AIDS Alert International
Epidemics in Asia, Eastern Europe worsen global picture
UNAIDS reports no good news in sight
New HIV infections worldwide topped 5 million in 2003, and 3 million people died of AIDS globally, catapulting the epidemic to its most bleak year yet.
"The most important finding of this report is that the epidemic continues to deepen and expand in southern Africa and also is threatening southern and eastern Asia," says Peter Piot, MD, executive director of UNAIDS in Geneva. Piot spoke in preparation of World AIDS Day on Dec. 1, 2003, addressing the current state of the world’s AIDS epidemic.
By comparison, in 2002, there were an estimated 4.8 million new HIV infections and 2.7 million deaths, he points out.
Despite a great deal of talk in the past year about expanding treatment and prevention services to Africans, only 2% of Africans who need HIV treatment have access to it, according to the UNAIDS report.
On the positive side, it appears that spending for HIV in developing countries will be about $4.7 billion in 2003, a 50% increase from the $3.1 billion spent in 2002, Piot says.
"That still is roughly half of what is needed to mount an effective response, but we are moving forward," he adds. "I feel strongly that we are entering a new phase in the global response to AIDS."
Unfortunately, it is beginning to appear that parts of Asia and Eastern Europe have lost any late-start advantages they may have had in stopping the epidemic before it began to penetrate the general population, the UNAIDS report shows. 1
For example, three Asian countries, Cambodia, Myanmar, and Thailand, have serious nationwide epidemics, the report states. 1
"I would say that we could describe the Cambodian and Thailand epidemic as being ones that have gone outside the high-risk groups," says Karen Stanecki, MPH, UNAIDS senior advisor on demographics and related data.
HIV prevalence in Cambodia has remained stable at 3%, but at the same time, HIV prevalence has dropped among its highest risk groups from more than 40% to 29%, Piot says.
"We have some worrisome information and data on behaviors in Nepal and Bangladesh, and we see great opportunities for these countries to put in controls and programs now," Stanecki says. This also is true for certain states in India, she adds. "So there is a big, crying need to look at those populations for risky behavior as well as with messages to the general population."
It’s estimated that India has about 4.5 million people infected with HIV, which compared with the country’s enormous population seems insignificant, but that is misleading, because in some states, there may be a 2% HIV prevalence rate, and in some districts, HIV prevalence may be as high as 5%, Piot says. "That’s really the highest prevalence rates in the general population outside of Africa and the Caribbean."
Also, in several Indian states, there are serious epidemics. Tamil Nadu and Maharashtra have HIV prevalence of more than 50% among sex workers in some cities; and in Manipur, there is an HIV prevalence among injection drug users (IDUs) of 60% to 75%. 1
In Thailand, the situation is a little different. The country has done a good job with fighting AIDS, starting in the early 1990’s, Piot says. "Basically, what happened is it made the sex industry safe thanks to 100% condom program, and so there has been a more than 85% reduction in new HIV infections," he explains. "But what we see now is there is an increase in transmission of HIV outside commercial sex among young people and IDUs."
For this reason, Thailand is a good example of how it’s a fantasy that a country can control the AIDS epidemic by only focusing on high-risk groups, Piot adds.
Also, shortly after World AIDS Day, there were reports from the United Nation’s AIDS agency in Thailand that condoms had disappeared from some sex venues that catered to men who have sex with men (MSM) due to police raids of these establishments and threats that condoms would be used as evidence against the clubs’ owners, according to national news reports.
The UNAIDS report also expresses concern about the budding epidemic in Vietnam, where HIV outbreaks among IDUs has begun to occur. Estimates show that 65% of the nation’s HIV infections are among IDUs and that more than 20% of IDUs in most provinces were HIV-positive.1 Likewise, Vietnam sex workers also are at increasing risk for infection as their prevalence rates have climbed to 24% in some areas, the report says.1
One major problem in Vietnam is the mobility of sex workers, Stanecki says.
"Sex workers from Vietnam go into other countries and then return, and it’s a huge issue. We’re trying to monitor the situation and provide help on it."
Myanmar’s epidemic primarily involves IDUs and commercial sex workers, but reports suggest it has spread to migrant gem miners and loggers, who may be spreading it to the general population.1 Injection drug use has driven large HIV outbreaks in regions of Indonesia and China. In Indonesia, for instance, studies have suggested that more than 90% of IDUs have used unclean injecting equipment. 1
In parts of Indonesia, there now is evidence of heterosexual HIV transmission that is not identified to any high-risk population, Piot says. "But it’s still a 1% to 2% infection rate," he adds.
1. UNAIDS/WHO. AIDS Epidemic Update December 2003. Geneva; 2003.