About one in five adults in southern Africa is now living with HIV/AIDS
By Geoffrey Cowley
Newsweek
Dec. 8 issue - Strolling through San Francisco’s Castro district or New York’s Chelsea—places where wheelchairs and funeral processions crowded the sidewalks a decade ago—you might guess that the scourge of AIDS had been beaten. In a sense, you’d be right.
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Since the advent of effective HIV treatments in 1996, death rates have plummeted in nations and neighborhoods that have access to them. Unfortunately, those places have become islands in an expanding sea of misery. Worldwide, HIV will kill 3 million people this year, according to new estimates from the United Nations AIDS program—and 5 million more will contract the virus. In UNAIDS director Peter Piot’s blunt assessment, the pandemic is “spiraling out of control.” But the news is not all bad. Governments, foundations and grass-roots groups have responded as never before, pushing global AIDS spending from $3.1 billion to $4.7 billion this year. It’s a spectacular achievement, health experts agree—but a far smaller effort than the crisis now demands.
For all their good fortune, even the wealthiest countries face sizable challenges. Some 900,000 Americans are now living with HIV—the largest number ever, according to the Centers for Disease Control and Prevention—and roughly 25 percent of them don’t yet know they’re infected. The annual number of U.S. AIDS deaths fell to 16,000 in 2002, as more people benefited from treatment. But with an estimated 40,000 Americans getting infected each year, the nation’s HIV reservoir is still growing. In a newly published study covering 29 states, the CDC reports that the rate of HIV diagnosis rose by 8 percent among whites and 26 percent among Latinos over a recent four-year period. The rate didn’t budge among African-Americans, but that was no great victory. Though blacks represent only 12 percent of the U.S. population, says Dr. Ronald Valdiserri of the National Center for HIV, STD and TB Prevention, they account for more than half of all HIV diagnoses—and AIDS rates among blacks are 10 times —those of whites. The disease is now the leading cause of death for African-American women between the ages of 25 and 34.
If there is work to be done in wealthy countries, there are mountains to move in poor ones. More than 95 percent of new HIV infections now occur in the developing world—two thirds of them in sub-Saharan Africa, where infection rates run as high as 40 percent. In that beleaguered region, AIDS is not just a health crisis but a growing threat to schools, economies and food supplies. Studies in Zambia suggest that AIDS is killing two teachers for every three who complete training each year. And researchers predict that several African countries will lose a fifth of their farmers to AIDS by 2020. The likely consequences include “a reduction in land under cultivation,” according to a recent report from the United Nations’ Population Division, as well as a “shift to crops that require less labor, decline in crop yields, and... a loss of knowledge about farming methods.” For many of Africa’s 11 million AIDS orphans, that loss could translate directly into hunger.
Fortunately, none of this is inevitable. We know how to prevent new infections, and the tools now exist to keep infected people healthy. The deepest irony, and the greatest cause for hope, is that our best weapons are still sitting idle. Africa’s “cycle of illness and death” reflects “the almost complete absence of large-scale HIV prevention or antiretroviral treatment programs,” UNAIDS asserts in its new global update. Voluntary testing and counseling initiatives are “threadbare,” and programs to spare children from infection at birth are “virtually nonexistent.” The cost of AIDS drugs has plummeted in recent years, and studies have shown that people can use them effectively even in the most impoverished settings. Yet across the developing world, only 5 percent of the 6 million people who now urgently need treatment are receiving it.
That record will surely improve next year. From China to South Africa, governments that have spent years denying the epidemic are now mounting vigorous national responses. South Africa, the country with the world’s largest HIV/AIDS burden, has recently launched a national treatment initiative and announced plans to quadruple spending over the next three years. Comprehensive AIDS programs are still beyond the reach of many hard-hit countries, but costs continue to fall. Under a deal orchestrated by former president Bill Clinton and his adviser Ira Magaziner, generic three-drug regimens could soon be available for as little as 40 cents a day in some countries—down from $33 just three years ago. And though international donors have yet to fill the resource gap, contributions are up sharply. The Global Fund to Fight AIDS, Tuberculosis and Malaria is now supporting programs in 121 countries, and the U.S. effort that President George W. Bush announced this summer could provide $15 billion to 14 countries over five years. “Things are moving faster than many of us thought possible,” says Dr. Allan Rosenfield, dean of Columbia University’s Mailman School of Public Health. “The point came where sitting back to watch 30 million people die was just too obscene. The question changed from ‘What can we do with the resources we have?’ to ‘What will it take to address this crisis?’” Experts agree it will take $10 billion a year by 2005—an amount that now looks entirely feasible.
