Saturday, July 6, 2002

p. A12.

The new AIDS numbers: Staring into an abyss

When a crisis is raging, few want to hear credible predictions that things are about to become much worse. But as the 14th International AIDS Conference begins in Barcelona this weekend, there can be no ignoring the first United Nations long-range forecast of where the pandemic is heading. Released this week, the study's alarming predictions should be required reading for all political leaders — there still seem to be plenty — who share the myopic view that AIDS is somehow going to go away. This latest batch of grim data suggests the reverse.

Since AIDS first surfaced 20 years ago, warnings about its potential scope have been tempered by skepticism. At the 1989 AIDS conference in Montreal, considerable doubt greeted predictions that the worldwide HIV-positive population might eventually reach 10 million. By 1996, the prognosis was that the total would peak at 40 million, the approximate number of people infected today, and then level off.

The newest UN findings indicate that, in fact, AIDS is still in its early stages. Fast-forward to 2020 and it will have claimed an additional 68 million victims unless prevention programs are drastically expanded, more than three times the toll to date and roughly equivalent to the number of people who perished in all the wars of the 20th century.

But AIDS is no equal-opportunity killer. Already there is a huge disparity between infection rates in the rich countries of the world and in the poor ones — 28 million of the current 40 million cases are in sub-Saharan Africa alone — and that gap seems sure to widen.

Treatment, too, is spread with brutal unevenness. Among that population of 40 million, only 700,000, less than 2 per cent, last year received the expensive drugs that can slow the development of AIDS. Of those 700,000, two-thirds live in the rich West and fewer than 30,000 in Africa.

Two lessons need digesting if the AIDS onslaught is to be checked. The first is that the insidious complexity with which the AIDS virus spreads has until now been severely underestimated. The second is that despite the ghastly statistics, the disease can still be controlled if the willpower and the money are there. And that remains the big "if."

Among the world's poor, the social factors that fuel AIDS remain rooted in poverty and social dislocation. In the worst-hit countries of southern Africa, political instability and economic upheaval tell part of the story. But mass migration by job-seekers and widespread prostitution are also proving deadly. The steadily growing economy of tiny Botswana, for instance, has for years been an African success story. Yet its two million people are afflicted with an HIV infection rate that has reached a staggering 39 per cent of all adults. In Zimbabwe and Swaziland, the figure is 33 per cent; in Lesotho, 31 per cent; in Namibia, 23 per cent. And across sub-Saharan Africa, women and girls are two to three times more likely to contract the virus than are men.

Only mass prevention can dent these numbers. Falling infection rates in such disparate countries as Uganda, Zambia, Poland and Cambodia attest to successful prevention campaigns.

But the obstacles are formidable. A separate UN report released last month found that fully half of the African women surveyed were unaware that the AIDS virus is transmitted by sex, and 25 per cent of both men and women did not know AIDS can kill. Rural China, where the virus is rapidly spreading after years of official denial, is just one of many other regions where similar ignorance is widespread.

Barring a major financial commitment, nothing is likely to change. Worldwide, $2.8-billion (U.S.) was spent last year on combatting HIV and AIDS, about one-quarter of what's needed to address current infection levels. Looking ahead, the cost soars. A blue-chip panel of British-based scientists has calculated that 29 million of the 45 million new infections expected between now and 2010 can be prevented. The price tag? About $27-billion.

That daunting estimate does not cover mass access to HIV-fighting drugs, which despite some price-cutting concessions by major drug companies (after heavy international pressure) remain far beyond the reach of those who most need them. Rather, the money would be spent purely on education and prevention, and would require a doubling and redoubling not just of Western aid but of spending by the countries directly affected.

First, however, there will need to be wholesale acknowledgment of the full dimensions of this crisis. At the recent Group of Eight summit in Kananaskis, Alta., Canada announced a new $50-million (Cdn.) contribution to AIDS research, but little other new money was pledged. It might have been, had the African leaders visiting the summit pressed the case harder. Instead, they wanted to talk mostly about investment and trade.

The bottom line about HIV and AIDS is that if their current trajectory does not alter, the long-term human and fiscal cost will relentlessly grow. AIDS activists insist that a dramatic rise in AIDS spending is not merely a moral imperative but would be a vital investment in the future of the whole planet. This week's frightening forecast should leave no doubt the activists are right.

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Created: July 9, 2002
Last modified: July 9, 2002
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