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AIDS
IN AFRICA 16th
July 2002 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 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 condomsto 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." By Ed
Susman - UPI Science News |
