Miami Herald, The (FL)
2004-11-24
Section: Front
Edition: Final
Page: 10A

Nearly five million people worldwide were infected with HIV during 2004, bringing the number living with the virus that causes AIDS to nearly 40 million, the highest number since the syndrome was identified in 1981.

The steepest increases were in Sub-Saharan Africa, Asia, Latin America and Eastern Europe. New cases leveled off in the Caribbean, but it remained the second-most-affected region in the world, with 2.3 percent of its population infected with HIV/AIDS. ``The number of people living with HIV has been rising in every region,'' said the AIDS Epidemic Update released Tuesday by the United Nations Joint Programme on HIV/AIDS and the World Health Organization.

Women were among those most affected, accounting for 47 percent of people living with HIV in 2004, up from 41 percent in 1997.

WOMEN WITH HIV

``Women make up nearly 50 percent of the people living with HIV. In nearly every region the percentage of women is going up,'' said UNAIDS Executive Director Dr. Peter Piot from a teleconference in Brussels.

``A female-centered strategy must be at the heart of efforts to fight AIDS,'' added UNAIDS senior advisor Karen Stanecki.

Worldwide, the report says:

* 3.1 million people died of AIDS in 2004, up from 2.7 million in 2002 - bringing total AIDS deaths since 1981 to more than 23 million.

* 4.9 million new cases of HIV were reported in 2004, up from 4.5 million in 2002 - bringing to 39.4 million the number living with the virus.

In East Asia, the increase is led by a spreading epidemic in China, caused by rural people who sold infected blood plasma to earn money, injecting drug use, and paid sex.

In Eastern Europe, the Russian Federation is home to the largest epidemic, with a new and serious epidemic spreading to Ukraine, the report said. More than 80 percent of cases are in people under 30. Major causes are injecting drug use and unprotected sex.

In the Caribbean, the adult prevalence of HIV/AIDS is higher than any other region except Sub-Saharan Africa.

``Among adults 15-44, AIDS has become the leading cause of death [in the Caribbean]'' the report says.

ADULT PREVALENCE

Adult HIV prevalence is more than 2 percent in the Bahamas, Belize, Guyana, Haiti and Trinidad and Tobago. In North America, the prevalance rate is 0.6 percent of the population.

``Life expectancy at birth in 2010 is projected to be 10 years less in Haiti and in Trinidad and Tobago nine years less that it would have been without AIDS,'' the report says.

Nearly two-thirds of all HIV infections in Caribbean countries come through heterosexual intercourse, although sex between men is growing, the report says.

One hopeful note is in Haiti, where public health programs have cut the prevalence of HIV among women 15 to 49 attending prenatal clinics from 4.5 percent in 1996 to 2.8 percent in 2004.

``It's a little premature to conclude very much from some small studies,'' said Sally Dodds, associate professor of clinical psychiatry at the University of Miami School of Medicine. But she said that at a Haitian Health Summit in Port-au-Prince last year she was impressed at the assistance coming from nongovernmental organizations.

BUILDING CLINICS

``The United Nations Foundation, the Bill Gates Foundation, the Green Family Foundation from Miami have made huge efforts, in some cases, to give money to build clinics.''

Dodds also credited Haitian self-help groups that, lacking the money to build clinics, contribute by creating HIV prevention classes.

In two Latin American countries, Guatemala and Honduras, HIV prevalence has reached more than 1 percent of the population, the report says.

THE GROWING THREAT

``This is the center of the epidemic in Latin America,'' says Paulo Lyra, advocacy advisor to the Pan American Health Organization. ``In these countries, it's no longer confined to what we call `vulnerable populations' such as homosexual men, sex workers, drug users and so on. It's now threatening the general population.

``When you look at the numbers today for Central America and those for Sub-Saharan Africa 10 years ago, there are a lot of similarities.''

But, the report warns, some Latin American countries may look like they have low rates, but have acute epidemics in some pockets.

In Brazil, for example, 7 percent of sex workers are HIV positive, but among sex workers in urban slums, the proportion is 18 percent.

Assistance in Brazil's fight against HIV is coming from Miami, says Charles Mitchell, professor of pediatrics at the University of Miami School of Medicine.

In association with Gwen Scott, director of UM's pediatric infectious diseases and immunology, Mitchell runs a program bringing Brazilian doctors to Miami to study AIDS-fighting methods.

STUDY IN BRAZIL

One graduate of the UM program is now creating a study in the Brazilian city of Belo Horizonte to learn how soon pregnant women should begin taking antiretroviral drugs to prevent passing HIV to their babies.

Meanwhile, Sub-Saharan Africa remains the worst-

affected region in the world, with only 10 percent of the world's population but accounting for 60 percent of all people living with HIV, the report says.

Women are among those most affected in Sub-Saharan Africa and the Caribbean. Women and girls make up almost 57 percent of adults living with HIV in sub-Saharan Africa.

CONTRIBUTING FACTOR

One factor contributing to the spread of HIV among women is when young women have sex with older men - often through violence or economic or social coercion, the report said.

``Sex between young women and considerably older men is common in many countries, including the Caribbean and sub-Saharan Africa,'' it said.

In Haiti, a 2001 survey said half the young women in Haiti said they had become sexually active before their 18th birthday.

In the United States, women made up one in 10 new AIDS patients in 1993 and one in four in 2003. AIDS is the third-leading cause of death for U.S. black women ages 35 to 44.

WOMEN VULNERABLE

Among the causes cited in the report: For physical reasons, women are three times as vulnerable as men to HIV infection during heterosexual intercourse; in many countries, women are forced by violence or poverty into unprotected sex; treatment programs in many undeveloping countries favor HIV-infected men.

Piot said that in a hospital he visited in Addis Ababa, Ethiopia, only about 30 percent of the 1,500 patients were women, even though more than half the people living with HIV in Ethiopia are women.

The reason: the hospital was charging a small fee for treatment.

``Women either didn't have the money, or their husbands had to provide it, and they weren't willing,'' Piot said.