by Dan Perkins

December 1, 2005 marked the 18^th observance of World AIDS Day, an international observance organized to draw world attention to the continuing challenges posed by the epidemic.  The theme of this year’s observance is Stop AIDS—Keep the Promise.  

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO), the total number of people living with HIV in 2005 was 40.3 million, which is double the number reported in 1995.

There were close to five million new HIV infections reported worldwide in 2005, 3.2 million in sub-Saharan Africa alone.  In the same year, three million people died of AIDS-related diseases around the world, and more than half a million were children.  

In 2005, AIDS has presented itself as an epidemic afflicting people of all ages, genders and nationalities.  The facts are a troubling reminder of the enormous social and economic devastation that is accompanying the spread of the disease – devastation that threatens to disrupt the emergence of a vibrant global economy.

HIV and AIDS Epidemic Worldwide December 2005
People Living with HIV in 2005	TOTAL	40.3 million (36.7-45.3 million)
	Adults	38.0 million (34.5 - 42.6 million)
	Women	17.5 million (16.2 - 19.3 million)
	Children under 15 years	2.3 million (2.1 - 2.8 million)
New Infections of HIV in 2005	TOTAL	4.9 Million (4.3 - 4.6 Million)
	Adults	4.2 Million (3.6 - 5.8 Million)
	Children under 15 years	700,000 (630,000 - 820,000)
AIDS Deaths in 2005	TOTAL	3.1 Million (2.8 - 3.6 Million)
	Adults	2.6 Million (2.3 - 2.9 Million)
	Children under 15 years	570,000 (510,000 - 670,000)
Note: The ranges around the estimates in this table define the boundaries within which the actual numbers lie, based on the best available information. Source:  UNAIDS and World Health Organization

Women and AIDS

Around the world, an increasing number of women are being infected with HIV, and UNAIDS and WHO point to widespread inequalities in the treatment of women as major contributors to the increase.  A release by the two organizations, noted that in many countries, marriage, and women’s own fidelity are not enough to protect them against HIV infection.

The agencies concluded that in order for HIV-prevent activities to succeed, they need to occur alongside other efforts, such as legal reform (including property rights) and the promotion of women’s rights that address and reduce violence against women.

Children and AIDS

The most vulnerable victims of the AIDS epidemic are children.  Many are orphaned by sick and dying parents, or are infected at birth.  In war-torn regions of Africa and elsewhere, children are often dual victims, of rape and HIV infection.

A generation of young people has grown up not knowing a world without AIDS. For too many young people, especially in developing nations, AIDS is not an abstraction, it is a dominant reality. In countries hardest hit by the pandemic, many young people are coming of age as HIV-positive people, and there is a growing debate as to what these children need to know to protect themselves and their sexual partners.

In America, an organization known as Sexuality Information and Education Council of the U.S. (SIECUS) used the World AIDS Day observance to draw attention to young people and AIDS. The group promotes "sexuality education for people of all ages," along with protected sexual rights and expanded access to sexual healthcare.

According to a release issued by the organization on AIDS World Day 2005, five young people worldwide become infected with HIV every minute – a figure that represents over 7,000 young people each day.

In the release, SEICUS criticized U.S. support for global HIV-prevention programs that emphasize abstinence-until-marriage.  According to SEICUS, those programs keep young people in the dark by not providing the education necessary to make "informed choices about relationships, sex, and their futures.

SEICUS’s World AIDS Day release stated, “The President's Emergency Plan for AIDS Relief (PEPFAR), the guiding policy for global HIV/AIDS funding, offers no policy support or funding for comprehensive HIV-prevention programs.” The release noted that PEPFAR will provide more than $133 million annually to abstinence-until-marriage programs in each of 15 "focus countries" in Africa and the Caribbean, as well as Vietnam.

"HIV prevention does not exist in a vacuum, and young people require a wide range of services and support. Without honest and complete education, other interventions to keep our youth HIV-free are meaningless," said Joseph DiNorcia, Jr., president and CEO of SIECUS.

While the debate over the appropriateness of abstinence education will continue, health organizations agree that the solution to the spread of AIDS requires a comprehensive and well coordinated effort.

Preventing HIV Transmission

Good news can be found in the growing number of countries that are making progress in their fight against the spread of AIDS, despite the fact that the epidemic continues to outpace global efforts to contain it.  According to a newly published UNAIDS/WHO report on the global AIDS epidemic, sustained HIV prevention programs have played a key role in lowering the rate of HIV infections in several countries, including Haiti, Kenya and Zimbabwe. 

