UN report warns that AIDS epidemic is still out of control

BMJ 1998; 317 doi: (Published 28 November 1998) Cite this as: BMJ 1998;317:1472
  1. Hugh Matthews
  1. BMJ

    A report published this week by the United Nations and the World Health Organisation shows that there has been little progress in preventing the transmission of AIDS. New drugs have increased survival times for patients in developed countries, but in some parts of Africa the epidemic threatens to reverse gains achieved by development programmes.

    The report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the WHO recorded six million new HIV infections in the past year. Half of these were among people in the 15-24 age group. Dr Peter Piot, executive director of UNAIDS, said: “Every one of these new HIV infections represents a prevention failure.” He blamed a “continuing feeling that the epidemic is over” for the lack of progress in prevention. Despite awareness campaigns, the rate of new infections in Europe and North America has remained steady for the past 10 years.

    New antiretroviral drugs have been responsible for a drop of two thirds in the number of AIDS deaths in the United States between 1995 and 1997, which Dr Piot called a spectacular success. However, in sub-Saharan Africa there are 5500 deaths from AIDS every day. In nine countries in this region, more than 10% of the adult population is HIV positive, and four countries have a 20-25% prevalence of infection, greatly impairing prospects for economic development and reducing the average life expectancy by as much as 17 years. Antiretroviral treatment remains unavailable to 95% of those who need it, and international efforts are concentrating on treating opportunistic infections such as tuberculosis and preventing vertical transmission.

    War and the migration of labourers are factors commonly implicated in the spread of HIV, but the report emphasised the role of a “blame and shame” culture in most countries. Many people have no access to HIV testing and those who do often decline the test. In Côte d'Ivoire less than half of the pregnant women offered interventions that could help their baby wanted to know their HIV status, and in southern Africa fewer than 1 in 10 people caring for someone with AIDS acknowledged that the person had the disease.

    AIDS Epidemic Update--December 1998 is available from UNAIDS, 20 Avenue Appia, CH1211 Geneva 27, Switzerland, or

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