A Global Epidemic More than 42 million people around the world are currently infected with human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS). New HIV infections have leveled off or even declined in most developed countries, but the virus is spreading rapidly through much of the developing world. In some areas of sub-Saharan Africa, one in four adults is carrying the virus.
AIDS was first identified in 1981 among homosexual men and intravenous drug users in New York and California. Shortly after its detection in the United States, evidence of AIDS epidemics grew among heterosexual men, women, and children in sub-Saharan Africa. AIDS quickly developed into a worldwide epidemic, affecting virtually every nation. By 2003 the United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimated that worldwide 40 million people, including 2.5 million children under the age of 15, were living with HIV infection or AIDS. The WHO, a specialized agency of the United Nations (UN), estimated that from 1981 to the end of 2002 about 20 million people died as a result of AIDS. About 4.5 million of those who died were children under the age of 15. UNAIDS and the WHO reported that 3 million people died in 2003 alone from AIDS, and 5 million more people became infected with HIV.
AIDS has struck sub-Saharan Africa particularly hard. In 2003 one in five adults in this region had AIDS or HIV infection, the highest rate of infection in the world since the epidemic began. Sub-Saharan Africa is the most severely affected region in the world with 26.6 million people living with HIV/AIDS as of 2003
In the United States about 40,000 new HIV infections occur each year. More than 30 percent of these infections occur in women, and 60 percent occur in ethnic minorities. As of 2002 about 886,000 U.S. residents were living with HIV/AIDS, and about 500,000 people had died of the disease since the epidemic began, according to the U.S. Centers for Disease Control and Prevention. In Canada about 4,200 new HIV infections occur each year. Nearly 25 percent of these infections occur in women. In 2002 about 55,000 Canadians were living with HIV infection and about 18,000 people were living with full-blown AIDS.
The incidence of new cases of HIV infections and AIDS deaths has significantly decreased in Canada and the United States since 1995. This decrease is attributed to the availability of new drug treatments and public health programs that target people most at risk for infection. But while the overall rate of HIV infection seems to be on a downturn, certain populations appear to be at greater risk for the disease. In the United States in 1987, Caucasians accounted for 60 percent of AIDS cases and blacks and Hispanics only 39 percent. But by 2000 the trend had reversed: 26 percent of new cases were diagnosed in Caucasians and 73 percent in blacks and Hispanics. Likewise the number of female AIDS patients in the United States has increased significantly in recent years, from 7 percent of all AIDS cases in 1985 to 30 percent in 2000. In the United States, African American and Hispanic women accounted for 82 percent of AIDS cases among women in 2000.
In western Europe the first cases of AIDS were detected in the early 1980s, and by the late 1990s, at least 30,000 new HIV infections occurred each year. In 2002 about 570,000 western Europeans were HIV positive, and 25 percent of these cases were women. Before the dissolution of the Union of Soviet Socialist Republics (USSR) in 1991, eastern Europe reported few HIV cases. But since 1995, HIV infection has spread rapidly in cities of several eastern European countries, including Ukraine, Belarus, and Moldova. The WHO estimates that the total number of HIV infections in this region may have risen from less than 30,000 in 1995 to about 1 million in 2002.
While cases of AIDS have been reported in every nation of the world, the disease affects some countries more than others. More than 95 percent of all HIV-infected people live in the developing world. In these areas, the disease has sapped the populations of young men and women who form the foundation of the labor force. Most die while in the peak of their reproductive years. Moreover, the epidemic has overwhelmed health-care systems, increased the number of orphans, and caused life expectancy rates to plummet. These problems have reached crisis proportions in some parts of the world already burdened by war, political upheaval, or unrelenting poverty.
Nowhere is this better demonstrated than in sub-Saharan Africa, where the number of AIDS cases far exceeds that of all other geographic regions. Of the estimated 14,000 HIV infections that occur each day worldwide, about half of these infections occur in sub-Saharan Africa. About 70 percent of all people infected with HIV live in this region. In some countries in the southern part of the continent, including Botswana, Lesotho, Swaziland, and Zimbabwe, more than 30 percent of the population has HIV infection or AIDS.
In Asia and the Pacific Islands an estimated 7.2 million people were living with HIV infection by 2002. Health officials fear that as the virus spreads through China and India, the world’s two most populous countries, cases of HIV infection in this region may surge up to 25 million cases by the year 2010, dwarfing the problems seen in sub-Saharan Africa.
In 2002 the Chinese government reported that China had about 1 million HIV-positive people in a population of more than 1 billion. However, public health experts are concerned by the fast-rising number of new infections among intravenous drug users who share infected needles. In 2000 HIV prevalence among intravenous drug users ranged from 44 percent to 85 percent in selected communities of drug users in both Yunnan, in southern China, and Xinjiang, in northwestern China. The incidence of HIV infection will likely be exacerbated by the growing sex industry in China. Surveys indicate that as many as 4 million prostitutes work in China. Of these, four out of ten never use a condom to protect themselves or their clients from HIV infection or other sexually transmitted infections. In rural areas of China the incidence of HIV infection is rising because many poverty-stricken people regularly sell their blood. The people who buy the blood use unsterile methods to draw blood, including reusing contaminated needles, which can spread HIV infection.
In Latin America and the Caribbean region nearly 1.7 million people have been diagnosed with HIV infection or AIDS, twice the incidence in the United States and Canada. Brazil, Mexico, Colombia, and Argentina are the Latin American countries with the highest number of cases of HIV infection or AIDS.