Image: AIDS ribbon
David Karp  /  AP
U.N. employees, special representatives, tourists and other participants take part in creating a human red ribbon to symbolize the fight against AIDS on the North Garden at United Nations headquarters on Tuesday.
msnbc.com news services
updated 5/30/2006 8:22:29 PM ET 2006-05-31T00:22:29

The world is still falling short in its battle against AIDS, with severe gaps in prevention and treatment, the United Nations said Tuesday.

“Despite some notable achievements, the response to the AIDS epidemic to date has been nowhere near adequate,” said UNAIDS, the U.N. agency that coordinates the global campaign against the pandemic.

Since U.S. doctors first described the disease in June 1981, AIDS and the HIV virus that causes it have spread relentlessly from a few widely scattered hot spots to virtually every country in the world, infecting 65 million people and killing 25 million, UNAIDS said in a 630-page report.

India now has the largest number of AIDS infections as the spread of the disease shows no sign of letting up a quarter-century into an epidemic that has claimed 25 million lives, the U.N. reported Tuesday. With an estimated 5.7 million infections, it has surpassed South Africa’s 5.5 million.

But the epidemic still remains at its worst in sub-Saharan Africa, where per capita rates continue to climb in several countries. A third of adults were infected in Swaziland in 2005. By comparison, India’s per capita rate is low, at 0.9 percent of its 1.02 billion people.

The UNAIDS report released Tuesday documents countries’ progress and failures, and projects what must happen to keep some regions from experiencing disaster. The agency report was released a day ahead of a high-level meeting on AIDS in New York and a week prior to the 25th anniversary of the first documented AIDS cases on June 5, 1981.

Nearly 40 million people are living with HIV/AIDS.

“It won’t go away one fine day, and then we wake up and say, ‘Oh, AIDS is gone,’” UNAIDS head Dr. Peter Piot told the AP in a recent telephone interview from Geneva.

Few babies are protected
The global AIDS incidence rate is believed to have peaked in the late 1990s. About 1.3 million people in the developing world are now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone.

Still, some 4.1 million people were newly infected and 2.8 million died in 2005. There were 4.9 million new infections and 3.1 million deaths in 2004.

Researchers have produced “mountains of evidence” about how to prevent and treat this disease, said the report, based on data gathered from 126 countries since December 2005.

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But anti-AIDS initiatives and their results vary widely from country to country, and many are falling short of the benchmarks set in a landmark high-level U.N. General Assembly session in 2001, UNAIDS said.

“Because this pandemic and its toll cannot be reversed in the short term, we need to sustain a full-scale response for the next decades,” it said on the eve of the follow-up session opening Wednesday in New York.

Piot said one of the report’s most disturbing findings was how few babies are being protected against infection. Only 9 percent of pregnant women in poor countries are receiving services, such as access to drugs, to help prevent mother-to-child transmission, despite a UNAIDS goal of 80 percent coverage.

“The thing I’m most disappointed with and surprised about is prevention of mother-to-child transmission,” Piot said. “For HIV, the coverage is still very low and we didn’t meet the target. “Here we have something that is non-controversial; it’s about saving the babies.”

Women’s vulnerability to the disease continues to increase, with more than 17 million women infected worldwide — nearly half the global total — and more than three-quarters of them living in sub-Saharan Africa, the report found.

South Africa remains one of the world’s most tragic situations with nearly one in three pregnant women testing HIV-positive in public antenatal clinics in 2004. Nearly 19 percent of adults were infected nationwide last year, and the per capita rate is continuing to climb.

“I think in Africa, it is only comparable in demographic terms to the slave trade regarding the impact it has had on the population,” Piot said. “In southern Africa, HIV prevalence continues to go up, and they’re already the world record.”

Stigma and discrimination still plague those infected worldwide, and young people’s knowledge about HIV/AIDS remains low, with less than 50 percent having adequate information about the disease — a far cry from the 90 percent target UNAIDS set for 2005.

While $8.9 billion is expected to be available in 2006 to combat AIDS in developing countries, $14.9 billion will be needed, UNAIDS said. By 2008, it predicted, $22.1 billion would be needed, including $11.4 billion for prevention plans alone.

The report called for more and better-targeted education and prevention strategies, more treatment opportunities, and more drug research, particularly on drugs for children, whose needs “have been largely left out of the research agenda.”

Signs of hope
But Piot said the new numbers do offer a small sliver of hope. Kenya and Zimbabwe, along with some cities in Burkina Faso, reported declines in the overall percentage of adults infected. He said Thailand and Uganda were two of the only previous examples where epidemics were curbed.

In India, officials said there are signs of hope despite the huge number of infections.

Intensive AIDS prevention efforts among prostitutes and the men who frequent them have pushed down HIV infections dramatically in four south Indian states, Andhra Pradesh, Karnataka, Maharashtra and Tamil Nadu. The UNAIDS report said the decline in HIV prevalence in those states was in 15- to 24-year-old pregnant women, where the rate fell from 1.7 percent in 2001 to 1.1 percent in 2004.

A recent University of Toronto study in those states credited efforts by authorities and non-governmental groups to educate sex workers. Places like Kamathipura are now scattered with posters and street theater performances and educators, all sharing information about AIDS and HIV. Bombay is in Maharashtra state.

Piot, at a news conference in New York on Tuesday, said that while four Indian states had been investing in HIV prevention, “the rest of the country is a totally different situation. There is an increase in new infections.”

“With a huge country like India, what matters is basically work in each and every state,” he said.

The Asia-Pacific region, with 8.3 million people infected, has the second-highest number after sub-Saharan Africa.

Piot, in the AP interview, said that the sheer population of Asia, home to most of the world’s people, makes it a potential problem because even small gains in per capita infections equal huge numbers — especially in countries like China and India, with more than 1 billion people each.

Infections growing in Eastern Europe, Central Asia
He said Eastern Europe and Central Asia have become a new front where infections have expanded as people have access to more money and started buying and injecting drugs — instead of just shipping them through — from countries like Afghanistan.

“Absolute numbers are still low, but when you look at the spread of the disease, we know from experience where that leads,” Piot said. “The Middle East is the last part of the world where HIV is not spreading rapidly.”

Thoraya Ahmed Obeid, executive director of the U.N. Fund for Population Activities, stressed that more action must be taken to empower women and enable them to take control of their sexuality. This is particularly important in southern Africa, where sexual violence against women is a factor in the transmission of HIV.

Piot said that there is time to stop AIDS from worsening, but action is needed on a number of fronts. Currently, about 1.3 million people in poor countries have access to antiretroviral treatment, but about 80 percent still are not receiving drugs.

“Intervention is very low ... for many critical populations in many countries. We need to really intensify the response to AIDS,” Piot said.

The Associated Press and Reuters contributed to this report

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