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UN reports drop in new HIV cases worldwide

Decline is notable in sub-Saharan Africa, study says

Dineo Sumoke, a member of a support group for people living with HIV, displayed the red ribbon awareness symbol in the fight against HIV/AIDS outside a clinic in Gabane, Botswana, in September. Dineo Sumoke, a member of a support group for people living with HIV, displayed the red ribbon awareness symbol in the fight against HIV/AIDS outside a clinic in Gabane, Botswana, in September. (Gianluigi Guercia/AFP/Getty Images)
Email|Print| Text size + By John Donnelly
Globe Staff / November 20, 2007

WASHINGTON - The number of people newly infected with HIV has dropped significantly in recent years around the world, especially in sub-Saharan Africa, according to a United Nations report to be released today.

Specialists hailed the drop as a possible historic shift brought about by billions of dollars spent in programs designed to prevent the spread of the deadly disease.

The new data suggest that infections may have peaked in the late 1990s and have been declining at least since 2001. In 2001, the report estimates that 2.2 million people contracted HIV in sub-Saharan Africa, compared with an estimated 1.7 million this year.

"We are seeing the beginnings of this epidemic turning around and showing an impact from all of the investments that have been made," Paul De Lay, director of evidence, monitoring, and policy for UNAIDS, said in an interview last night.

De Lay said that the most significant reason for the decline in new infections in the hardest-hit areas in southern Africa appeared to be the increase of fidelity - more people were being faithful to one partner. "A mix of things are going on," he said. "Clearly, a reduction in the number of partners is a big factor in most of these countries."

Other factors, he said, were the consistent use of condoms among some high-risk groups, such as sex workers; and the treatment of other sexually transmitted diseases, which can be a gateway for HIV to enter the body. He also cited studies showing the effectiveness of male circumcision as a protective measure. "Circumcision definitely impacts the gender ratios, with the greater preponderance of HIV infections in younger women," De Lay said.

The annual update on the AIDS epidemic, produced by UNAIDS, also dramatically revised downward the number of people living with HIV because of what it called past problems with the way it analyzed the data. The UN organization used new modeling to decrease the previous estimates for the past several years.

For more than four years, a handful of independent researchers have criticized UN officials for sticking to estimates they said were too high. They pointed out demographic studies that, country by country, showed much lower HIV estimates than those cited by the United Nations. Some suggested that UN officials, and many governments, wanted to keep the numbers as high as possible for fund-raising purposes; UN officials strongly denied the accusations.

Officials said the drops were innocent errors. One was assuming that HIV prevalence data taken from pregnant women in urban clinics could be used to represent the entire country. But studies have shown that in most countries, pregnant women in cities had significantly higher infection rates than those living in rural areas. The women also were more sexually active than the general population.

In some cases, the differences between today's estimates and past year's numbers were dramatic. UNAIDS estimated that 28.5 million people were infected with HIV in 2001. The new report now estimates that 20.9 million were infected in 2001 - a drop of 7.6 million people.

New household surveys in recent years - notably in India, Nigeria, Mozambique, Zimbabwe, Kenya, and Angola - led to the lower estimates, officials said.

Now, according to UNAIDS, 33.2 million people around the world are infected with HIV. The report also estimated that 2.5 million people were infected this year.

UNAIDS pointed out that even with the reduced estimates, AIDS remains the biggest killer in Africa. Around the world, more than 6,800 people become infected with HIV every day, and more than 5,700 people die from AIDS daily "mostly because of inadequate access to HIV prevention and treatment services," the report said.

In addition, the report said that it appears the number of AIDS-related deaths has declined in the last two years because of greater access to life-extending treatment. In 2007, the report estimates that AIDS-related diseases will kill 2.1 million people, of which 1.7 million are adults, and 330,000 are children under the age of 15. Roughly three-quarters of the deaths this year will occur in sub-Saharan Africa, the report said.

"There is a momentum of program interventions and we're seeing that effect," De Lay said, referring to AIDS treatment and prevention efforts. "In some parts of sub-Saharan Africa, the evidence is pretty convincing that the epidemic has turned. We have up to five years of data. In other areas, we are just starting to see a change with the numbers coming down."

But he also said some parts of the world are "backsliding." He mentioned Uganda and the United States - two countries in which researchers have found that with the advent of antiretroviral drugs, which can turn HIV into a chronic and largely controllable disease for many - more people have resorted to risky behavior.

John Donnelly can be reached at donnelly@globe.com.

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