AIDS toll may reach 100 million in Africa alone

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AIDS toll may reach 100 million in Africa By TERRY LEONARD,

Associated Press Writer Sat Jun 3, 1:54 PM ET

JOHANNESBURG, South Africa - It began quietly, when a statistical

anomaly pointed to a mysterious syndrome that attacked the immune

systems of gay men in California. No one imagined 25 years ago

that AIDS would become the deadliest epidemic in history.

Since June 5, 1981, HIV, the virus that causes AIDS, has killed

more than 25 million people, infected 40 million others and left a

legacy of unspeakable loss, hardship, fear and despair.

Its spread was hastened by ignorance, prejudice, denial and the

freedoms of the sexual revolution. Along the way from oddity to

pandemic, AIDS changed they way people live and love.

Slowed but unchecked, the epidemic's relentless march has established

footholds in the world's most populous countries. Advances in

medicine and prevention that have made the disease manageable in the

developed world haven't reach the rest.

In the worst case, sub-Saharan Africa, it has been devastating. And

the next 25 years of AIDS promise to be deadlier than the first.

AIDS could kill 31 million people in India and 18 million in China by

2025, according to projections by U.N. population researchers. By

then in Africa, where AIDS likely began and where the virus has

wrought the most devastation, researchers said the toll could reach

100 million.

" It is the worst and deadliest epidemic that humankind has ever

experienced, " Mark Stirling, the director of East and Southern Africa

for UNAIDS, said in an interview.

More effective medicines, better access to treatment and improved

prevention in the last few years have started to lower the grim

projections. But even if new infections stopped immediately,

additional African deaths alone would exceed 40 million, Stirling

said.

" We will be grappling with AIDS for the next 10, 20, 30, 50 years, "

he said.

Efforts to find an effective vaccine have failed dismally, so far.

The International AIDS Vaccine Initiative says 30 are being tested in

small-scale trials. More money and more efforts are being poured into

prevention campaigns but the efforts are uneven. Success varies

widely from region to region, country to country.

Still, science offers some promise. In highly developed countries,

cocktails of powerful antiretroviral drugs have largely altered the

AIDS prognosis from certain death to a manageable chronic illness.

There is great hope that current AIDS drugs might prevent high-risk

people from becoming infected. One of these, tenofovir, is being

tested in several countries. Plans are to test it as well with a

second drug, emtricitabine or FTC.

But nothing can be stated with certainty until clinical trials are

complete, said Fauci, a leading AIDS researcher and

infectious diseases chief at the U.S. National Institutes of

Health.

And then there is the risk that treatment will create a resistant

strain or, as some critics claim, cause people to lower their guard

and have more unprotected sex.

Medicine offers less hope in the developing world where most victims

are desperately poor with little or no access to the medical care

needed to administer and monitor AIDS drugs. Globally, just 1 in 5

HIV patients get the drugs they need, according to a recent report by

UNAIDS, the body leading the worldwide battle against the disease.

Stirling said that despite the advances, the toll over the next 25

years will go far beyond the 34 million thought to have died from the

Black Death in 14th century Europe or the 20 to 40 million who

perished in the 1918 Spanish flu epidemic.

Almost two-thirds of those infected with HIV live in sub-Saharan

Africa where poverty, ignorance and negligent political leadership

extended the epidemic's reach and hindered efforts to contain it. In

South Africa, the president once questioned the link between HIV and

AIDS and the health minister urged use of garlic and the African

potato to fight AIDS, instead of effective treatments.

AIDS is the leading cause of death in Africa, which has accounted for

nearly half of all global AIDS deaths. The epidemic is still growing

and its peak could be a decade or more away.

In at least seven countries, the U.N. estimates that AIDS has reduced

life expectancy to 40 years or less. In Botswana, which has the

world's highest infection rate, a child born today can expect to live

less than 30 years.

" Particularly in southern Africa, we may have to apply a new notion,

and that is of `underdeveloping' nations. These are nations which,

because of the AIDS epidemic, are going backwards, " Piot, the

director of UNAIDS, said in a speech in Washington in March.

Later, at a meeting in Abuja, Nigeria, last month, Piot cited

encouraging news including a sharp fall in new infections in some

African countries. There also has been an eightfold increase in the

number of Africans benefiting from antiretroviral treatment, he said.

But, he warned, " the crisis of AIDS continues and is getting worse

and any slackening of our efforts would jeopardize the hard-won gains

of each and every one of us. "

Besides the personal suffering of the infected and their families,

the epidemic already has had devastating consequences for African

education systems, industry, agriculture and economies in general.

The impact is magnified because AIDS weakens and kills many young

adults, people in their most productive years.

So many farmers and farmworkers have died of AIDS that the U.N. has

invented the term " new variant famine. " It means that because of

AIDS, the continent will experience persistent famine for generations

instead of the usual cycles of hunger tied to variable weather.

Africa's misery hangs like a sword over Asia, Eastern Europe and the

Caribbean.

Researchers don't expect the infection rates to rival those in

Africa. But Asia's population is so big that even low infection rates

could easily translate into tens of millions of deaths.

Although fewer than 1 percent of its people are infected, India has

topped South Africa as the country with the most infections, 5.7

million to 5.5 million, according to UNAIDS.

The astonishing numbers have grown from a humble beginning.

Nobody knows for sure when or where, but the AIDS epidemic is thought

to have begun in the primeval forests of West Africa when a virus

lurking in the blood of a monkey or a chimpanzee made the leap from

one species to another, infecting a hunter.

Researchers have found HIV in a blood sample collected in 1959 from a

man in Kinshasa, Congo. Genetic analysis of his blood suggested the

HIV infection stemmed from a single virus in the late 1940s or early

1950s.

For decades at least, the early human infections went unnoticed on a

continent where life routinely is harsh, short and cheap.

Then, on June 5, 1981, the Centers for Disease Control in Atlanta

reported five young actively homosexual men in Los Angeles had a new,

mysterious and as yet unnamed illness that attacked the immune system

and caused a type of pneumonia. A month later, it reported an odd

surge among homosexual men in the number of cases of Karposi Sarcoma,

a rare cancer now linked to AIDS.

In the early days of the epidemic, just the mention of AIDS elicited

snickers and jokes. Few saw it as a major threat. It was the " Gay

Plague, " and for some, divine retribution for a lifestyle Christian

fundamentalists and other conservatives consider deviant and sinful.

When heterosexuals began to contract the disease through blood

transfusions and other medical procedures, they were often portrayed

as " innocent " victims of a disease spread by the immoral and

licentious behavior of others.

The initial reactions and prejudices associated with AIDS slowed the

early response to the epidemic and limited the funding. Too much

time, money and effort was spent on the wrong priorities, Stirling

aid.

" Over the last 25 years, the one real weakness was the search for the

magic bullet. There is no quick and simple fix, " he said. " But with

the recent successes we are starting to see the end of epidemic. "

" There is evidence to suggest we are at the tipping point, " said

Stirling.

The pace of change over the last couple of years suggests the number

of new infections can be reduced by 50 to 60 percent by 2020 — if the

momentum continues.

" It is surely possible, it is doable, " Stirling said.

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