HIV epidemic is far worse than thought

BMJ 1997; 315 doi: (Published 06 December 1997) Cite this as: BMJ 1997;315:1485
  1. Jacqui Wise
  1. BMJ

    HIV infection is far more common than previously thought, according to a report from the joint United Nations programme on HIV/AIDS (UNAIDS) and the World Health Organisation. The new figures show that about one third more people are living with HIV worldwide than was estimated in December 1996.

    Dr Peter Piot, executive director of UNAIDS, said: “We are now realising that rates of HIV transmission have been grossly underestimated-particularly in sub-Saharan Africa, where the bulk of infections has been concentrated to date.”

    Over 30 million adults and children are now believed to be living with HIV infection-one in every 100 sexually active adults worldwide. And if current transmission rates hold steady, by the year 2000 the number of people living with HIV or AIDS will reach 40 million.

    The pattern of infection had been assumed to be similar in different countries in the same region, but as more data became available it became apparent that there were huge differences in the way the epidemic was developing in different countries. In sub-Saharan Africa, for example, very few countries had reliable data on HIV infection and some, notably Nigeria and South Africa, had virtually none. The country with the best surveillance rates was Uganda, and that showed that infection rates were beginning to level off, with new infections dropping in younger age groups. The situation in Uganda was wrongly taken to be typical of the whole region.

    Over 90% of people with HIV live in the developing world, where few facilities exist for voluntary testing and counselling and where, according to UNAIDS, 9 out of 10 HIV positive people will have no idea they are infected. The organisation warns that the full impact in terms of mortality from AIDS is only just beginning. It is estimated that 2.3 million people died of AIDS in 1997-a 50% increase on 1996. Nearly half of those deaths were in women, and 460000 were in children under 15.


    Estimates of the number of people infected with HIV are a third higher than previously thought


    The report states that in very badly affected countries the development gains achieved over the past few decades are being wiped out by the epidemic. In Botswana, for example, life expectancy, which rose from under 43 years in 1955 to 61 years in 1990, has now fallen to levels found in the late 1960s. On current trends, Zimbabwe's infant mortality can be expected to rise by 138% by the year 2010 because of AIDS.

    Clare Short, Britain's international development secretary, said that although recent scientific advances were very encouraging, people in developing countries were unlikely to see the benefit: “The new advances in drug therapies are prohibitively expensive in societies where expenditure on all health needs is often only £3 a day. It is just not feasible for such therapies to be a solution for the vast majority of people affected by HIV today. The search must continue for affordable means of slowing down the progression of HIV to AIDS and to increase protection, especially for young people.”

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