By Charlene Porter
USINFO Staff Writer

Washington - The number of people living with HIV/AIDS climbed in 2006, the 25th year since first detection of the virus, according to an annual survey of the epidemic conducted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), released in Geneva November 21.

The report - 2006 AIDS Epidemic Update - points out the “promising developments” made in the last few years to increase access to treatments and expand prevention programs. Still, an estimated 39.5 million people are living with HIV/AIDS worldwide, with 4.3 million new infections in 2006 and almost 3 million deaths.

In 2005, the same annual survey reported about 38.6 million total cases worldwide, but precise comparisons from year to year are difficult to make because the estimates are made in wide ranges.

“In the past two years, the number of people living with HIV increased in every region in the world,” according to the report’s introduction. “The most striking increases have occurred in East Asia and in Eastern Europe and Central Asia, where the number of people living with HIV in 2006 was over one-fifth” (21 percent).

Despite those regional increases, sub-Saharan Africa is still the region most severely affected, home to 63 percent of the total number of those infected worldwide.

“Declines in national HIV prevalence are being observed in some sub-Saharan African countries, but such trends are currently neither strong nor widespread enough to diminish the epidemics’ overall impact in this region,” according to the report, considered the most authoritative global accounting of the epidemic made each year.

The update is released each year prior to the observance of World AIDS Day on December 1.

THE TRENDS IN INFECTION

The trends detected in the pandemic by the annual survey are just as significant as the numbers, and this year's report reveals how the spread of the disease may take widely different courses in different countries, cultures and subcultures.

“Knowing your epidemic,” Dr. Peter Piot, UNAIDS executive director, said in a statement accompanying the report’s release, "and understanding the drivers of the epidemic such as inequality between men and women and homophobia is absolutely fundamental to the long-term response to AIDS.”

The epidemic update finds increasing evidence of HIV outbreaks among men who have sex with men in Cambodia, China, India, Nepal, Pakistan, Thailand and Vietnam and in Latin American nations. At the same time, the national AIDS prevention programs fail to reach these marginalized groups.

In some cases, nations have failed to sustain prevention programs because of a sense that the epidemic has been brought under control. However, new waves of young people continue to reach the age of sexual maturity and become vulnerable to HIV exposure. As a result, infection numbers have remained stable, rather than showing the reductions health officials hope for.

Uganda demonstrated significant success over the last 10 years in reducing the numbers of new infections occurring in its population, but now research indicates increasing infection rates in rural areas.

“This means that countries are not moving at the same speed as their epidemics,” said Piot. “We need to greatly intensify life-saving prevention efforts while we expand HIV treatment programmes.”

THE BENEFITS OF TREATMENT

Despite its cautionary themes, the epidemic update also points up the progress made in recent years to broaden the access to antiretroviral drug therapies. These drugs, available in some form for about a decade to developed-world patients, cannot cure AIDS, but they can contain and control the disease so that people living with AIDS can live functionally and productively.

The report assesses the cumulative impact of that development.

“Through the expanded provision of antiretroviral treatment (ARVs) an estimated 2 million life years were gained since 2002 in low- and middle-income countries,” according to the 2006 AIDS Epidemic Update. “In sub-Saharan Africa alone, some 790,000 life years have been gained, the vast majority of them in the past two years of antiretroviral treatment scale-up. In Latin America, where wide-scale treatment provision began earlier, some 834,000 life years have been gained since 2002.”

U.S. EFFORTS TO PROVIDE TREATMENT

The President’s Emergency Plan for AIDS Relief (PEPFAR) has been a key program to increase the numbers of people receiving ARVs. Launched in 2003, PEPFAR is a $15 billion, five-year emergency plan, providing funds to fight the pandemic in 100 countries, with a special focus on the 15 hardest-hit countries. At latest count, the program, working with scores of partner organizations at the local level, has begun drug treatment for more than 560,000 people.

A State Department fact sheet provides a broader overview of the services being provided to communities beset with the epidemic:

• Prevention of mother-to-child HIV transmission for women in more than 4.5 million pregnancies;

• Anti-retroviral prophylaxis for women during 342,200 pregnancies and prevention of an estimated 65,100 infant HIV infections; and

• Counseling and testing services for more than 13.6 million men, women and children

The full text of the U.N. report is available on the organization's Web site.  A fact sheet on PEPFAR is available on the State Department Web site.  Additional information on PEPFAR is available on the program's Web page.

For more information on U.S. policy, see HIV/AIDS.