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AIDS: A World Wide Concern

December 1, 1997 at 12:00 AM EDT
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ELIZABETH FARNSWORTH: Today’s 10th annual observance of World AIDS Day comes as the United Nations and the World Health Organization say many more people have been infected than previously estimated. According to a new joint report nearly 31 million people have the human immunodeficiency virus, HIV, 30 percent higher than previous estimates. Only one in ten of those affected is aware of it, and 2/3 of those infected live in subsaharan Africa. To tell us more we’re joined now by Dr. Stefano Bertozzi, coordinator of policy, strategy, and research for the United Nations AIDS program. Thanks for being with us.

Dr. Bertozzi, this figure is quite a bit higher than the UN thought even a year ago. What’s changed?

DR. STEFANO BERTOZZI, UNAIDS: It’s a frightening figure, I agree, and unfortunately, it reinforces the fact that we’re faunfortunately, it reinforces the fact that we’re far from a situation where the AIDS epidemic is over. What’s happened is that we’ve reassessed the figures, and we had believed last year that approximately 8,500 people were being affected every single ple were being affected every single day. This year our estimate is 16,000 people being infected every day. Much of that difference is because we thought that the epidemic was slowing down in Africa, and, in fact, the opposite seems to be true, especially in Southern Africa. There have been dramatic increases in the proportion of people infected.

ELIZABETH FARNSWORTH: How bad is it in sub-saharan Africa? What are some of the figures?

DR. STEFANO BERTOZZI: It’s very variable from country to country, but some of the worst figures are coming out of Southern Africa. In Zimbabwe, for example, in the major urban centers, women going in for prenatal care–30 percent/40 percent–50 percent of women infected, and one border town with South Africa, seven out of ten women presenting for prenatal care were infected with HIV, but if you look at the continent as a whole, it’s about 7 1/2 percent of adults that are infected.

ELIZABETH FARNSWORTH: And why is it spreading so rapidly? This is basically through heterosexual contact, right?

DR. STEFANO BERTOZZI: It is largely through heterosexual contact, almost entirely, but recognize that any place that you’ve got heterosexual spread, men and women are being infected, and in Africa, it’s about one to one, men to women, which means that many children are also being infected from their mothers. In fact, last year more than 1/2 million children were infected with HIV.

ELIZABETH FARNSWORTH: Tell us about places where there is some success in confronting HIV. Uganda has had some success, right?

DR. STEFANO BERTOZZI: Exactly. And, in fact, that contributed to our relatively–our under estimates last year. We saw the HIV epidemic starting to level off in Uganda, and, in fact, in young people, especially adolescent girls and boys, we’ve seen lower, significantly lower incidence rates of HIV in Uganda, realizing Uganda was one of the first countries to be affected in Africa and was a country that really confronted the AIDS epidemic and instituted prevention programs, and we’re seeing the payoff now in changed behavior and in reduced incidence.

ELIZABETH FARNSWORTH: And are some of the other countries trying to do the same things Uganda has done?

DR. STEFANO BERTOZZI: Absolutely. There are prevention programs in many countries, but unfortunately, prevention programs that are not to the scale needed, given the size of the epidemic. And that’s especially true, as we’re seeing now, in Southern Africa, in countries like Zimbabwe, Zambia, Botswana, and South Africa. In South Africa we now estimate that–actually the government of South Africa estimates that about one in ten adults are infected with HIV.

ELIZABETH FARNSWORTH: What has to be done? What did Uganda do?

DR. STEFANO BERTOZZI: It’s prevention programs that work on multiple fronts. To start with, about 50 percent of the infections are in young people between the ages of fifteen to twenty-four, so it’s essential we get prevention programs working that are targeting that age group. We need to make sure that in schools and out of school that young people have the knowledge and the skills to deal with HIV infections and to prevent themselves from becoming infected. But it has to go much beyond that. It has to go beyond that to the societal level. It has to be a discrimination and stigma that people with HIV infection face in countries around the world has to decrease so that it’s okay for people to have HIV infection and be public about it and raise the level of awareness in the communities and in the society. There has to be care available for people so that that’s another motivation for people to find out whether they’re infected or not.

ELIZABETH FARNSWORTH: And the problem in Africa is that the care and especially the drugs are so terribly expensive, is that right?

DR. STEFANO BERTOZZI: Well, there’s been very hopeful news, as I know you know, over the last couple of years in the U.S. and in Europe because of new therapies that for a substantial proportion of people living with HIV offer real new hope. Unfortunately, these are so expensive that most people in developing countries don’t have access. In Africa, in particular, they’re largely out of reach, and that creates a very different situation obviously than we’re facing here.

