He said the number of people living with HIV/AIDS today includes 37.1 million adults and 3 million children. In 2001, 3 million people -- including 580,000 children -- died of the disease. The disease has left 14 million children as orphans -- having lost at least one parent to AIDS.
Even in the United States and Western Europe, officials continue to be concerned about the epidemic. "In high-income countries," Piot said, "where reduced AIDS mortality has made headlines in recent years, increases in unsafe sex and in HIV infections have crept up almost unnoticed."
In these countries, drugs to treat the disease -- but not cure it -- are generally available. But in the developing world, where 90 percent of the HIV infected people live, only 4 percent have access to the drugs, reported Hein Marais and Andrew Wilson, authors of the 225-page document, released just prior to the 14th World AIDS Conference, which begins in Barcelona, Spain, next week.
"While inaction has proved to be a deadly mistake, the evidence has never been stronger that action against AIDS gets positive results," Piot said.
Not all the news is grim, however. The authors cited some success stories:
--The establishment of a program to provide anti-retroviral medications in Brazil has reduced AIDS deaths to one-third of the rate in 1996 and similarly has reduced health care costs. Also, new infections have decreased in South America's largest nation.
--In Zambia, prevention programs have resulted in a fall of HIV infections among pregnant urban women from 28.4 percent in 1993 to less than 15 percent in 1998.
--In Cambodia, a prevention and education campaign resulted in a reduction of 33 percent among pregnant women between 1997 and 2000.
--In Uganda, which once had double-digit infection rates, government programs and citizen action continue to show the disease may be controlled. Infection rates of 8.3 percent in 1999 have continued to fall to less than 5 percent in 2001.
Despite these advances, Piot said, "The unprecedented destruction wrought by the HIV/AIDS epidemic over the past 20 years will multiply several times in the decades to come unless the fight against this disease is dramatically expanded."
Piot urged nations with accelerating epidemics to move quickly to adopt proven strategies from the countries that have succeeded in turning the epidemic around.
"One reason we have had such a large epidemic has to be the lack of political leadership," he commented. Although there are signs this is changing, Piot said he was disappointed in the recent G8 summit, involving the major economic powers, because no real commitment was made to attack the epidemic.
(Written by Ed Susman, UPI Science News, on assignment in Paris)