An AIDS Appraisal

About 40 million people worldwide live with human immunodeficiency virus (HIV), the virus that causes AIDS. And about 3 million of them will die from AIDS this year, including more than half a million children.

Those numbers are staggering. But they’re just the start of the story. To get a better sense of the global AIDS crisis, you have to follow the virus around the world – because where we are in the fight against AIDS depends to a large degree on where in the world we are.

In the West, prevention programs and anti-retroviral drug treatments have lessened the disease’s impact – though more than a million people still live with AIDS in the United States alone. Elsewhere, the outlook is far scarier. Here’s how the fight against AIDS is going in three key places: Africa, Asia, and Latin America.

AIDS in Africa

In sub-Saharan Africa, AIDS is an epidemic of epic proportions. Roughly two thirds (25 million) of the world’s 40 million HIV-infected people live here. About 1 in every 14 adults in the region is infected, as opposed to 1 in 200 adults in the West. (Even in the Caribbean, the world’s second-most affected region, the ratio is 1 in 60.)

This year, about 2.5 million people in sub-Saharan Africa will die from AIDS. Local efforts to reverse the disease’s onslaught have managed to stabilize its prevalence, so that roughly the same number of people die from the disease each year as become infected. In some places, infection rates are even falling. But that’s small comfort to the millions still dying, or the millions more struggling to carry on amid the carnage.

Not all sub-Saharan nations, or regions within them, are equally affected. In Kenya, Uganda, and Zimbabwe, HIV prevalence is declining. Meanwhile, epidemics in Mozambique and Swaziland continue to expand. The numbers are worst in southern Africa, where four countries – Botswana, Lesotho, Namibia, and Swaziland – regularly record HIV prevalence rates over 30 percent among pregnant women. Throughout the region, women and girls now account for some 57 percent of all people infected.

Those numbers mean that AIDS will plague the region for many years, even if more nations can achieve declines in total prevalence. Prevention and treatment programs are hard to mount in regions that lack public health infrastructure. At best, only 10 percent of the Africans who need them get the anti-retroviral drugs that could extend their lives. Still, there is hope. A scale-up in treatment since late 2003 has already saved more than 250,000 lives.

AIDS in Asia

In Asia, the prevalence of AIDS among adults is slightly lower than it is in the West: about 1 in every 250 is infected. Yet sheer population size means that some 8 million Asians have the virus. What’s more, while some Asian areas are nearly AIDS-free, others face expanding epidemics – including Indonesia, Vietnam, and parts of China.

China’s longest-running local epidemic hits poor peasants who for years have sold their blood to help support their families. More recently, infection rates have taken off among injecting drug users, from whom the disease could jump into the general population. Experts stress that every epidemic is unique, but they’ve seen this pattern before. Women who inject drugs (one high-risk behavior) often prostitute themselves (another high-risk behavior). Worse yet, infected prostitutes who inject drugs often don’t use condoms (yet another high-risk behavior). Their customers then catch the disease and carry it home to wives and girlfriends.

Prostitution and injecting drug use are also key to the disease’s spread in India, where about 5 million people are infected – possibly the most in any single country (though South Africa has roughly that number in a much smaller population). AIDS warriors worry that an exploding epidemic in India or China could quickly dwarf even Africa’s current crisis for sheer numbers of people infected. Barring serious efforts to contain the virus, that could happen in a decade.

AIDS in Latin America

Meanwhile, halfway around the world, about 1 in every 100 adults in Guatemala, Honduras, and Belize is infected with HIV. Prevalence rates in other Latin American countries are somewhat lower. But nearly 2 million people in the region still live with HIV. About a third of them live in Brazil – which has nevertheless become a beacon in the fight against AIDS.

A dozen years ago, experts predicted that more than a million Brazilians would be infected with HIV by 2000. Yet the number is half that even now. Why? Brazil blunted the impact of its once-exploding epidemic in part by adopting politically prickly programs: distributing millions of free condoms every month and giving away clean needles to injecting drug users. It’s also been aggressive about treatment, handing out free generic versions of anti-retroviral drugs – despite complaints from companies that own the patents.

Similar programs have helped contain epidemics in other places. But as critics are quick to point out, condoms and clean needles alone can’t stop the worldwide HIV/AIDS pandemic. The search for a cure continues, and efforts to get anti-retroviral treatments to more victims are increasing. But millions more will die this year.

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