HIV/AIDS pandemic is worsening.

Since the beginning of the AIDS epidemic in the early 1980s, the number of people infected with HIV - the virus that causes AIDS - has climbed to nearly 50 million. Nearly 6 million people were infected in 1998, and 2.5 million people died from AIDS. (Each year since 1980 there has been a record number of new infections and AIDS deaths.) Cumulative AIDS deaths stand at over 14 million, and with 34 million people currently living with HIV, the number of deaths is expected to keep climbing.

The region worst hit by the epidemic has been sub-Saharan Africa. Crippled by poverty and a lack of widespread prevention efforts, the region has been the site of 7 out of every 10 of the world's cases of HIV infection, and 9 out of every 10 deaths due to AIDS. In a dozen African nations, at least 10 percent of the adult population now carries the virus. In the two hardest-hit nations, Zimbabwe and Botswana, one of every four adults is infected, and the average life expectancy has been cut by nearly 20 years.

In Asia, the rate of new infections remains relatively low, but the total number of people infected is expanding rapidly. The rate of infection is fairly low in India, for example, but with nearly 1 billion people, the country is home to an estimated 4 million infected individuals - more than any other nation.

Since 1994, the number of people living with HIV in Eastern Europe has surged nearly sevenfold. General collapse of economic and health care systems - on top of soaring drug use - has kindled the epidemic in the former Soviet bloc.

With the help of antiviral drugs that prolong the onset of AIDS, the number of AIDS deaths has declined in the United States and Western Europe, though new HIV infections are rising steadily as risky behaviors persist. In the United States, 64 percent of new infections occur in blacks and Hispanics, who account for just 24 percent of the population.

In contrast to other epidemics in human history, most of which predominantly affected the young and the elderly, AIDS has taken its most serious toll on working adults - the economically active cornerstone of a nation's development. As wage earners die off, families are forced to find alternate sources of income. In addition, the number of children orphaned by AIDS now exceeds 9 million, and that number is expected to grow substantially in the future.

National health-care systems in the countries hardest hit are being overwhelmed by the epidemic. The estimated cost of providing antiviral treatment to all infected individuals in Malawi, Mozambique, Uganda, and Tanzania greatly exceeds these countries' gross national products.

Impoverished peoples and nations are now faced with the brunt of the epidemic, according to participants at the 12th Annual World AIDS Conference in July 1998. Because of inadequate access to health care and education, the have-nots of the epidemic have been the least prepared to prevent the spread of AIDS. For example, in Latin America - as in other regions - infection rates are most severe in impoverished nations, such as Bolivia and Honduras.

At the same time, infection rates have slowed or declined in several nations that adopted strong prevention programs, including Senegal, Tanzania, Thailand, and Uganda. Successful efforts have included free distribution of condoms, needle-exchange programs, sex education at all levels of schooling, and support from religious and civil leaders.

In roughly half of the developing world, the epidemic still has not spread widely in the general population or even in high-risk groups. That provides a huge opportunity for governments who realize that prevention now costs a fraction of the price of treatment later.