New AIDS Demographics (scary)

Man. Millions dead, millions of kids without parents, nobody to grow or harvest or prepare food, and the breakdown of the maternal elements of society. If there's a better argument for women's rights, I haven't seen it. I recall a few years ago CDC was trying to figure out which risk was greater for infants: nursing from a mother with AIDS or drinking formula made from contaminated water. This is a timebomb and it's not just confined to Africa. Still, it looks like prevention programs do work at times... let's hope we figure this out before some charismatic despot leaps onto the scene.
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Women Make Up Half of HIV Cases
Milestone Explains Effects of Epidemic

By David Brown
Washington Post Staff Writer
Wednesday, November 27, 2002; Page A01

About half the people now infected with the AIDS virus worldwide are women, epidemiologists at the United Nations and World Health Organization said yesterday.

The announcement marks the arrival at a milestone experts charting the course of the global pandemic had predicted for several years. Although it is uncertain whether the trend toward increasing numbers of female infections will continue, the current state helps explain some of the epidemic's unexpected effects, such as its worsening of the food crisis in parts of Africa.

The continued spread of AIDS in sub-Saharan Africa -- where the majority of new infections have occurred in women for several years -- is the main engine behind the "feminization" of the epidemic. However, the number of infected women is rising elsewhere as well.

Heterosexual transmission is now the main cause of new infection in Western Europe, and is of growing importance in Eastern Europe. There, the epidemic has spilled beyond mostly male drug users to their female sex partners, according to the new report.

"We are far away from the gay white male disease it was in the 1980s," said Peter Piot, executive director of the joint U.N. program on AIDS (UNAIDS). He spoke in a telephone news conference from London, where the organization released its annual review of the epidemic.

In all, 42 million people are living with human immunodeficiency virus (HIV) infection, according to the report, released each November. Of the 38.6 million infected adults, 19.2 million are women -- slightly less than 50 percent.

In sub-Saharan Africa, 58 percent of infected adults are women. That is not likely to change soon, as the prevalence of HIV infection among girls ages 15 to 24 is about twice that of boys the same age -- 11 percent vs. 6 percent, according to high-end estimates.

African girls are at higher risk of becoming infected for numerous reasons. Their partners tend to be older -- and more likely to be infected -- than boys their age. Their sexual relationships are often characterized by what the report called "dependence and subordination," and many girls (including married ones) find it difficult to demand safe practices, such as condom use.

There are also biological factors that put girls in jeopardy in general. Male-to-female virus transmission is more "efficient" than female-to-male, and the genital tract of teenage girls is more vulnerable to infection than that of older women.

The rising number of infected women is having myriad social and economic effects, according to the report. In particular, women in Africa do most of the work on subsistence farms and are primarily responsible for food preparation. In addition, they are generally more invested in the education of their children than men, and when a family member becomes ill, they are the caregivers.

"You can imagine what happens when that central role in society is disproportionately impacted by HIV/AIDS," said Bernhard Schwartlander, director of AIDS programs for the World Health Organization. "If that is eroded, then it is a question of loss of 'human capital' that future generations will have to deal with."

Epidemiologists and demographers now believe the drought and famine in southern Africa is much worse because of AIDS. About 14.4 million people are at risk of starvation in six countries -- Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe.

"Whole communities have less resilience, are weaker and will be less able to start planting seeds again when the rains come back," Piot said. "We can probably count on a longer food crisis than the region is used to."

Experts have warned of other secondary effects of AIDS in Africa, notably the risk of poor socialization of many of the 11 million children who have lost one or both parents to the disease. But Piot said the worsening of the current African food shortage "is the first sign of the larger societywide destabilizing impact of AIDS, as was predicted several years ago, but which I frankly didn't think would happen so quickly."

That notion is shared by others. Stephen Lewis, U.N. special envoy for HIV/AIDS in Africa, said earlier this week that officials of the U.N.'s World Food Program believe that AIDS is as entrenched a reason for impending famine as lack of rainfall.

"Increasingly, people in the U.N. system have come to the conclusion that AIDS is more than a complicating factor. . . . AIDS is fiercely driving it," he said.

