UN International AIDS Day report reveals growing pandemic

By Ann Talbot
2 December 2003

Five million people were infected with HIV this year. This is a record number of new infections and indicates that the global AIDS epidemic is continuing to worsen.

A new report from the United Nations and the World Health Organisation was issued for World AIDS Day yesterday, December 1. AIDS Epidemic Update 2003 catalogues a human catastrophe without being able to suggest any realistic way of stopping it.

The report points to a developing pandemic as the disease takes hold in new areas of the world. Two out of three new infections are in sub-Saharan Africa. But the number of cases in China, India, Indonesia and Russia is rising dramatically.

Experts are warning that the infection levels in Asia and Eastern Europe are reaching a critical point. The epidemic in these regions could soon take on the same proportions as in Africa unless action is taken. The reports warns, “The epidemic is spreading into areas and countries where, until recently there was little or no HIV present—including China, Indonesia and Vietnam (home to over 1.5 billion people).”

In India almost 5 million people are HIV positive. This makes it second only to South Africa in terms of the total number of cases. So far the disease has been officially ignored because this represents less than one percent of the population. But serious epidemics have emerged in the states of Maharashtra and Tamil Nadu. Over 50 percent of sex workers have been found to be HIV positive in some cities in these regions.

In China, thousands of poor farmers in Henan province are suffering from AIDS after selling their blood to the government. Up to 20 to 40 percent of the population in some villages in the area are thought to be infected. The full extent of the problem is unknown because local officials are attempting to cover up the existence of the disease. They have driven AIDS activists and journalists out of the area and rounded up sick people in night time raids.

If AIDS is allowed to develop in the same unchecked way that it has in Africa the scale of the problem in China will be unprecedented because the population is so large. The UN warns that the number of AIDS cases in China could increase to 20 million within the next decade.

In Latin America and the Caribbean 2 million people are HIV positive. The disease is reported to be well entrenched, with more than 2 percent of pregnant women testing positive.

The most serious epidemics are in Haiti and the Dominican Republic. It is estimated that 30,000 people are dying and 200,000 children are being orphaned a year as a result of AIDS.

North Africa and the Middle East were thought to have side-stepped the epidemic, but they now show a rising rate of infection. Among injecting drug users in Iranian prisons the rate of infection is 63 percent. Very few Middle Eastern and North African countries are making any efforts to monitor the spread of HIV and prevention and education programmes are non-existent.

Even in the United States there has been an alarming jump in the infection rate. It was previously falling, but there was a 5.1 percent increase between 1999 and 2002. These figures are probably an underestimate since less than half of US adults have had an AIDS test and of those who take a test a third do not return for the results.

What the figures show is a widening social divide. A growing section of the US population have no medical insurance and although they live in a rich country they suffer Third World health care. More than half of new cases were among African-Americans and 26 percent among Hispanics. AIDS is now the leading cause of death for African-American women aged 25-34 years

In Britain the number of HIV cases reported in 2002 was double that in 1998. A recent survey by the Terrence Higgins Trust found that sex education in the UK is inadequate. “It is unsurprising that we are now seeing the country’s worst sexual health epidemic since the NHS (National Health Service) was founded,” a spokesman for the trust said.

In Germany the number of HIV cases has risen for the first time since 1997.

Amid this growing worldwide crisis, sub-Saharan Africa continues to face the worst situation. The epidemic has clearly not peaked as was expected, but continues to rise. Of the 40 million people who are HIV positive worldwide, two-thirds are in sub-Saharan Africa. Despite these figures only 50,000 people are currently receiving treatment with anti-retroviral drugs in Africa.

Globally 3 million people died of AIDS this year. Two million of those deaths were in sub-Saharan Africa. In the West anti-retroviral drugs have brought down the death rate from this still incurable disease.

Eleven million children have been orphaned by AIDS in sub-Saharan Africa. By 2010 this figure is expected to have reached 20 million. Most of these children are cared for by their extended families, but this traditional support network is breaking down under the strain.

David Agnew of UNICEF Canada recently visited Zimbabwe. He reported that AIDS is “relentlessly, horribly boring its way through village after village, town after town, city after city, country after country.... And the impact is just extraordinary to witness. It’s a terrifying thing.”

AIDS is producing more orphans in Africa than all the military conflicts in this region. In Botswana, Lesotho, Swaziland and Zimbabwe one in five children will be an orphan by 2010.