ELIZABETH FARNSWORTH: You’re talking about in the United States these drugs are about $15,000 a year, right, which is considerably above what most people in Africa would be–would have access to.

DR. STEFANO BERTOZZI: It’s at those prices completely unrealistic, absolutely.

ELIZABETH FARNSWORTH: What about Asia? What’s happening there? Thailand had such a high incidence of AIDS and Thailand has also had some success like Uganda, right?

DR. STEFANO BERTOZZI: Well, Thailand was the place where the epidemic initially moved the fastest in Asia, and as you say, like Uganda, where the government really responded aggressively. Much of the AIDS epidemic was fueled by the commercial sex industry, and the government instituted a program called the 100 Percent Condom in the brothels. And that–that program working with the clients, working with sex workers, working with young people, has turned much of the epidemic in Thailand with the new infection rates in young people falling dramatically. The new military recruits have seen infection rates fall dramatically. Unfortunately, elsewhere in Asia the picture isn’t nearly as optimistic. In Cambodia, for example, frightening new statistics. In India, the epidemic continues to climb. We estimate that there were between 3 and 5 million people infected with HIV now in India.

ELIZABETH FARNSWORTH: Dr. Bertozzi, why do only one in ten know that they have it?

DR. STEFANO BERTOZZI: Well, you have to recognize that the situation with respect to access to testing is very different in much of the developing world than it is in the United States. Here people have largely access to testing if they want to find out if they’re–if they’re infected with HIV or not. There was also strong motivation here to know whether you’re HIV-infected or not because there’s successful treatments available if you are. The situation is very, very different in most developing countries. In Africa, very little therapy is available. Certainly, anti-retro viral therapy is largely unavailable. Same thing in much of Asia. And in that sense–in that situation, the motivation to be tested is certainly less. In addition, people don’t have access to testing. They don’t have a nearby testing center where they can go to be tested either, because it’s too far away, because they can’t afford to be tested, or because there isn’t one available where they happen to live.

ELIZABETH FARNSWORTH: Now, there is some good news, isn’t there, in the United States, the number of new cases dropped 6 percent last year, is that right?

DR. STEFANO BERTOZZI: 6 percent. Exactly.

ELIZABETH FARNSWORTH: Why is this good news happening in the United States? Is it because of the drugs that you talked about?

DR. STEFANO BERTOZZI: Exactly. What we’re talking about there is it’s difficult to know. Hopefully, there is also some decreasing incidence, meaning new infections, but most of what you’re seeing with the 6 percent drop is the result of the fact that people are healthier longer because of the drugs that are available in the U.S. And that’s true also in Europe. It’s true in Australia, but it’s largely not true in most of the developing world.

ELIZABETH FARNSWORTH: And it’s not true in the United States for black men and women, is that right? Those rates are way up.

DR. STEFANO BERTOZZI: Well, let’s divide the question up a little bit.

ELIZABETH FARNSWORTH: Yes.

DR. STEFANO BERTOZZI: It’s true, I think, in the United States, although, as you know, our work is mostly with developing countries, but in the United States minority and marginalized populations certainly have less access to care, less access to the drugs that you’ve been talking about, than is the case for non-minority populations in the U.S.. And you’d expect the drop–a 6 percent drop, would, therefore, be less in those populations.

ELIZABETH FARNSWORTH: Dr. Bertozzi, are you worried that people have become complacent about AIDS, that because there was the thought that the corner had been turned on AIDS, people are not caring about it the way they did say five years ago?

DR. STEFANO BERTOZZI: Worried isn’t strong enough. I’m seriously worried. I’m frightened about that because we’re seeing a global epidemic that’s accelerating, not slowing down, and our response globally has to accelerate, not to slow down. And I think you’re absolutely right, that in some countries, where people perceive that a cure is around the corner, that that’s causing people to let up. We need to do exactly the opposite because in this increasingly globalized world, with travel, with increasingly interdependent markets, we need to be worried about the global epidemic. And the global epidemic has now 30–almost 31 million people living with HIV–sixteen thousand new people a day. I mean, if you put that into the context of some of the other stories that we’ve been watching around the world recently, that’s a staggering number, and it’s one that ends up touching the United States even if most of the new infections are outside of the United States.

ELIZABETH FARNSWORTH: Well, Dr. Bertozzi, thanks for being with us.

DR. STEFANO BERTOZZI: Thank you very much.