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A vaccine against AIDS may be available within five years, which together with other new treatments could improve the lives of millions of sufferers. Yet despite such advances, prevention still remains the most effective way of dealing with the global crisis. There is still no end in sight to an increase in the number of people being infected, researchers told the 14th International AIDS Conference, which was held in Barcelona from July 7th-12th 2002. Unless effective methods of preventing the spread of the disease are quickly put in place, another 45m people will become infected within the next eight years.

Some 29m of those new cases could be prevented through better education about HIV, the virus that causes AIDS, the distribution of condoms and other programmes, such as testing, says the Global HIV Prevention Working Group. “We failed to act decisively in the early stages of the epidemic in sub-Saharan Africa, and now we are paying the price,” said one of the group’s leaders, David Serwadda of Uganda’s Makerere University. But concern is not just limited to poor countries: one study suggests that ignorance and infrequent testing amongst gay and bisexual men in America means the epidemic could be accelerating again there.

The prevalence of HIV in the worst-affected countries is growing faster than was previously believed possible, according to a report by the Joint United Nations Programme on HIV/AIDS. It says that theories that the epidemic might level off in heavily-affected countries are being disproved. Botswana, for instance, has the highest HIV infection rate in the world, but still the prevalence of the disease is increasing: almost 39% of all adults in Botswana are now infected.

Caribbean countries have managed to greatly improve the treatment of HIV with new policies to ensure that drug therapies are widely available. Almost 100 countries now have national AIDS strategies in place and a number are making progress. Despite huge problems, Zambia may become the second African country (after Uganda) to reverse the epidemic. After promoting safer sex, HIV prevalence among young Zambian women is now falling: from 28% in 1996 to 24% in 1999 in the cities, and there are signs of a similar fall in rural areas too. Poland is also containing an epidemic among drug users and Cambodia has lowered its rates of HIV infection. But these countries are exceptions.

The Economist, 8 July 2002

BARCELONA, July 8 -- People in China know very little about AIDS, with nearly three-quarters unaware that the disease is caused by a virus or able to describe how they can avoid becoming infected, according to the first attempt to measure the country's knowledge about HIV. About one in six Chinese has never heard of the disease.

In India, the other sleeping giant in the AIDS pandemic, the number of infections with human immunodeficiency virus (HIV) has increased tenfold in a decade, with a huge share of cases found in rural, entirely monogamous women who have scarcely left their villages. In the meantime, almost no one on the subcontinent is receiving life-sustaining antiretroviral therapy, even though Indian manufacturers of generic drugs are rapidly becoming the suppliers of choice to the developing world.

That was among the gloomy news presented today as scientists and activists attending the 14th International AIDS Conference discussed the state of the epidemic in the world's two most populous countries.

In China, HIV infection was for years confined to relatively small numbers of intravenous drug users on the country's southern border with Burma. It recent years, cases have been found elsewhere, spread not only by drug use but also by prostitution and, in one region, by procedures that infected a large number of peasants selling their own blood for money. Countrywide, the number of cases increased from 600,000 in 2000 to 850,000 last year.

In December 2000, China's State Family Planning Commission conducted a survey of about 7,000 people between age 15 and 50 in seven counties chosen to represent all stages of economic development.

Seventeen percent of people had never heard of AIDS. (Among farmers, the country's most common occupation, the figure was about 25 percent.) About 90 percent said they knew AIDS could be transmitted from person to person, but 85 percent were unaware it could be passed from mother to child; 81 percent didn't know it could be acquired by sharing needles; and 52 percent didn't know it could be transmitted by unsafe blood transfusions. Slightly over 75 percent were unaware that proper use of condoms could prevent infection.

"There are cases [of AIDS] in every province in the country, but I think the level of knowledge we found shows that people don't know how to protect themselves," said Deborah Holtzman, a sociologist from the Centers for Disease Control and Prevention (CDC) who helped analyze the data with the Chinese researchers.

The survey also found that only 8 percent of people reported using condoms as the form of contraception in their most recent sexual encounter. (Sterilization was the most common method.) Condom use is the central strategy to prevent sexually transmitted HIV infection.

The State Family Planning Commission reaches into virtually every Chinese village and historically has been the chief enforcer of the one-child policy promulgated for much (although not all) of the country's population. Holtzman said it expressed keen interest in the survey results and plans now to add HIV/AIDS education to its mandate.

The Daily Telegraph reported 29 August 2002 that "a Chinese Aids campaigner, who exposed the scandal of HIV-tainted blood transfusions infecting hundreds of thousands of villagers, has disappeared while under 24-hour surveillance by state security agents." "Mr Wan set up China's first helpline for Aids sufferers in 1992. Two years later, he was forced out of the Ministry of Health after upsetting officials there. .. [Mr Wan] repeatedly petitioned Beijing to halt blood-collection schemes in central China that bought blood from peasants, mixed it in common vats and extracted red cells for sale to drugs companies. The remaining mixed plasma - frequently infected with HIV - was returned to donors as the scheme's operators thought this would be good for their health."

In India, about 4 million people are infected, up from 400,000 in 1990. The true size of the epidemic, however, may be larger, said Salim J. Habayeb, who until recently was the World Bank's lead public health specialist for South Asia. (There are currently about 40 million people infected with the virus in the world.)

"The numbers are not important; the trend is important. We are very concerned, and the worst is yet to come," he said. "It may not increase by 10 times in the next decade, but it will multiply several-fold at least." The Washington Post, 9 July 2002

Up to 70% of the South African National Defence Force may be infected with HIV, according to preliminary military medical examinations, The Johannesburg Mail & Guardian has reported (31 March 2000).
In one unit in KwaZulu-Natal, 90% of the troops are infected. Some military units near PieterMaritzburg and on the South Africa-Mozambique border also have HIV-infection rates higher than 70%.
South Africa’s military infection rate is similar to neighbouring countries. In Malawi, 75% the military is HIV-positive, and in Zimbabwe, 80% have tested positive. Forces in Democratic Republic of the Congo and Angola also have high rates of HIV infection. (Source UN)

UN AIDS Program

The Report on the Global HIV/AIDS Epidemic - "The Barcelona Report" pub. 2002
Table of Contents
Global Overview of the epdemic

Epidemiology of AIDS - UN Publications

UNICEF AIDS Information

UNICEF Young People and HIV/AIDS: Opportunity in Crisis
July 2002
This landmark report contains important new data about why young people are key to defeating the global HIV/AIDS epidemic, including results from more than 60 new national surveys.
Download pdf version

UNICEF Children orphaned by AIDS 1999
Some 13.2 million children have lost their mother or both parents to AIDS – 95 per cent of these children are living in Africa.
pdf version

The Sunday Telegraph 4 August 2002 reported that "According to the United Nations Programme on Aids (UNAIDS), Zimbabwe has 780,000 children of 14 or under whose parents have died of HIV and the numbers are rising faster than in any country in the world. Thirty-eight per cent of the population is infected with the virus, the second highest rate after Botswana." The paper quotes, "We have seen life expectancy in Zimbabwe plummet from 61 to 38 in the last decade," says an official from Safaids, the Southern Africa AIDS Information Dissemination service. "Part of this is the high rate of infection. But there is no doubt it is being exacerbated by the crisis that the country is in." The Telegraph also reported that, "The money from the five per cent Aids levy imposed on income is widely believed to be being misappropriated. Two weeks ago, a letter demanding £400,000 ($600,000) from the funds to host Miss Malaika, a pan-African beauty pageant, was leaked from the President's office to the National Aids Council."

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