What is most striking about the report from the UN and WHO is that these international institutions have nothing to offer in response to the crisis they document. UN Secretary-General Kofi Annan admitted that he was losing the fight against the disease. “I don’t think the leaders of the world are engaged enough,” he complained.

In an interview with the BBC World Service he described AIDS as “a weapon of mass destruction.” “We are operating at a relatively low level,” he admitted. “We estimate that, by 2005, we will need $10 billion worldwide per annum to fight the disease. Today I’m trying to see if we can get $3 billion a year for the next five years going into the Global Fund.”

The reality is that Annan has no idea where this money is going to come from. Dr Kingsley Moghalu, head of resource mobilisation for the Global Fund to Fight AIDS, put the matter bluntly at a conference last month when he said, “The real question in the fight against AIDS is where is the money?”

Even if the current plans went ahead they are on too small a scale to make a significant impact on the problem. The WHO has announced what it calls its “3 by 5” initiative. Under this plan it is proposed that 3 million people will receive anti-retroviral drugs by 2005. Out of a population of 40 million HIV positive people this would be a drop in the ocean.

In October this year former US President Clinton announced a plan to make generic drugs available to poor countries. Three Indian drug manufacturers—Ranbaxy, Cipla and Matrix Laboratories—plus a South African company—Aspen Pharmacare Holdings—have agreed to participate in the scheme. They will produce generic anti-retroviral drugs more cheaply than the patented products of the big drug companies. The treatment regime will cost US40 cents a day under this programme rather than US$1.50.

The Clinton scheme aims to have 2 million people on anti-retroviral drugs by 2008. Even this minuscule figure depends on the target countries winning funding from other sources to pay for the programme. So far, four African countries have the money to participate. There are no plans to provide cheap generics to Russia or China where the epidemic is gathering pace. India, the country where the drugs are manufactured, is not included in the Clinton scheme.

This is a desperate sticking plaster measure. In no way does it measure up to the scale of the problem. However, it does indicate in a primarily negative fashion what could be done if Western governments made a concerted effort to address the problem.

While there is a humanitarian element to Clinton’s proposals they have been drafted within an entirely capitalist spirit. As Yusuf Hamied, chairman of Cipla, pointed out, the Clinton Foundation has become a market maker by offering the pharmaceutical companies predictable volumes.

The Clinton Foundation first approached the major Western pharmaceutical companies with a business plan to produce and sell anti-retroviral drugs cheaply but with a small profit guaranteed. They have ignored the offer, but their smaller rivals have jumped at the opportunity.

Indian companies stand to make a huge profit by their standards from the Clinton plan. Matrix Laboratories estimate that the deal is worth a billion dollars in sales to them.

To the Western companies, however, this is small pickings because they have a virtual monopoly in the rich industrialised countries. So far they have been cautious about commenting on Clinton’s plans. They have already damaged their public image by contesting patent cases in South Africa, but they are unlikely to let it go ahead unopposed.

Drug companies guard their intellectual property rights jealously because that is how they control the most profitable markets. If Indian and South African companies are allowed to produce anti-retrovirals for use in developing countries it may be the thin end of the wedge. A whole range of cheap drugs might begin to find their way into the West.

Rather than increasing the money available, both the Bush administration and the Blair government in Britain are pushing for a slowdown in AIDS funding. At a meeting in Thailand last month they called on the Global Fund to delay the next round of spending. They claim that the recipient countries are unable to absorb the money because their health services are so weak.

No Non Governmental Organisations engaged in the AIDS battle take this argument seriously. The real concern of the US is that, as one unnamed Washington official told the Boston Globe, the administration “have become angry over the attention given to the Global Fund and WHO for their efforts in fighting AIDS.”

The Bush administration has proved itself a firm friend of the big pharmaceutical companies, which are major contributors to Republican Party funds. Bush has appointed a pharmaceutical executive, Randall Tobias, to head his new AIDS initiative. The US want their initiative to be the centrepiece of the Western response to AIDS.

Most of the money that President Bush has pledged for the US programme will find its way into the pockets of the drug companies. Rather than serving as an anti-AIDS fund it is an initiative to support the profits of the pharmaceutical corporations.

In effect the US and British governments are saying that those who are poor should not be provided with lifesaving treatment. This is the equivalent of a death sentence for millions of people.

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