World AIDS Day: how many millions more will die?

Millions of people living with HIV/AIDS in poor parts of the world could lose their lives in the next few years if governments fail to keep their promises to fight the deadly pandemic, warn UN officials and health advocacy groups. In the absence of treatment, as many as 74 million people could die from HIV/AIDS-related causes by 2015, according to the Geneva-based International Labor Organization (ILO), which notes that young workers are the ones who are most at risk. Though acknowledging that the international community has made some progress in the past few years, UN officials and independent groups say governments must do more to combat HIV/AIDS. "The world has made considerable promises," said UN Secretary-General Kofi Annan on the eve of World AIDS Day Dec. 1. "The time has come to keep them." There are more than 40 million people living with HIV/AIDS today, according to the United Nations. The disease has already claimed some 25 million lives. Though HIV/AIDS cases have been reported in all parts of the world, studies show that most people living with the disease reside in low-and-middle income countries, where most new HIV infections and deaths are occurring. Among them, sub-Saharan Africa has been hardest-hit, and is home to nearly 26 million people living with HIV/AIDS. In South and Southeast Asia, there are more than seven million people suffering from HIV/AIDS. In Latin America, the number of AIDS patients is estimated to be around two million, and almost the same number of people are infected in Eastern Europe and Central Asia. Research shows that in developing countries, it is working class people who are disproportionately threatened by death from HIV/AIDS. "Nearly 90 percent of AIDS-related fatalities occur among people of working age, making it the leading cause of death worldwide for people between the age of 15 and 49," according to the Worldwatch Institute, an independent think-tank based in Washington. The group estimates that due to HIV/AIDS, Africa loses at least 10 percent of its working age adults every five years. By contrast, industrial countries lose about one percent of this age group to all deaths in the same period of time. Last September, while attending a major UN summit on development, world leaders pledged to implement the Declaration of Commitments they had adopted in 2001, by intensifying efforts for prevention, treatment, care and support. But those campaigning for international action against AIDS doubt if governments will take their promises seriously. "We have been asked to stomach year after year of rhetorical statements disguised as commitments on AIDS," says Marcel Van Soest, executive director of the World AIDS Campaign based in Europe. "The litany of broken promises now rings hollow against unrelenting advance of the epidemic throughout the world," he adds. In a new report titled "Promises, Promises... But How Many Get Delivered," the group notes that many declarations on AIDS have been cast as "commitments and promises," but simply restate the current understanding of the epidemic and avoid committing to concrete deliveries. Halting and reversing HIV/AIDS by 2015 is also one of the Millennium Development Goals world leaders had agreed on at a major UN summit held in New York in 2000. Among others, these goals are targeted to reduce poverty by half, ensure primary education for girls, and provide clean drinking water. "Halting the spread of AIDS is not a Millennium Development Goal in itself, it is a prerequisite for reaching most of the others," Annan said in urging governments to speed up their efforts in the fight against the pandemic. Studies suggest that among young people between the ages of 15 and 24 living with HIV/AIDS, women outnumber men. According to the Kaiser Family Foundation, gender inequalities in social and economic status and in access to prevention and care services are increasing women's vulnerability to HIV/AIDS. Researchers say the epidemic has multiple effects on women, such as added responsibilities of caring for sick family members, loss of income and property if they become widows, and even violence when their HIV status is discovered. In their messages on World AIDS Day, various UN agencies, including UNICEF and the World Health Organization (WHO), tried to draw the world's attention to the suffering of millions of women living with HIV/AIDS, especially those who are pregnant. UNICEF says the number of children who become HIV-positive every year could be more than halved if pregnant women with HIV received comprehensive services, including anti-retroviral drugs. Currently, more than 600,000 children are estimated to become infected with HIV each year, more than 80 percent of them because they are born to mothers infected with the virus. "Hundreds of thousands of children are needlessly born with HIV every year, and many of them die in the first year of life," said UNICEF executive director Ann Veneman. Veneman thinks that the number of children with HIV could be "dramatically" reduced by providing essential services to their mothers. That requires additional funding as well as practical action on promises made by government leaders in the recent past. International funding to fight AIDS has increased significantly in recent years–from $300 million in 1995 to $8 billion in 2005. However, it remains to be seen how effectively governments implement the pledges made in the 2001 Declaration. According to UNAIDS, prevention efforts are reaching fewer than 20 percent of those in need. And critics like Health GAP complain that US-initiatives in particular, rather than delivering comprehensive and scientifically-based prevention messages, preach abstinence and faithfulness only in a society where 50 percent of youth are sexually active. "Failing on treatment is bad enough, but for the US government to fuel the pandemic with evangelic messages that ignore women's vulnerability and the realities of human sexuality is criminal," Sharonann Lynch of Health GAP said in a statement. "The US has created an artificial condom shortage in Uganda; it refuses to fund comprehensive sex education for youth; and it gags comprehensive family planning services and simultaneously undermines efforts to work with sex workers by requiring an anti-prostitution oath by service providers," she said.