Global Policy Forum

By Sarah Boseley

The lethal spread of the HIV/Aids pandemic across the globe is speeding up, in spite of intensifying efforts on the part of UN agencies, the US, Britain and other European governments to turn the tide. A record five million people were infected by the virus last year and nearly three million died.

The UN's latest bi-annual report on the state of the pandemic made it plain yesterday that the HIV virus that causes Aids is defeating man's best efforts to contain it. There are 38 million people carrying the virus, sub-Saharan Africa is being devastated, and the fastest spread is in Asia and eastern Europe.

"More people than in any previous year became infected with HIV. That is clearly a failure to reach the people who need it with prevention methods. More people than ever before died of Aids. That is a failure to reach them with treatment," said Peter Piot, executive director of Unaids, at the launch of the report in London yesterday. The epidemic, he said, is reaching its global phase, and is no longer is a problem largely confined to sub-Saharan Africa.

One in every four new infections is occurring in Asia, where huge populations are at risk, said the report, published just before the international Aids conference in Bangkok, which opens this weekend. There have been sharp increases in the numbers infected in China, Indonesia and Vietnam, while India alone has 5.1 million people with HIV - the second largest number infected in any country, after South Africa.

In eastern Europe and central Asia, 1.3 million have the virus, spread largely by injecting drug use. Russia, with more than three million injecting drug users and 860,000 with HIV, is one of the worst hit.

It is a dispiriting picture, because more work and money is going into the battle against the world's worst disease outbreak than ever before, both in helping people to protect themselves against contracting the virus and more recently in efforts to get drugs that can prevent HIV developing into Aids to people in poor countries.

But still not enough is being done, said Dr Piot. "The world is falling short on prevention. Preventing new infections will at the end of the day stop this epidemic," he said. "Only one in five who need it have access to HIV prevention - [such as] education of children in schools, access to condoms and access to clean needles for those who are injecting drugs."

Limited progress

There had been some progress on treatment, he said, but too little. There are now about 440,000 people in the developing world on Aids drugs, which keep the level of the virus in the blood low, although they are not a cure. Half of those people are in Brazil, although the drugs are becoming more available in Asia. Where they are most needed - in sub-Saharan Africa with its 25 million infected and where 2.2 million people died of Aids last year - the antiroviral drugs that can keep people alive are still rare. Treatment, said Dr Piot, "is still dramatically, shockingly low in Africa".

He expects it to improve. The World Health Organisation has set a target of three million people on treatment by 2005 and international funds are being made available to poor countries that want to put into place treatment plans. President George Bush has pledged $15bn (£8.1bn) over five years to fight Aids, which the US has recognised as a threat to world security. Philanthropic foundations, such as that of Bill and Melinda Gates and also Bill Clinton, are putting money and muscle into the struggle.

But nobody yesterday was underestimating the scale of the challenge, even though drug prices have come down dramatically.

Many of the worst affected countries are hard-pressed to draw up treatment plans and are very short of nurses, doctors and hospitals, even without the Aids epidemic. They need to train people to ad minister the drugs and overcome the stigma of the disease to persuade people to come forward for testing before they become sick.

But there is little alternative. Prevention efforts have been successful in a few countries such as Thailand and Uganda but have not slowed the pandemic and need a rethink, said Dr Piot.

For many women in Africa, the mantra of ABC - abstinence, be faithful and condoms - which is regularly recited by outside agencies and especially the US is "pretty irrelevant", he said. The Aids pandemic in Africa is hitting women worst. Nearly 60% of the victims are female, and they often do not have the option of abstinence, fidelity or condom use. Many are subject to violent, non-consensual sex by men.

"To ensure women become less infected, we have to target men," said Dr Piot. "We are getting into a need for quite fundamental and long-ranging behaviour change. We have to change norms in society." One of the best hopes for women, he said, was the development of a microbicide - a drug that can prevent the transmission of HIV during intercourse. Clare Short, as international develop ment secretary, put substantial British funding into microbicide research, which has not yet borne fruit, although her successor, Hilary Benn, said yesterday that five clinical field trials were about to get under way.

The UK is the second biggest donor to HIV/Aids initiatives, and yesterday Mr Benn announced a further £116m to two UN agencies involved in the fight - Unaids and the United Nations Population Fund. He also launched a paper setting out how the Department for International Development plans to push for high quality family planning in developing countries.

"Sexual and reproductive health and Aids are inextricably linked. By taking action on one, we know we are also helping to tackle the other," he said. The statistics in the Unaids report have been collated from a number of sources, including countries' own estimates of the numbers infected, surveys and data from anonymous testing of women at antenatal clinics.

Unaids says some of the estimates are lower than previously, because of improved methodology, but there is no doubt of the upward trend of infections and deaths.