LONDON -- The world is losing the race against the AIDS virus, which last year infected a record 5 million people and killed an unprecedented 3 million, the United Nations reported Tuesday.
The virus has now pushed deep into Eastern Europe and Asia, and tackling it will be more expensive than previously believed, according to the most accurate picture to date of the global status of HIV infections.
The number of people living with HIV has risen in every region. UNAIDS chief Dr. Peter Piot said the deaths and infections were a testament to the world's failure to get prevention and treatment to those who need it.
Nine out of 10 people who urgently need treatment are not getting it, and prevention is only reaching one in five at risk, the report said.
The AIDS epidemic is now entering its globalization phase, Piot said at the launch of the U.N. AIDS agency's report, which is compiled every two years and released ahead of the International AIDS Conference, which kicks off this weekend in Bangkok, Thailand.
"AIDS is truly a disease of our globalized world. Whereas until recently AIDS was largely a problem for sub-Saharan Africa, one out of every four new infections is occurring in Asia today, and the fastest growing epidemic is happening in Eastern Europe," Piot said. "The virus is running faster than all of us."
In revised estimates based on improved information, the report says about 38 million people are infected. Until now, experts had put the ranks of the HIV afflicted at about 40 million.
Although there have been successes and money is starting to flow, the cost of tackling the pandemic has risen. Two years ago, the United Nations predicted that $10 billion a year would be needed by 2005. Now that figure is $12 billion, because of the cost of delaying action and because the planned campaign is now more comprehensive than it has ever been, said Piot.
Less than half that money has been set aside so far.
The London-based aid agency ActionAid termed the latest figures "depressing and worrying."
"Business as usual cannot remain the answer. The world needs to spend a lot more money and it must also be more strategic in its approach to the epidemic," the group said.
Among the reported successes, many countries -- including Brazil, Uganda and Thailand -- have reduced HIV infections; prices for medicines have dropped dramatically; money is beginning to flow in for the global effort; more politicians are showing commitment to the fight; and medicines are becoming increasingly available in poor countries.
Among the major challenges are improving the plight of women; keeping health workers in the developing world; tackling the stigma surrounding the disease; and looking after children orphaned by it. In some places, the size of the health work force needs to quadruple, the report found.
AIDS remains untamed in Africa and progress there has been mixed. Prevalence is still rising in countries such as Madagascar and Swaziland, even though it is declining in Uganda.
In sub-Saharan Africa, the number of people living with HIV appears to have leveled off at about 25 million. However, that stability is deceptive: Both deaths and new infections are up, and it remains the worst-hit region.
Eastern Europe and Asia, which is home to 60 percent of the world's population, are emerging as the new front lines in the fight against AIDS.
In Asia, the disease is confined mostly to drug addicts, homosexual or bisexual men, prostitutes and their clients, and the sexual partners of people who frequent prostitutes.
"A country like Thailand shows that AIDS is a problem with a solution. In 1991, 140,000 people became infected in Thailand. Last year it was 21,000," Piot said. "So there is a major decrease, thanks to a massive promotion of condoms and of encouraging men to change their behavior, to reduce their partners and not engage in commercial sex."
In one worrying sign, there is a lack of leadership in the fight against AIDS in Asia, outside of Thailand and Cambodia, Piot said.
"Without such strong leadership, there's no way that we can contain this epidemic," he warned.
The epidemics in Central Asia and Eastern Europe are being driven by intravenous drug users. About 1.3 million people there have HIV, compared with 160,000 in 1995. More than 80 percent of the infected are under age 30.
Russia, with more than 3 million intravenous drug users, is one of the worst-hit in the region.
In Latin America, the epidemic is concentrated among drug addicts and homosexuals. Countries have low infection rates overall, but pockets are bad. For instance, in Brazil, the most populous country in the region, national HIV prevalence is below 1 percent, but in some cities, 60 percent of intravenous drug users have the virus.
In the Caribbean, the disease is mainly spread through heterosexual sex and in many places is focused around prostitution. The worst-affected country is Haiti, which has the highest infection rate outside Africa with 5.6 percent of the population afflicted.
Infections are on the rise in the United States and Western Europe, particularly among homosexual or bisexual men.
In the developing world, AIDS is increasingly becoming a women's issue, Piot said.
In sub-Saharan Africa, the infection gap between men and women has widened. There are, on average, 13 infected women to every 10 infected men, up from 12 to 10 in 2002, the report found.
The gap is even more pronounced among teenagers and young people. The ratio ranges from 20 infected girls to every 10 boys in South Africa, to 45 women to every 10 men in Kenya and Mali.
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