Data from Africa are more detailed and accurate now than it was even five years ago. The female predominance of infection in that continent may have existed for a while, and consequently the global equalization of the sexes may also have occurred earlier than this year, said Peter Gys, a UNAIDS epidemiologist.

With the future growth of the epidemic expected to be in China and India -- two places where more men than women are being infected -- "we would expect that it [the current trend] might be turning around again," Gys said.

Nevertheless, the male-to-female ratio has "narrowed considerably" in many places (such as Latin America and the Caribbean) in recent years, the report noted. As a mode of transmission, heterosexual intercourse is increasingly significant in Eastern Europe. In Ukraine, 28 percent of new cases in the first half of this year occurred through heterosexual intercourse, compared with 15 percent in 1998.

Most new infections in Western Europe occur through heterosexual contact. But the number of new infections there this year was very low -- 30,000 out of 5 million new infections worldwide. In most cases, women are partners of drug users or are from -- or have partners from -- regions where HIV prevalence is high.

"I wouldn't say it has penetrated to the heterosexual population at large," Piot said.

The report was not without good news. Early evidence shows that prevention campaigns that have helped reduce new infection rates in Uganda and Thailand are working elsewhere.

In South Africa, HIV prevalence in pregnant women fell to 15 percent last year, down from 21 percent in 1998. In Addis Ababa, Ethiopia, prevalence in women at prenatal clinics was 15 percent last year, down from 24 percent in 1995. It has also declined in the Dominican Republic in the last decade.

 

A related article.
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AIDS Activists March on White House
31 Protesters Arrested In Scenario Coordinated In Advance With Police

By Manny Fernandez
Washington Post Staff Writer
Wednesday, November 27, 2002; Page A08

Several hundred AIDS activists marched in downtown Washington yesterday to call on President Bush to increase funding for global and domestic AIDS treatment, prevention and education, in a spirited protest that ended with planned arrests in front of the White House.

In a scenario agreed on with police ahead of time, 31 protesters, some linked by thin chains around their waists, lay on their backs on the sidewalk outside the White House fence and were arrested and charged with conducting a stationary demonstration in a restricted area, a misdemeanor, U.S. Park Police said.

"It's a weapon of mass destruction, and it's being ignored," Philadelphia resident Tymm Walker, 42, said of AIDS. Walker said that he was diagnosed with HIV 18 years ago and that he has one brother who has the virus and another who died of AIDS complications seven years ago. "I don't want to see nobody else's mother go through what my mother has been through," he said.

Walker and others with HIV and AIDS boarded buses from New York, Philadelphia and Baltimore to participate in the noon protest. The event -- organized by the Health GAP Coalition and ACT UP groups in New York and Philadelphia, among others -- was held as World AIDS Day approaches on Sunday.

Some carried mock body bags reading "Bush: Stop AIDS Deaths" and others cardboard skulls as the protesters marched from McPherson Square at 15th Street NW to nearby Lafayette Square, across from the White House.

Activists said the fight against AIDS in the United States and developing countries is being neglected. They said more than 3 million people, many in poor countries, will die this year because they lack access to HIV/AIDS treatment. They argued that the Bush administration has made the war effort and tax cuts its priorities, ignoring the plight of those with HIV/AIDS.

"He's a man without a plan," Paul Davis, 33, said of the president. Davis, a director of the Health GAP Coalition and one of those arrested, said Bush "has not kept his promises to respond to the global AIDS disaster."

Davis and others demanded that the United States contribute more to the newly created Global Fund to Fight AIDS, Tuberculosis and Malaria. The U.S. pledge of $500 million is too little, said activists, who also called on the administration to support a global AIDS initiative for $2.5 billion in new spending.

Organizers cooperated with D.C. police and U.S. Park Police on the march route and the arrests. At Lafayette Square, where large protests are banned, police on foot and horseback stopped protesters. At 1:45 p.m., 31 protesters left the larger group and marched to the White House fence, where they were surrounded by police and carried to waiting vans.