- AIDS killed more than 3 million people worldwide in 2002, or 8,220 persons per day.
- There are 42 million people currently infected with HIV worldwide.
- An estimated 2.8 million people in the Americas are currently living with AIDS— including the 235,000 people who contracted the virus last year.
In Latin America, 1.4 million people are living with HIV/AIDS; in the Caribbean, 420,000; and in North America, 940,000.
The relative increase in the number of new infections is higher in the Caribbean (16 percent), followed by Latin America (10 percent) and North America (5 percent).
The Caribbean is the second most affected region on the planet, after Sub-Saharan Africa, with about 2 percent of the adult population living with HIV/AIDS. The countries with the highest prevalence rates are Bahamas and Haiti, where the rates in adults are above 4 percent.
Heterosexual transmission of HIV continues to be responsible for almost three-quarters of the cases in the Caribbean and Central America.
In the Andean countries, Canada, Mexico, and United States of America, transmission among men who have sex with men is responsible for roughly 50 percent of the cases.
Intravenous drug use plays a significant role in HIV transmission in several countries, such as Argentina and Brazil.
Prevention and treatment are both essential for controlling the spread of HIV/AIDS. The availability of Antiretroviral (ARV) therapy makes it more likely that people will come forward for HIV testing, learn their status, receive counseling and care and become knowledgeable about preventing the spread of the virus.
Worldwide, 5 to 6 million people urgently need antiretroviral treatment (ART) due to the seriousness of their illness.
Currently, only 300,000 people in developing countries receive antiretroviral medicines. In Africa, less than 50,000 people have access to these medicines.
Many groups have shown that ART can be delivered in poorer countries with comparable effectiveness and benefits to that seen in richer countries.
Given current trends, including all the programs under way and all the funds donated for this effort, these medicines will reach fewer than one million people by the end of 2005. To address the failure to deliver ARV treatment, WHO is leading an emergency "3 by 5" response with UNAIDS and other partners to get three million people on treatment by 2005.
The cost of antiretrovirals has been reduced substantially, and treatment is available in some of the poorest countries in the world for one dollar a day or less.
World AIDS Day 2003
World AIDS Day 2003 highlights "Live and let live" — the theme of the World AIDS Campaign 2002-2003. The campaign focuses on eliminating stigma and discrimination, the major obstacles to effective HIV/AIDS prevention and care.
World AIDS Day is commemorated around the globe on 1 December. It celebrates progress made in the battle against the epidemic — and brings into focus remaining challenges.
AIDS epidemic update, December 2003
On the occasion of World AIDS Day, PAHO will launch its report, Understanding and Responding to HIV/AIDS-related Stigma and Discrimination in the Health Sector. UNAIDS is launching its AIDS epidemic update, December 2003. The annual report describes the latest developments in the global HIV/AIDS epidemic and provides regional summaries.
What's happening on 1 December?
Many events are being scheduled throughout the Americas and worldwide to observe World AIDS Day. These include:
MTV: Music Television and OneWorld International will announce the winner of the first annual Staying Alive Award on World AIDS Day. The award was launched to recognize the contribution of an individual to increasing awareness of HIV/AIDS. Young people from around the world were invited to produce and submit original audio or video public service announcements that convey the messages of Staying Alive, MTV's award-winning HIV/AIDS awareness campaign. The Staying Alive campaign is a partnership between MTV, Family Health International, Kaiser Family Foundation, UNAIDS and the World Bank.
HIV/AIDS and Discrimination
A new report by the Pan American Health Organization (PAHO) reveals that patients with HIV or AIDS experience stigma and discrimination from doctors, nurses and other health care providers as well as from members of society at large.
The PAHO report reviews research on the attitudes and practices of health care providers and the experiences of HIV/AIDS patients in the Americas and other regions. According to the report, examples of discrimination in the health sector include:
- Refusal to admit patients to health care facility
- Delayed treatment
- Other forms of care (e.g. presentation of food, hygiene) delayed or withheld
- Premature discharge of patients
- Testing without consent
- Breach of confidentiality within or outside the health care system
- Inability to inform patients of HIV-positive result
- Inappropriate comments
- Inappropriate behavior (e.g. shouting, rudeness, etc)
- Use of excessive precautions
Some examples mentioned in the report:
- In the city of Cochabamba, in Bolivia, high levels of ignorance about HIV/AIDS diagnosis and treatment among health workers. More than a third of 305 respondents were afraid of HIV/AIDS patients and believed they should be isolated.
- In Venezuela, higher rates of discriminatory attitudes among dentists (45 percent) and nurses (46 percent) than among doctors and students (both 42 percent).
- In the Dominican Republic, nearly a third of surgeons in a 1994 study reported feeling anxiety over treating HIV patients, and one in 10 said they did not accept HIV-positive patients.
In its conclusions, the report calls on PAHO’s member countries to promote activities aimed at further reducing stigma and discrimination in the health sector, including:
- Training projects to increase health workers’ sensitivity to HIV/AIDS affected clients.
