HIV now infects 39.5 million people around the world, a jump of 2.3 million over the past 2 years, according to an update released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS). "The evidence is showing that not only is the global epidemic growing, but there are also worrying trends where some countries are seeing a resurgence in infection rates," says Paul De Lay, who directs monitoring and evaluation for UNAIDS.
The report--titled “AIDS Epidemic Update"—is revised annually. In most years, there is an overall increase in AIDS cases, and this year is no exception. There are also some new, and grim, developments. Prevalence increased in certain populations in both Thailand and Uganda, which have in the past received worldwide recognition for their successful prevention efforts. Men who have sex with men now account for 21% of new infections in Thailand, and cases are also rising in heterosexual couples in rural villages in Uganda (Science, 25 August, p. 1030). In both situations, there appears to be limited use of condoms.
The report also for the first time documents HIV's spread through injecting drug users--especially those who use heroin--in four countries in sub-Saharan Africa that have had little of the drug in the past: Kenya, Tanzania, Nigeria, and South Africa. The region already accounts for 63% of all infections worldwide.
In Eastern Europe and Central Asia, which has a relatively recent epidemic, the annual number of new infections was 70% higher than 2 years ago. In all, the regions have experienced a 20-fold increase in AIDS cases in less than a decade. About 90% of these infected people live in the Russian Federation and the Ukraine, and injecting drug users remain the predominant risk group, but the virus increasingly is spreading from them to their sexual partners. Solid scientific evidence has shown that strategies such as needle exchange can powerfully slow the spread, says epidemiologist Kevin De Cock, who heads the HIV/AIDS program for the World Health Organization, which co-authored the report. But De Cock says the number of these kinds of programs in place is still "woefully inadequate."
Not all the news is bad. While AIDS cases in the United States and western/central Europe continue to increase, the report notes that this largely is due to effective anti-HIV drugs extending people's lives, rather than an increase in new infections. De Lay emphasizes that the report documents success stories--particularly in young, pregnant women in sub-Saharan Africa. According to the report, prevalence fell by at least 25% among 15- to 24-year-old women in urban areas in Kenya, Côte d'Ivoire, Malawi, and Zimbabwe. Changes in sexual behavior, including condom use with "non-regular partners," may account for some of the drop. Also encouraging: The world is spending more money than ever before to combat AIDS, says De Cock.
The report "is a solid global summary, and it remains an enormously useful document," says epidemiologist Chris Beyrer of the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. But he cautions that readers should keep in mind that in countries such as Burma/Myanmar and Zimbabwe, "political and human rights considerations limit both what we know about HIV and what a U.N. agency can say."
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