The number of people receiving antiretroviral treatment in low- and middle-income countries has tripled since the end of 2001.  However, best estimates suggest that only one in ten people in need of treatment and living in Africa were receiving it in mid-2005.  The numbers were one in seven in Asia.

To get ahead of the epidemic, UNAIDS and WHO assert that HIV prevention efforts must be scaled up and intensified, and delivered as part of a comprehensive response that simultaneously expands access to treatment and care.

Most Americans are unaware of how close the international pandemic of AIDS lies to their shores.  After Africa, the Caribbean has the second highest level of HIV prevalence in the world.  Even more disturbing are estimates that suggest only 5 to 10 percent of those who need care and treatment in the region are currently receiving it. The White House reported that Haiti and Guyana are two nations that receive special focus under PEPFAR, although the Plan extends to many nations in the region.  In fiscal year 2005, the U.S. government spent over $75 million to address HIV/AIDS in the Caribbean, up 115 percent from spending levels in 2003.

In observance of World AIDS Day President Bush stressed the importance of the global fight against HIV/AIDS and actions being taking both at home and abroad to fight the disease, and he renewed America's commitment to continue to lead the fight against the disease.

AIDS in America

According to the UNAID and WHO, unprotected sex between men remains the primary mode of transmission of HIV in the United States, accounting for 63 percent of newly-diagnosed HIV infections reported in 2003.  Sharing needles accounted for roughly 20 percent of new infections in the same year.  For American women living with HIV, unsafe heterosexual intercourse is the primary means of transmission.  It accounted for an estimated 73 percent of the cases reported in 2003.

While AIDS continues to be viewed by the American public as a disease afflicting primarily gay, white men, the facts present a much more complex and menacing picture, especially for the African American population.

AIDS among African Americans

African Americans make up roughly 13 percent of the U.S. population, but statistics regarding rates of HIV infections and AIDS related deaths reveal alarming trends.

In 2003, African Americans accounted for 48 percent of the reported new cases of HIV infection in the United States. 

One half of the people who died of AIDS in the United States in 2003 were African Americans.

The spread of the disease among African American women is no less disturbing.  African American women are more than a dozen times as likely to be infected with HIV as their white counterparts, according to a UNAID/WHO fact sheet.

The occurrence of HIV among African American young men who have sex with men is 32 percent – that’s almost one in three - four times the rate of occurrence among their white counterparts (currently at 7 percent), and more than twice that among their Latino counterparts (14 percent).

The UNAID/WHO fact sheet cited earlier noted that although AIDS therapy in the U.S. has progressed steadily, “African Americans appear not to be benefiting equally from such life-prolonging treatment.”  The fact sheet referred to a recent study that indicated African Americans are half as likely to receive antiretroviral treatment compared with other population groups.

The most compelling evidence of the catastrophic effect AIDS is having on the African American community is the fact that AIDS is now among the top three causes of death for African American men ages 25-54 and for African American women ages 25-34.

Finding Hope

Despite sobering statistics, there is evidence that individuals and governments are beginning to take the steps necessary to address the AIDS epidemic.

Before the President Bush announced his emergency plan for AIDS relief (PEPFAR) in 2003, only 50,000 of the more than four million people in sub-Saharan Africa that needed immediate AIDS treatment were receiving medicine, according to the White House.  After two years, roughly 400,000 sub-Saharan Africans have received and continue to receive needed treatment.  In addition, resources are now being directed to a variety of organizations providing health care in the developing world, including faith-based and community organizations.  In the United States, the federal government provides more than $17 billion annually to help people living with HIV/AIDS.

The coordinator of the federal government's global AIDS efforts is Ambassador Randall Tobias.  In observance of World AIDS Day, Tobias fielded questions from the public during an online interactive forum.  When asked how much responsibility for preventing AIDS from spreading is the government's, and how much is the people's, the ambassador responded by stating that the fight against the spread of HIV/AIDS is everyone's responsibility. 

"It starts with citizens doing what they can, at the grassroots level, to combat the stigma that is one of the greatest enemies we face," wrote Tobias.  "That means becoming educated about the disease, talking openly about it, and responding to people living with HIV/AIDS with compassion.  That fuels a very positive cycle, in which more and more people are willing to be tested and learn their status, which in turns enables them to seek treatment if needed and take appropriate prevention steps," he continued.

The End