U.N. report says women now make up half of all HIV-infected adults worldwide.
Disease is destabilizing the worst-hit nations.
UNITED NATIONS -- As the AIDS epidemic enters its third decade, for the first
time women account for about half of all infected adults, and the disease has
begun to destabilize countries as it leaves large swaths of people unable to
work or care for their families, a U.N. report said Tuesday.
This year, 5 million more people have contracted HIV, the virus that causes
AIDS, and about 3 million have died from the disease. And as the epidemic
expands in Asia and Europe, its political and economic consequences may alter
the balance of power in entire regions, analysts say.
The face of HIV/AIDS has become that of a young African woman -- seven of 10
people living with the disease are in sub-Saharan Africa, and 58% of infected
Africans are female. Of the 38.6 million adults living with the disease
worldwide, 19.2 million are women, the report said.
"We're far away from the gay white men's disease it used to be in the '80s,"
Peter Piot, the executive director of UNAIDS, an alliance of six United Nations
agencies fighting HIV and AIDS, said after introducing the report Tuesday.
Young women are especially hard hit because of their lack of awareness of safe
sex practices or ability to demand them, social vulnerability to older men and
greater physical susceptibility to the virus, the report said.
The "feminization" of AIDS has stunning consequences. Because women usually
manage their children's care and education, tend to ailing relatives and play a
major role in agriculture in Africa, the effect of their absence is magnified in
a way that "many generations ahead have to deal with," said Bernhard
Schwartlander, the HIV/AIDS director of the World Health Organization.
The disease is changing the demographic landscape of Africa. Millions of people
in their prime are unable to contribute to the economy. Often, women contract
the virus from their husbands or boyfriends, and ultimately their children are
"You have a whole chunk of the population that is disappearing," Piot said.
"It's something that we have only seen up until now after wars, but then it was
only on the male side. A whole generation of millions of orphans -- and what
will probably be desocialized youth -- will grow up, and that is going to create
some social instability as well."
As southern Africa is ravaged by famine caused by drought and poor food
policies, the epidemic only exacerbates the region's devastation. Illness and
death hamper people's ability to grow food or earn the money to buy it. Studies
found that people have adopted survival strategies that put them at greater risk
for infection, including trading sex for food and migrating to slums without
adequate health care.
Piot pointed to such effects as the first signs of the larger, societywide
destabilizing impact of AIDS that was predicted some years ago. "But frankly,"
he said, "I didn't think it would occur that fast."
Although Africa has the greatest concentration of infected people, the world's
fastest-growing epidemic is occurring in Russia, Eastern Europe and Central
The increase -- 250,000 new infections and 25,000 deaths last year -- has mostly
been caused by a sharp rise in the number of young people who inject heroin and
other drugs. Uzbekistan, in particular, is showing explosive growth: In the
first half of this year, there were nearly as many new HIV infections as had
been recorded in the whole of the previous decade.
China and India are also facing "serious, localized epidemics," the report said,
with more than 1 million Chinese infected with HIV, many through the donation
and receipt of tainted blood, and 4 million Indians also infected.
Economy a Victim
As the AIDS crisis shifts from Africa to higher-income and densely populated
countries in Eurasia, the disease could cause a power shift in the world's
economy as well, analysts say. The spread of the disease in the three of the
region's most populous countries -- China, India and Russia -- threatens to
derail the economic prospects of billions of people and alter the global
military balance, said Nicholas Eberstadt, a researcher at the American
Enterprise Institute, a conservative think tank in Washington.
Eurasia is home to the majority of the world's population, its combined gross
national product outweighs that of the U.S. or Europe, and four out of five of
the world's strongest armies are there, Eberstadt said.
And so, a jolt in Eurasia caused by the unfolding AIDS epidemic will have major
worldwide repercussions -- much greater than the impact caused by the public
health crisis in Africa, Eberstadt said, citing mathematical models. "The reason
more attention hasn't been paid to sub-Saharan Africa is that it is 'only' a
humanitarian catastrophe, given its relatively minor weight in the overall world
economy," he said. "That's just a cruel fact of modern life, and the modern
constellation of geopolitical forces."
Balance of Power
But if current trends continue unchecked, AIDS could be a factor in the balance
of power within Eurasia in the coming decades -- and in the relationship between
its giant nations and the rest of the world.
There were some glimmers of good news in the report, however, suggesting that
the infection rates aren't irreversible.
Various prevention campaigns in Africa and Asia are beginning to work in a
handful of countries.
* In Ethiopia's capital, Addis Ababa, infection levels among young inner-city
women have dropped, from 24.2% in 1995 to 15.1% in 2001.
* In Uganda, a steady drop in HIV infection in young women is attributed to
changes in sexual behavior, including increased condom use and abstinence and
delayed sexual activity -- the results of a lengthy information campaign.
* In South Africa, which has the world's largest HIV-positive population, there
has been a marked drop in the number of young pregnant women testing positive
for HIV, to 15.4% in 2001 from 21% in 1998.
* In Cambodia, the Asian country with the highest prevalence of adult HIV
infection, rates appear to be stabilizing and high-risk behavior decreasing. The
report credits the improvements to a campaign persuading sex workers to use
* In the Dominican Republic, where about 2.5% of the population is estimated to
be infected, HIV prevalence appears to be leveling off and perhaps declining,
apparently because of increased condom use and fewer sex partners.
"It's too early to cry victory, because prevalence rates are still extremely
high and they continue to go up among older people," Piot said.
"But we build on experience elsewhere. It should be very encouraging ... that
prevention has an impact."