Stark Statistics on AIDS/HIV from the U.N.
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GWEN IFILL: Twenty years have passed since the first cases of Acquired Immuno-Deficiency Syndrome or AIDS were reported.
Since then AIDS has moved to epidemic status as the leading cause of death in sub-Saharan Africa and the fourth biggest killer in the world. Worldwide, 40 million people are living with HIV, the virus that causes AIDS, with 5 million new cases and 3 million deaths reported last year.
A new United Nations report shows the disease is not only spreading but at record rates in new areas of the world. The steepest increases are in Eastern Europe and Central Asia. In Russia, reports of new infection have doubled. In Estonia, where only 12 new cases were reported in 1999, 1,400 were reported during the past 12 months.
In China, reported HIV infections rose by 67 per cent and in sub-Saharan Africa, which has attracted most attention, the rate for new infections has slowed overall from 3.8 million to 3.4 million but the disease is spreading in some places like the populous country of Nigeria.
For more background on the new U.N. findings, we’re joined by Dr. Desmond Johns, a South African who heads the U.N. AIDS Office in New York; and Laurie Garrett, science and medical correspondent for Newsday and author of Betrayal of Trust, the Collapse of Global Public Health.
Dr. Johns, one of the most interesting findings in the report is the spread of AIDS in Eastern Europe. What is behind that?
DR. DESMOND JOHNS: Thank you, Gwen. The spread of the infection in Eastern Europe is largely due to young people experimenting with intravenous drug use and with sex.
GWEN IFILL: How about in China? We hear about the great spread in China. Why is it spreading so much there?
DR. DESMOND JOHNS: Like much of the developing world, China has a range of factors which render people more vulnerable to the infection: Large migrating populations, poverty, a degree of gender inequality, which is driving the general epidemic amongst selected populations.
In addition, we have had a scandal involving blood transfusion in the Hainan Province in China which has greatly added to the number of infected people.
GWEN IFILL: Laurie Garrett, you covered this subject extensively and traveled in a lot of countries which were mentioned in this report. What has contributed to the spread of this disease? Is it the lack of funds, lack of political will? What’s driving this?
LAURIE GARRETT: All of the above. And more. I think when you combine sex, death and narcotics, you hit every taboo imaginable, and everybody runs for cover and doesn’t want to talk about it.
What we’re seeing now is that after a momentum had finally been building 20 years into this epidemic for national political leaderships and U.N. leadership to speak out by HIV/AIDS it’s suddenly all gone quiet once again.
GWEN IFILL: Why is that? How much of this had to do with international attention focus focused elsewhere after Sept. 11.
LAURIE GARRETT: Oh, I think that’s it in a nutshell. Sept. 11 shifted the entire global radar screen, and we saw our Congress respond by saying, well, we had committed a hefty $750 million to the global fund for AIDS, but now we need to shift our attention to bioterrorism and we’re going to lower our commitment to about $120 million.
GWEN IFILL: So what is the status of that global fund for AIDS that was announced with such fanfare?
LAURIE GARRETT: That’s a good question what the status of that fund is, because not a lot of information is terribly public but what we hear about the behind-the-scenes negotiations sounds like it’s been deeply controversial and it’s still mired in some real difficulties.
Only one nation has actually given its money to the World Bank and deposited in the bank account. That’s Italy, and that’s $200 million which is significantly less than the target goal of $7 to $10 billion.
GWEN IFILL: Doctor Johns, we have read extensively about the AIDS epidemic in sub-Saharan Africa. This reports shows that the rate of infection seems to be decreasing but it’s not all good news, is it?
DR. DESMOND JOHNS: Certainly not, Gwen. In the first instance, we revised our methodology to a certain extent which could account for some of the decline that you see.
We also believe that the pool of people at risk has been diminished as a national consequence of the epidemic itself. And this in turn has lowered the numbers to a certain extent.
GWEN IFILL: You talk about the way the numbers are being counted. What about… How many of these numbers are accurate? How much underreporting is there of people who suffer from HIV?
DR. DESMOND JOHNS: The question… The answer will actually vary depending on which geographical region we’re talking about. Certainly in sub-Saharan Africa, our reporting is based on sentinel surveillance, anonymous unlinked and therefore fairly credible.
However, certain parts of the world such as Russia and Eastern Europe depend on case reporting. Case reporting requires that there is a conscious act of notifying the authorities as to the number of cases. And of course this depends on people testing in the first instance.
GWEN IFILL: So the numbers could be significantly worse than what you’re reporting today?
DR. DESMOND JOHNS: Yes. We estimate that it’s probably an underestimate by three- to five-fold.
GWEN IFILL: Laurie Garrett, one of the other things which we have all covered is the debate over the use of anti-retroviral drugs, which have had such success in the United States, around the world. What does the report tell us about where that debate stands?
LAURIE GARRETT: Where we stand is that there are a number of pilot projects underway on the ground in various African countries and in Latin America trying to do distribution of this very complicated drug regimen in one form or another but none of them are far enough along that one can draw any conclusions.
The largest of all the projects, the Botswana Project in which the Gates Foundation has sunk a lot of money, Harvard University’s involved, Merck Pharmaceuticals and so on, has yet to really get off the ground. They’re still trying to hammer out a lot of the methodological details.
GWEN IFILL: Has the pressure to bring the cost for these drugs down for these countries, has that had an effect?
LAURIE GARRETT: Well, the price has come down but it still is completely out of control for people who live in countries where per capita spending on health is less than $12 a year.
GWEN IFILL: Dr. Johns, what does this report tell us about what should be happening next?
DR. DESMOND JOHNS: Well, it certainly says that we need to bear in mind that this is a global epidemic of enormous proportions. And it’s going to require a response on the same scale.
It also says that we need to look a lot closer at the success stories that we’ve seen in diverse sections as Uganda, Senegal, Cambodia, Thailand, extract the lessons that can be learned and applies these with suitable cultural adjustments to places where the epidemic is running out of control.
GWEN IFILL: And, Laurie Garrett, 20 years later, we all in this country presume to know what AIDS is and how it progresses.
But around the world that’s not necessarily the case. What is your assessment of the state of understanding about what AIDS is and what degree does that drive these numbers?
LAURIE GARRETT: Well, I think there are a lot of people in the United States of America who don’t fully understand what AIDS is and certainly don’t completely understand how HIV is transmitted.
When you get outside of countries where people have a concept of the germ theory of disease and at least a vague notion of what a virus is, understanding drops dramatically. I’ve been in countries where there’s no word in the language for virus. And there’s no real concept of a disease being transmitted by a living organism of one kind or another.
Then you can get to a place such as Ukraine or Russia where, according to the U.N. AIDS report today, this week anyway, it’s “the” fastest growing epidemic in the world. Yes, there’s a sound knowledge of basic biology, good education, and yet no one has really integrated that information into their own life and understood what that means for them.
What I’ve seen in places like Odessa, Ukraine or Moscow or out in, you know, Eastern Siberia are huge numbers of teenagers injecting drugs and sharing needles en masse. In one situation in Odessa I counted 1,000 kids injecting together simultaneously in a single hour. They don’t understand, even though they’ve learned some biology in school, that there is this tremendous risk associated with sharing that needle one to another.
GWEN IFILL: Or that there’s any connection between that and HIV/AIDS.
LAURIE GARRETT: The knowledge hasn’t connected.
GWEN IFILL: Laurie Garrett and Desmond Johns, thank you very much for joining us.
LAURIE GARRETT: Thank you.
DR. DESMOND JOHNS: Thank you, Gwen.