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:
The newly independent states
Previously characterized by very low prevalence, the region is now experiencing an extremely steep increase in the number of people living with HIV/AIDS. While the estimated cumulative number of HIV/AIDS cases was 170,000 at the end of 1997, it climbed to 400,000 by end 1999.
Parallel epidemics of HIV, injecting drug use and sexually transmitted infections are unfolding in a social context of economic crisis, rapid social change, increased poverty and unemployment, growing prostitution, and changes in sexual norms.
The bulk of new HIV infections occurred in two countries, Russian Federation and Ukraine, and were caused by unsafe practices among injecting drug users. The potential for further spread is enormous: the Russian Federation, for example, has an estimated 1-2.5 million injecting drug users, compared with 130,000 people already infected. Clearly, hundreds of thousands of drug users and their sex partners are at immediate risk of infection.
The skyrocketing prevalence of sexually transmitted infections - with reported rates of syphilis of more than 200 per 100,000 - is yet another warning sign that transmission through sex may grow in importance.
In the Russian Federation, the epidemic continues to spread, both in larger metropolitan areas and in smaller provincial cities.
In Moscow city and region, more than 7000 new HIV cases were reported during 1999, and in Irkutsk, Siberia, more than 2200 new cases were reported during the same period. Here, as in other newly independent states, the actual number of newinfections is higher than the number of officially reported cases.
In St Petersburg, only 4 HIV-positive persons were identified among 1500 injecting drug users tested in 1996-1997. In 1999, surveys among injecting drug users found HIV prevalence rates of 12%, which rose six months later to 16%.
Looking at recorded HIV cases alone, one sees a steep upward trend in the country. Up to the end of 1998 there were just over 10,000 cases. The year 1999 saw just over 16,000 new infections, while 10,000 new infections were recorded in just the first three months of this year.
In Ukraine the annual number of diagnosed HIV infections jumped from virtually zero before 1995 to around 20,000 a year from 1996 onwards.
As a result, the estimated number of people living with HIV/AIDS has grown from 110,000 in 1997 to 240,000 at the end of 1999. Ukraine is now estimated to have an HIV prevalence rate among adults (aged 15-49) of just under 1%, the highest rate in the region.
The proportion of HIV diagnoses that are in injecting drug users seems to have decreased from about 80% to 60%, indicating that an increasing number of Ukrainians are becoming infected through unsafe sex.
In Belarus, an HIV prevention programme among drug users in Svetlogorsk, which included education about safe injecting and safe sex and provided clean syringes, seems to have led to far safer behaviour among drug users. In 1997, before the prevention programme began, 92% of those surveyed said they shared syringes. By 1999, this percentage had dropped to 35%. While some people did continue toreuse syringes, the proportion that cleaned them before using them again rose to 55%, from just 16% before the prevention campaign. The programme, which cost around US$0.36 per disposable syringe distributed, is estimated to have prevented over 2000 cases of HIV infection by its second year of operation, at a cost of around US$29 per infection prevented - far below the cost of an AIDS case to a family or a health system. The Belarus campaign was bolstered by a change in the law, which made it legal to carry syringes.
Between 1996 and 1999 there was a significant drop in the proportion of young people aged 15-19 among those testing HIV-positive. During the same period, HIV prevalence among army recruits dropped sharply, from 670 to 210 per 100,000 tested. This demonstrates the impact of a strong national response in Belarus.