Lethal epidemic is much larger than feared

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Many more people are infected with the HIV virus than previously thought - probably 30 million in all, according to the United Nations. But the victims of this `invisible epidemic' are mostly in Africa. In Western Europe the number of new Aids cases is dropping sharply; in the United States, new cases are falling for the first time in nearly 20 years. John Lichfield reports from Paris.

The poor countries are getting sicker and the rich countries are getting better - better treatment, better informed and better behaved.

This was the underlying message of the UN report published to mark World Aids Day yesterday.

A combination of greater public awareness, improved precautions and the increased use of the new anti-retroviral drugs has, for the first time, seriously checked the HIV/Aids epidemic in the industrialised countries.

In the developing world, and especially in Africa, the virus continues to take an extraordinary, and often hidden, toll of suffering. It is estimated that 2,300,000 people will die of Aids-related diseases this year, a 50- per- cent increase on 1996.

One in five of the victims will be children, mostly infected from birth. New infections, although much slower in Europe and the US, are occurring at an "alarming rate" in Africa and parts of Asia and Latin America.

The UN-Aids programme now admits that it has "grossly under-estimated" the number of people who have the HIV virus, and full-blown Aids, in Africa. The missing victims - about 4,600,000 more than previous calculations - account for a large part of the vastly increased global estimate of the reach of the virus. The UN now believes that 30,000,000 people in the world have HIV or Aids, a 50 per cent increase on last year's figure. Of these, 5,800,000 people were infected during the course of this year.

"The main message of our report is that the Aids epidemic is far from over. In fact, it's far worse," Peter Piot, executive director of the UN Aids programme, told a press conference in Paris yesterday.

Much more needs to be done to increase awareness of HIV, and the methods of safe sex which can control its spread, Mr Piot said. The UN estimates that nine out of 10 HIV victims around the world, mostly in the developing countries, are not even aware they are infected. Even in the West, Mr Piot said, prevention campaigns are not sufficient.

"I have a daughter at a lycee here (in Paris) and what she's getting in terms of sex education is inadequate."

Bernard Kouchner, the French Health Minister, said he intended to push for the creation of a world-wide fund to combat Aids, especially in the developing world. Two-thirds of all HIV victims are in sub-Saharan Africa, according to the UN report. One in 12 of sexually active adults in Africa has the virus; one in 10 in South Africa.

The impact of HIV on the continent is so devastating that it has wiped out 30 years of gains from improved nutrition and medical treatment. In Botswana, life expectancy has collapsed to the levels seen in the late 60s. In Zimbabwe, 10 years has been wiped off the life expectancy of every child born since 1990.

In Asia, where HIV did not strike until the late 1980s, the UN also reports worrying trends. The sheer size of Asian populations makes the prospect of a full-scale epidemic horrifying, the UN warns. Two separate outbreaks are reported in China, one among drug-users in the south-west of the country, another among homosexuals along the eastern seaboard. In India, the infection rate remains small, in proportional terms, only 1 per cent of the adult population. But this still represents up to 5,000,000 people, making India the country with the largest number of HIV victims in the world.

Although Mr Piot warned against complacency, the report suggests that a significant turning-point has been reached in the battle against HIV in the industrialised world. The number of new Aids cases in Western Europe will drop by 30 per cent this year, partly because of the use of the new drugs which arrest the onset of Aids proper, partly because the number of HIV infections is declining. In the US, figures suggest that the number of new Aids cases fell by 6 per cent last year, the first fall since the epidemic began in the late 1970s.

World Toll

People living with HIV/Aids: 30.6 million

New HIV infections in 1997: 5.8 million

1997 deaths due to HIV/Aids: 2.3 million

Cumulative number of deaths due to HIV/Aids: 11.7 million

Percentage of adults worldwide living with HIV/Aids: 1.0