H.I.V. Infection Rate in Asia Increases Sharply, U.N. Finds

By Lawrence K. Altman
July 6, 2004

Bangkok — The proportion of the world's new H.I.V. infections occurring in Asia has risen sharply over the last two years as the global epidemic has outstripped efforts to stop it, the United Nations said in a report released here today.

The size of the increase surprised United Nations health officials, who said that 1 in 4 -- nearly 1.2 million of the estimated 4.8 million new infections in 2003 -- occurred in Asia. That figure rose from one in five - or about 910,000 of the 4.4 million new infections in 2001.

Worldwide, the rate of new H.I.V. infections in 2003 was the highest of any year since the epidemic was first recognized more than two decades ago, the report said. Since 1981, more than 20 million people have died of AIDS, 2.6 million of them in 2003.

Kathleen Cravero, the deputy executive director of the United Nations AIDS program, said that a small window of opportunity exists to stop the H.I.V. epidemic in Asia and elsewhere.

"If we miss it, it will slam shut forever" and "we will see an epidemic the likes of which we never imagined, despite what has happened in Africa," Ms. Cravero said at a news conference here today.

Eastern Europe also has a fast-growing epidemic, the United Nations said.

The United Nations updates the state of AIDS in the world every two years in advance of the International AIDS Conference. The 15th conference opens here on Sunday. Many health officials have repeatedly warned that Asia faces an H.I.V. epidemic that could rival Africa's.

The epidemic is expanding rapidly in Asian countries, particularly in China, Indonesia and Vietnam, nations that account for 50 percent of Asia's population. So even small percentage increases can represent large numbers of people.

For example, about 1 percent of India's population is living with H.I.V. But that represents 5.1 million infected people, leaving India poised to overtake South Africa as the country with the most infected people, 5.3 million.

In a separate news conference conducted by telephone from London tonight,Ms. Cravero's boss, Dr. Peter Piot, the director of the United Nations AIDS program, speculated that some Asian countries might reach the level of 20 percent or more already reported in some African countries. However, Dr. Piot said he doubted that the Asian continent would experience as devastating an epidemic as the African continent.

Many epidemiologists say that when more than 1 percent of a country's population is living with H.I.V., the country is in a general epidemic that is much harder to stop than if the prevalence was less than 1 percent, Ms. Cravero said.

In Asia, Ms. Cravero said, "many countries have prevalence rates less than 1 percent and some are hovering around 1 percent. So that is where the window of opportunity comes.

"You either drive it down now through maximum scaling up of prevention or you spend exponentially more money and energy trying to drive it down," she said, adding that the H.I.V. epidemics in Asian countries began largely among injecting drug users, prostitutes and gay men, but now "are fast moving into the general population."

To stop the rise, countries need to vastly increase their efforts for prevention and treatment, Ms. Cravero said. But in Asia, current prevention strategies largely miss women and girls, who lack the option of abstaining from sex and have little control over whether their husbands use condoms or have extramarital sexual contacts, she said.

Health workers have less than half of the $12 billion that is needed for treatment and prevention by the end of 2005, if the course of the epidemic is to be reversed, Ms. Cravero said. More than 22 percent of the $12 billion is needed for Asia alone.

In response to questions raised by political leaders, scientists and advocates, the United Nations used newer statistical methods to derive the latest infection estimates of 37.8 million people. Using those methods, the number could vary from 34.6 million to 42.3 million, the United Nations said.

The figures were lower in Cameroon, Ivory Coast, Ethiopia, Kenya, Rwanda, Zambia and Zimbabwe and higher in Senegal. But the new figures do not represent real changes in the numbers of people infected, the United Nations said.

If the United Nations had continued to use its older methods to calculate the current figure, the estimate would have been 43 million, Dr. Piot said.

Because there is no logistical and ethical way to test everyone, the United Nations based many of its earlier estimates on surveys conducted in antenatal clinics and assumed that the figures represented a broader population. But experience has shown that such surveys lead to overestimates in urban areas and underestimates in rural areas.

The United Nations and the Centers for Disease Control and Prevention in Atlanta have conducted workshops training epidemiologists from 130 countries in the newer statistical methods that have allowed countries to use more detailed data in generating their own estimates, often based on house-to-house surveys.

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