World underestimates global AIDS epidemic

"The world clearly underestimated how rampant this epidemic would become. We’re got far more cases than the worst case scenario that was thought out 10 years ago," Dr Peter Piot said in an interview.

The executive director of UNAIDS, the UN agency that spearheads the global battle against AIDS, said the latest figures in its annual update on the epidemic showed AIDS would have killed three million people in 2000, more than in any previous year.

"It is the number one cause of deaths in many, many parts of the world," Piot said.

"But we are seeing, for the first time ever, less new infections in Africa than the year before. But we are talking about 3.8 million people who became infected through HIV in Africa, so it is far too many."

With 25.3 million adults and children estimated to be living with HIV/AIDS by the end of the year, sub-Saharan Africa is by far the worst hit area of the world.

According to the agency’s AIDS Epidemic Update, one in three adults in some African countries are HIV-positive.

But Piot said some countries such as Uganda, Gambia and Senegal had fewer people infected with HIV now than they did 10 years ago, thanks to better prevention.

Rates of infection had stabilised in Kenya, Zimbabwe and some part of South Africa.

"But let’s make clear what it means. It means there are as many people dying from HIV/AIDS as there are people becoming infected. That’s not good enough," Piot said.

Women are hardest hit by the epidemic in Africa because it is more easily transmitted from men to women, but in Russia and Eastern Europe, which have the fastest spread of HIV/AIDS in the world, the picture is very different.

"It’s mostly due to injecting drug use but increasingly to sexual transmission, both homosexual and heterosexual transmission. That’s very, very worrisome," said Piot.

Russia had more new HIV cases in 2000 than all the combined cases in previous years. Infections jumped from an estimated 130,000 at the end of 1999 to 300,000 by the end of this year, according to Piot.

"There is a true explosion going on. The absolute numbers are still fairly low for a huge country," he said.

"If current trends continue in Eastern Europe, with more than a doubling of new infections in one year’s time, then we will soon get to a situation that is not as bad as the worst affected parts of Africa but it certainly could have a major impact on society in Russia and the former states of the Soviet Union."

Piot described the year 2000 as one of breakthroughs. HIV/AIDS is firmly on the political agenda of most countries and has been debated by the UN Security Council.

Major pharmaceutical companies have agreed to sell anti-AIDS drugs that are still under patent at reduced prices to poor countries. But Piot said even if the drugs were free, there would still be problems getting them to the people in most need.

"The top priority remains prevention and the better job we do in terms of prevention, particularly among young people, the less people will have to be treated," Piot said.

He is convinced Africa will have fewer new infections in five years’ time. What will happen in Asia and other parts of the world will depend on how society responds to the epidemic.

"The political will is greater than ever before but now the words have to be translated into action. That’s the challenge for next year," he added.