HIV/AIDS epidemic is still in early stages. (Update).

The scale of the AIDS epidemic is far beyond even the worst-case scenarios projected a decade ago, according to several new reports released at the 14th International AIDS Conference in Barcelona in July 2002. HIV/AIDS, now the world's fourth-largest killer and the leading cause of death in sub-Saharan Africa, is expected to kill 68 million people between 2000 and 2020 in the 45 most-affected countries, according to a report by UNAIDS. About 55 million of those deaths will take place in sub-Saharan Africa.

Contrary to earlier assumptions that HIV had reached "a natural limit" and had begun to level-off in hard-hit southern African nations, HIV prevalence (the percent of the population infected) in the region has increased. In Zimbabwe, the proportion of infected adults rose from a quarter of the population in 1997 to one-third by the end of 2001. Even in the world's most-affected country, Botswana, prevalence increased from 36 percent in 1999 to 39 percent in 2001.

New hotspots of the disease are emerging in Asia, reports UNAIDS. Large numbers of people are now infected in the populous nations of India and China, a fact that is masked by the countries' low rates of HIV prevalence (see World Watch January/February 2001). After a decade of negligible HIV rates, Indonesia is now seeing rising infection among high-risk populations.

The epidemic is growing most quickly in Eastern Europe and Central Asia. The number of reported cases has doubled every year since 1998 in Russia, where the epidemic is tied to economic hardships and rising unemployment, which have driven many young people to drug use and sex work. With public health services crumbling, sexually transmitted infections are on the rise, which also heightens the risk of contracting HIV.

One-third of the 1.5 million HIV-infected people in high-income countries are receiving antiretroviral treatment, while only 230,000 of the 38.5 million infected in low and middle-income countries have access to treatment. Consequently, AIDS-related mortality is far greater in poorer countries. A handful of Latin American, Caribbean, and Asian countries, however, have instated antiretroviral use. In 1996 Brazil established a legal right to free medication that has helped more than 100,000 NW-positive people receive treatment and reduced the number of AIDS-related deaths by one-third. The Brazilian Ministry of Health estimates that providing antiretroviral drugs in 2001 cost $50 million less than it would have spent treating patients without access to AIDS therapy.

Lack of treatment has reduced life expectancy in at least 51 countries. The U.S. Census Bureau projects that life expectancy in 11 countries in sub-Saharan Africa will be around 30 years of age in 2010. Projected life expectancies for the Bahamas, Guyana, and Honduras are at least 10 years lower due to AIDS.

"One of the most telling and troubling consequences of the epidemic's growing reach is the number of children it has orphaned," according to a new 88 country survey by the UN and the U.S. government. More than 13.4 million children have lost one or both parents to AIDS, and that number will hit 25 million by 2010--accounting for a quarter of all orphans. Orphans face high risks of malnutrition, physical abuse, and impoverishment, finds the report, and they are less likely to be enrolled in school and more likely to be working more than 40 hours a week.

The vast majority of the world's young people aged 15 to 24 have no idea how HIV is transmitted or how they can protect themselves from the virus, according to a report by the World Health Organization (WHO) and other UN agencies. Scaling up prevention measures--including public education, condom promotion, testing and counseling, and outreach to high-risk groups--could prevent 29 million new infections by 2010, according to a study published in the British medical journal The Lancet. Implementing and sustaining this effort on a global scale would cost $27 billion, or about $1,000 per averted infection.

At the Barcelona conference, UNAIDS Executive Director Peter Piot asked governments to donate $10 billion for the Global Fund to Fight AIDS, Tuberculosis, and Malaria. "Defeating the epidemic is possible but it is not inevitable," he warned.

[GRAPH OMITTED]