HIV/AIDS Continues Worldwide Climb

As of December 2006, some 39.5 million people around the world were living with HIV, the virus that causes AIDS—37.2 million of them were adults, with an estimated 17.7 million women over the age of 15 carrying the infection. 1 Some 4.3 million people were newly infected with HIV in 2006, with a little more than 500,000 of those new infections occurring in people under the age of 15.2 In 2006, 2.9 million people died from AIDS.3

In Western Europe, HIV infection rates increased sharply in the last eight years, from 42 cases per million people in 1998 to 74 cases per million in 2006.4 Around the Baltic region, the high HIV infection trend that characterized the turn of the twenty-first century there appears to be abating, particularly in Latvia and Estonia.5 South and Southeast Asia is home to 7.8 million infected individuals, an 8-percent increase from 7.2 million in 2004; in East Asia, the figure is around 750,000 people, up from 620,000 in 2004; and in Latin America, the infected total is around 1.7 million, up from 1.5 million in 2004.6

Sub-Saharan Africa is home to nearly two thirds of people worldwide living with HIV.7 (See Figure 1.) In this region, there were 2.8 million newly infected individuals in 2006, up slightly from 2.6 million just two years earlier.8 At the end of 2006, UNAIDS estimated that 24.7 million sub-Saharan Africans are infected with HIV, an increase of 1.1 million since 2004.9 Seventy-two percent of deaths due to AIDS occur in sub-Saharan Africa.10

Modes of HIV transmission vary widely by region. For example, injecting drug users account for 67 percent of all HIV cases in Eastern Europe and Central Asia.11 In South and Southeast Asia, in contrast, they account for 22 percent of cases, while 49 percent of victims there are infected through commercial sex work (8 percent are sex workers; 41 percent are clients).12 Men having sex with men accounted for 4 percent of HIV cases in Eastern Europe and Central Asia, 5 percent in South and Southeast Asia, and 26 percent in Latin America.13

In 2006 there were more women infected with HIV in every region of the world than ever before.14 Women are at particularly high risk in countries with rampant infection rates, since they are not traditionally in a position of power or decisionmaking in their sexual relationships. In the Caribbean, North Africa, Oceania, and the Middle East, almost half the adults infected with HIV are women age 15 or older.15

In sub-Saharan Africa, women outnumber men in infection estimates, accounting for up to 60 percent of people living with HIV.16 According to Ludfine Anyango, national HIV/AIDS coordinator at Action Kenya-International, “many women cannot even choose when to have sex or not. Many cannot ask their husbands to use a condom because in addition to being thought as unfaithful, they fear being beaten. The woman then has no choice but to continue having unprotected sex with her spouse.”17 Street violence likewise exposes female sex workers to high risk of HIV infection for the same reasons, according to Ros Sokunthy of Women’s Agenda for Change, a Cambodia-based organization fighting to protect women’s rights, including those of female sex workers.18

In 70 countries surveyed, use of testing and counseling services has quadrupled since 2001, from 4 million to 16.5 million people in 2005.19 In Sudan, where HIV prevalence in North Africa is at its highest, 350,000 people—1.6 percent of the country’s population—were living with HIV in 2005.20 Current knowledge of the benefits of contraception and of how HIV is transmitted is pitifully poor there: in a 2005 survey of police officers in Khartoum, only 2 percent of the men knew that condoms could prevent transmission.21 Certain countries, including Iran, have implemented clean syringe and methadone operations as well as government- funded clinics that offer free HIV counseling, testing, and treatment.22

From 1996 to 2005, funding for HIV/AIDS assistance efforts in low- and middle-income countries increased from $300 million to $8.3 billion.23 But current trends in existing pledges may indicate the funding is waning, with pledges totaling just $8.9 billion in 2006 and $10 billion in 2007.24 The United Nations has projected needs at $14.9 billion in 2006, $18.1 billion in 2007, and $22.1 billion in 2008, highlighting a sustained gap between current funds and future needs over the next few years.25 In August 2006, the Bill & Melinda Gates Foundation committed $500 million over five years to the Global Fund to Fight AIDS, Tuberculosis and Malaria—the largest gift to support AIDS and other disease research from a nongovernmental source since the fund was established.26

In 2000, after settling a lawsuit by the South African government on patent rights, the leading producers of HIV medicines established the Accelerating Access Initiative (AAI) in collaboration with five U.N. agencies, including UNAIDS, to provide more anti-retroviral medicines at lower costs.27 An AAI report in June 2003 indicated that the number of Africans receiving treatment under this initiative was eight times higher than when the program began in 2000, totaling approximately 75,000.28 By March 2005, AAI was reaching more than 427,000 patients.29

Pharmaceutical companies have made considerable strides in working with corporate firms and national governments to craft national efforts that address HIV infection and alleviate stress from limited access to drugs.30 Public-private partnerships are an encouraging development, such as Johnson & Johnson’s royalty-free collaboration with the International Partnership for Microbicides—a cross-sector partnership that aims to develop and distribute its recently developed compound TMC120 as an experimental vaginal microbicide.31

Generic anti-retroviral drugs are beginning to dominate the global consumer drug market. In 2006, preliminary statistics suggested that 70 percent of anti-retrovirals in Nigeria, Haiti, and Zambia were generic.32 This influx is primarily the result of the U.S. Food and Drug Administration’s approval of 29 generic AIDS drugs.33

In the 1990s, Brazil had an HIV rate that rivaled South Africa’s, but since 1996 it has cut the infection rate to 0.6 percent of the adult population—including an 80-percent reduction in HIV-related hospitalization—by becoming the first country to offer universal treatment.34 But as HIV patients build resistance to old drugs and as drug companies refuse to offer contracts for newer generic versions, Brazil was forced to spend 75 percent more on anti-retrovirals between 2004 and 2006.35 Although the government has negotiated with drug companies for the cheapest price outside of Africa, it still has to pay $17,000 a year per patient—a jarring price tag for a government accustomed to buying older generic drugs for hundreds of dollars per patient annually.36