UNAIDS, the multi-agency UN coordinating body for AIDS prevention and control, has produced its increasingly horrifying review of the world AIDS situation, just ahead of next month's world AIDS conference in South Africa. We present here an edited version of five of the organization's "fact-sheets" relating to the most affected regions and countries, including - here and there - some hints of success:
While some gains were made in prevention and care in a number of countries, there were 4 million new HIV infections in sub-Saharan Africa during 1999. In Africa, AIDS now kills ten times more people a year than war.
There are now 16 countries in Africa in which more than one-tenth of the adult population (aged 15-49) is infected with HIV.
In the six countries of southern Africa, AIDS is expected to claim the lives of between 8% and 25% of today's practising doctors by the year 2005.
In seven countries, all in the southern cone of the continent, at least one adult in five is living with HIV. In countries where 10% of the adult population has HIV infection, almost 80% of all deaths in young adults aged 25-45 will be associated with HIV.
Infection rates in young African women are far higher than in young men. According to studies presented in the report, the average rates in teenage girls were over five times higher than in teenage boys. Among young people in their early 20s, the rates were three times higher in women. In Africa, women's peak infection rates occur at earlier ages than men's. This helps explain why there are an estimated 12 women living with HIV for every 10 men in this region.
A recent study estimates that in 1997, public health spending for AIDS alone already exceeded 2% of gross domestic product (GDP) in 7 of 16 African countries sampled - a staggering figure in nations where total health spending accounts for 3-5% of GDP.
In Zimbabwe, by 1997 the likelihood of a 15-year-old woman dying before the end of her reproductive years quadrupled from around 11% in the early 1980s to over 40% by 1997. More than 2000 Zimbabweans die of AIDS each week.
Nevertheless Zimbabwe has established child-friendly courts in every province after finding that low rates of conviction in cases of sexual assault and rape, particularly of children, were usually due to lack of testimony. With the help of a friendly intermediary, abused children can testify in privacy without fear or embarrassment. They are also provided with male and female dolls to demonstrate the sexual acts to which they may have been subjected. More people are now bringing cases to trial, and the percentage of convictions is on the rise. The government also provides medical and psychological care to abused children through the Family Support Trust, a special service located within a major hospital in Harare. In 1998-99, over 5% of children aged 13-16 seen at the Family Support Trust were estimated to have become infected with HIV at the hands of their abuser.
In Botswana, a shocking 35.8% of adults are now infected with HIV, while in South Africa, 19.9% are infected, up from 12.9% just two years ago. The adult HIV prevalence rate in Botswana has more than tripled since 1992, when it was an estimated 10%.
With a total of 4.2 million infected people, South Africa has the largest number of people living with HIV/AIDS in the world, as well as one of the world's fastest-growing epidemics. Already, one in four South African women between ages 20 and 29 are infected with the virus.
More than 1 in 4 adults living in Zambian cities are HIV-positive, and more than one in seven Zambian adults are infected in the country's rural areas. A study in Zambia showed that in one hospital, deaths among health care workers increased 13-fold over the 10-year period from 1980 to 1990, largely because of HIV.
On the other hand, the percentage of pregnant girls aged 15-19 infected with HIV in the capital, Lusaka, has on average dropped by almost half in the last six years. The percentage of unmarried women who were sexually active fell from 52% to 35% between 1990 and 1996.
And premarital sex is losing popularity in Zambia: only 35% of young women in Lusaka reported premarital sex in 1996 compared with 52% in 1990. Male sexual abstinence is also rising. In 1998, more than half of young unmarried men reported no sex in the past year compared with just over a third two years earlier. Additionally, the frequency of casual sex is decreasing, as shown by a fall in the proportion of men reporting two or more casual partners in the past year.
In West Africa, relatively less affected, prevalence rates in some countries are creeping up. Côte d'Ivoire is already among the 15 worst-affected countries inthe world. In Nigeria, by far the most populous country in sub-Saharan Africa, over 2.7 million people are infected with HIV.
By the year 2010, crude death rates in Cameroon will have more than doubled as a result of HIV/AIDS. An estimated 340,000 people in Ghana are currently living with HIV.
Infection rates in East Africa, once the highest on the continent, hover above those in West Africa but have been exceeded by the rates now being seen in the southern cone.
The prevalence rate among adults in Ethiopia and Kenya has reached double-digit figures and continues to rise.
Since the epidemic began, AIDS has created some 12.1 million orphans in Africa, out of a global total of 13.2 million AIDS orphans. Before AIDS, about 2% of all children in developing countries were orphans. By 1997, the proportion of children with one or both parents dead had skyrocketed to 7% in many African countries.
HIV-positive patients have occupied 39% of the beds in Kenyatta National Hospital in Nairobi, Kenya, and 70% of the beds in the Prince Regent Hospital in Bujumbura, Burundi.
Through strong prevention programmes, Uganda has brought its estimated prevalence rate down to around 8% from a peak of close to 14% in the early 1990s, making it the first country in sub-Saharan Africa to reverse its own epidemic. HIV prevalence among 13-19-year-old girls has fallen significantly over an eight-year period, while the rate in teenage boys - always much lower because boys areless likely than girls to have partners in the older, more heavily infected age groups - has remained roughly stable. The percentage of teenage girls who had ever used a condom tripled between 1994 and 1997.
Even rural areas, which are frequently among the last to evidence signs of both the advent and the reversal of an HIV/AIDS epidemic, have shown a reduction in HIV rates. In some areas of rural Uganda, for example, HIVinfection rates among teenage girls dropped to 1.4% in 1996-97, from 4.4% in 1989-90. This was matched by a fall in teen pregnancies.
In Egypt, the government has helped set up an AIDSHotline and Counselling Service (at the time of its evaluation, Egypt was the only Middle East government to have done so). Staffed by counsellors and widely advertised, this anonymous hotline attracts thousands of calls and provides a vital link to HIV information and counselling services that would not otherwise be accessible. This is a significant step in a society where HIV vulnerability is heightened by cultural taboos that prohibit open discussion of topics such as sexuality, condom use, premarital sex and homosexuality.