- Appropriate procedures, equipment and supplies to prevent occupational exposure of health care workers.
- Establishment of patient and staff support groups.
- Institutional and sector-level programs based on adequate needs assessments and involving staff, patients and other affected groups.
- Promotion of voluntary counseling, testing and care (including post-exposure prophylaxis) for all health workers.
- Development of simple, effective systems that maintain privacy and confidentiality.
- Development and dissemination of guidelines and training resources in appealing formats.
- Support for general and specialist professional associations in AIDS care.
The PAHO report notes that discrimination can take terrible forms and also acts as a barrier against prevention efforts. For example, many children are turned away from schools on the basis of their HIV status, denied housing and shunned by friends and colleagues. Some even suffer physical attacks. These actions are often extended to their families and communities and even to orphans whose parents died of AIDS. Discrimination and stigma can keep people from getting the treatment they need.
In part this discrimination derives from the understandable fear of a virus that is transmissible, incurable and potentially deadly. But much has been learned since the beginning of the epidemic. Today there is widespread awareness that the virus cannot be transmitted through everyday contact. Most people know that there is nothing to fear if they adopt basic precautions and that there is no reason to keep a distance from people with HIV.
Discrimination against people with HIV persists because it has additional deeply rooted causes. Among them is the prejudice against groups hardest hit during the early stages of the epidemic, such as men who have sex with men, sex workers and drug users. Segregating these already stigmatized groups allows some people to feel safe from HIV. It provides an excuse for them to neglect to take basic precautions. It is an irony of tragic consequences: The ones who most discriminate are precisely the ones less likely to protect themselves against HIV transmission. When discrimination against people with HIV creeps into health services the consequences can be very serious.
What are the benefits of access to ARV treatment?
- ARV medicines have dramatically reduced death rates, prolonged lives, improved quality of life, revitalized communities and, to a large extent, transformed HIV/AIDS from a fatal condition to a manageable illness;
- While there is still no cure for HIV/AIDS, ARV treatment can add many years of healthy life to an infected person. In high-income countries, an estimated 1.5 million people currently live with HIV/AIDS. Most of them lead productive lives, largely due to ARV therapy. In the US, for example, the introduction of triple combination ARV therapy in 1996 led to a 70 percent decline in deaths attributable to HIV/AIDS;
- Delivering ARV therapy has other returns. Millions of dollars spent now can save billions in the future. Data from Brazil indicates that the costs associated with providing universal access to ARV therapy from 1996 to 2002 amounted to US$1.8 billion, but the savings in hospital and ambulatory care services reached US$2.2 billion – not to mention the broader savings related to teachers who keep on teaching, parents who remain with their children, and farmers who continue to work on their land;
- Brazil has also proven that it is possible to contain HIV/AIDS in resource-poor environments with relatively weak health infrastructure. It has delivered free ARVs to virtually every AIDS patient in need – in spite of the size of the country and its large population. From 1996 to 2002, Brazil saw a decrease in mortality rates of 40 percent-70 percent, morbidity rates of 60 percent-80 percent, plus a seven-fold drop in hospitalization needs;
- The availability of ARV therapy makes it more likely that people will come forward for HIV testing, learn their status, receive counseling and care and become knowledgeable about preventing the spread of the virus. Access to treatment will reduce the fear, stigma and discrimination associated with HIV/AIDS, thereby enabling societies to discuss the epidemic more openly and to prevent new infections more effectively.
What progress has been made so far?
A number of international developments enhance the possibility of treating more people living with AIDS in the developing world:
- There is awareness that prevention and treatment are both necessary for controlling the spread of HIV/AIDS and that these two approaches are mutually reinforcing elements of a comprehensive response to HIV/AIDS;
- There has been a significant reduction – more than 90 percent in some cases – in the price of ARV drugs offered to all sub-Saharan African countries; reducing costs from about US$10,000 per year to as low as US$300 for some combinations;
- Many developing countries, including several in Africa, have made a promising start by showing that ARV treatment is not only implementable, but also affordable and sustainable;
- The World Trade Organization decision in late August 2003 allowing poorer nations to import generic versions of patented antiretroviral drugs under certain circumstances, can facilitate the provision of low cost drugs for people living with HIV/AIDS in developing countries;
- There are growing numbers of partners engaged in the response to the epidemic, and continuing forceful activism and advocacy by people living with HIV/AIDS and civil society;
- The increased availability of international financial resources, including the creation of the Global Fund to fight AIDS, Tuberculosis and Malaria, signals a renewed commitment from the international community with the global fight against AIDS;
- At the UN General Assembly High-Level Meeting on HIV/AIDS on 22 September 2003, the World Health Organization (WHO) declared the lack of access to HIV treatment a global health emergency;
- WHO is committed to lead the way towards the ambitious “three-by-five” target. Working with a wide range of partners including UNAIDS, there will be urgent action to see that three million people are on ARVs by the end of 2005.