By Charlene Porter
Washington File Staff Writer

Washington – Twenty five years after the first detection of the HIV virus, medical science has identified how effectively to treat and prevent infection, but extending those treatments and practices to almost 40 million people worldwide living with HIV/AIDS remains a challenge, according to a report released August 11 by the U.S. Centers for Disease Control and Prevention’s (CDC) Mortality and Morbidity Weekly Report.

The report, prepared by CDC in collaboration with other U.S. and international health agencies, says that 2.8 million persons died from AIDS in 2005, and 4.1 million newly were infected with HIV.

The report was released two days before the opening of the XVI International AIDS Conference (August 13-18) to be held in Toronto. The biennial meeting sponsored by the International AIDS Society is the world’s largest meeting focused on the disease. More than 25,000 people involved in research, health care, policymaking or activism are expected to attend, according to conference organizers.

THE REGIONS

“Southern Africa is the epicenter of the AIDS epidemic,” according to the report. Sub-Saharan Africa is home to about 10 percent of the world’s population, but 64 percent of all people with HIV/AIDS reside in the region.

Prevalence rates in four countries – Botswana, Lesotho, Swaziland and Zimbabwe – exceed 20 percent, the report says. At the same time, declines in prevalence also have been documented in recent years, notably in Kenya, Uganda, Zimbabwe and urban areas of Burkina Faso.

In Asia, prevalence rates generally are lower than in Africa, with the disease largely confined to people engaged in various high-risk behaviors, such as sex workers, intravenous drug users or males who have sex with males.

By virtue of its large population of more than 1 billion people, India is now the nation with the single largest number of HIV infected persons, about 5.7 million, the report says, while its prevalence rate – 0.9 percent - is low compared to Africa’s but varies by Indian state.

The Caribbean is the second most HIV-affected region of the world after sub-Saharan Africa. The epidemics in the two regions also are similar in that transmission is heterosexual, a pattern which will create a more generalized epidemic, epidemiologists have concluded.

Different access to treatment in each of these regions underscores the need to improve the delivery of medicine to those who need it. In sub-Saharan Africa, 17 percent of the estimated number of persons who need anti-retroviral therapy (ART) received it. In Asia the rate is 16 percent, and in the Caribbean and South, and Central America, 68 percent.

TREATMENT AND SERVICES

Improving access to treatment and prevention requires more than shipping the right drugs to the right people. Complex social and cultural issues also are involved.

“Stigma and discrimination associated with HIV/AIDS,” according to Dr. Anthony Fauci of the National Institute of Allergy and Infectious Disease, “and sometimes community or even governmental denial of the disease, too often dissuade individuals from getting tested or receiving medical care.”

Fauci wrote an editorial in the July 28 edition of Science magazine reflecting on 25 years of HIV/AIDS and the challenges that remain ahead.

“Women’s rights remain elusive at best in many cultures. Worldwide, thousand of women and girls are infected with HIV daily in settings where saying no to sex or insisting on condom use is not an option because of cultural factors, lack of financial independence, and even the threat of violence.”

Despite these challenges ahead, U.S. health officials also announced that progress is been made in the distribution of treatment and prevention due to U.S. and international efforts. In two-and-a-half years, the number of persons receiving ART climbed by 225 percent. (See related article.)

The President’s Emergency Plan for AIDS Relief, a five-year, $15 billion dollar program assisting 120 nations in combating the AIDS epidemic is a significant contributor to that increase. (See related article.)

The MMWR report is available on the CDC Web site.

The Fauci editorial in Science (PDF, 1 page) is available on the magazine’s Web site.

For more on U.S. efforts to combat the epidemic, see HIV/AIDS.