USIS Washington File - November 23, 2005

Washington - While HIV/AIDS is still robbing sub-Saharan Africa of potential economic gains by decimating whole populations, a recent United Nations report reveals that the pandemic is decreasing in intensity among adults in Kenya, Zimbabwe and Uganda.

According to the report UNAIDS/WHO AIDS Epidemic Update: December 2005, sub-Saharan Africa is home to more than 60 percent of all HIV/AIDS victims -- around 25.8 million people, and growing. In 2005, an estimated 2.8 million to 3.9 million people in the region became newly infected. (See related article.) The good news, however, is that in three African nations, Kenya, Uganda and Zimbabwe, "declines in adult national HIV prevalence appear to be under way," the U.N. report states.

"East Africa continues to provide the most hopeful indications that serious AIDS epidemics can be reversed," it reported, with "the countrywide drop in HIV prevalence among pregnant women -- seen in Uganda since the mid-1990s -- now being mirrored in urban parts of Kenya, where infection levels are dropping, in some places quite steeply." Uganda's HIV prevalence rate now is estimated to be around 7 percent, one of the lowest in Africa.

The AIDS epidemic in Kenya peaked in the late 1990s with an overall HIV prevalence of 10 percent in adults, which declined to 7 percent in 2003, the U.N. report said. The "most dramatic drops in prevalence have been among pregnant women in urban areas -- especially in Busia, Meru, Nakaru and Thika, where median HIV prevalence plummeted from approximately 28 percent in 1999 to 9 percent in 2003.

"This is only the second time in more than two decades that a sustained decline in national HIV infection levels has been seen in a sub-Saharan African country," the report added.

Significantly, the U.N. report emphasized that "In both countries, behavioral changes are likely to have contributed to the trend shifts." Ironically, the U.N. report also noted a significant decline in infections in Zimbabwe, where social conditions have declined precipitously under the political and economic mismanagement of President Robert Mugabe.

The report says, "Recent data from Zimbabwe's national surveillance system show a decline in HIV prevalence among pregnant women from 26 percent in 2002 to 21 percent in 2004. In Harare, HIV prevalence in women attending antenatal or postnatal clinics fell from 35 percent in 1999 to 21 percent in 2004. In rural eastern Zimbabwe, declines in HIV prevalence in pregnant women were also reflected in declines among both men and women in the general population." It adds that, "a significant decline in HIV prevalence among pregnant young women (15�24 years) -- which fell from 29 percent to 20 percent in 2000-2004 -- suggests that the rate of new HIV infections [incidence] could be slowing, too." On the less positive side, the report continues: "With the exception of Zimbabwe, countries of southern Africa show little evidence of declining epidemics. HIV prevalence levels remain exceptionally high (except for Angola), and might not yet have reached their peak in several countries -- as the expanding epidemics in Mozambique and Swaziland suggest." PROGRESS ALSO SEEN IN WEST, CENTRAL AFRICA The picture is brighter in West and Central Africa, where, the United Nations estimates, "national HIV prevalence is considerably lower than in the south and east of the region." Attempting to dispel misconceptions about the disease's spread in Africa, the U.N. report said: "It is inaccurate to speak of a single 'African' AIDS epidemic. National-level HIV prevalence data can sometimes prompt incomplete pictures of the actual state of affairs." For example, "In most countries, HIV prevalence observed among pregnant women attending antenatal clinics � differs by wide margins, depending on the location." The difference in rates might also be prompted by "the social and socioeconomic status of women, who remain disproportionately affected by HIV in this region [Africa] and, at the same time, poorly informed about the epidemics," it said.

The report explained: "Generally, women are less well-informed about HIV than are men; this is also true of [people living in] rural areas compared with those living in cities and towns. Data from 35 of the 48 countries in sub-Saharan Africa show that, on average, young men were 20 percent more likely to have correct knowledge of HIV than young women." Education levels also "make a huge difference," the U.N. report stated. For example, "young women in Rwanda with secondary or higher education were five times as likely to know the main HIV transmission routes than were young women with no formal education." According to U.S. Global AIDS Coordinator Randall Tobias, President Bush's Emergency Plan for AIDS Relief, a $15 billion worldwide initiative launched in 2003, is on track, especially in sub-Saharan Africa.

Tobias told reporters at a State Department news conference in June that "as results are reported from the field, it is increasingly clear that the launch of the Emergency Plan marked a turning point in the fight against HIV/AIDS. On the ground, the reality is changing -- rapidly." Tobias said: "As of March 31 of this year, the Emergency Plan has supported antiretroviral treatment for approximately 235,000 men, women and children through bilateral programs in 15 of the most afflicted countries in Africa, Asia and the Caribbean. Of that number, more than 230,000 of those being supported live in sub-Saharan Africa." Looking ahead, the U.S. AIDS official said, "These results indicate that the Emergency Plan remains on track, scaling up to meet the president's ambitious goal of supporting treatment for two million people in five years." Additional information is available on the Office of the U.S. Global AIDS Coordinator Web site.

The U.N. report, available on the UNAIDS Web site in English, French, German, Russian and Spanish, was released November 21 in advance of World AIDS Day, December 1.