The New York Times
Wednesday, November 24, 1999
More African Women Have AIDS Than Men
By LAWRENCE K. ALTMAN
AIDS has long been considered primarily a men's disease. But on Tuesday the United Nations reported for the first time that more women than men were infected with the AIDS virus in Africa, the site of the vast majority of such infections in the world.
In a report released in advance of World AIDS Day on Dec. 1, the United Nations said that of the 22.3 million adults in sub-Sahara Africa infected with H.I.V., the AIDS virus, 12.2 million, or 55 percent, are women.
This is the first time that data have been available to make such a comparison, officials said.
United Nations officials said the precise reasons for the shift were unclear, though they noted that H.I.V. was spread in Africa primarily through heterosexual intercourse. The virus passes more easily from men to women than from women to men.
"Ten years ago, it was hard to make people listen when we were saying AIDS wasn't just a man's disease," said Dr. Peter Piot, head of UNAIDS, which joins a number of United Nations agencies, including the World Health Organization. Dr. Piot (pronounced PEE-yot) spoke to reporters by telephone from London.
Infection rates among women are much lower in the United States and other developed countries than in Africa. But more women, primarily in minority groups, are becoming infected through heterosexual sex in this country, Dr. Piot said.
The new evidence that Africa has 6 infected women for every 5 infected men comes from a number of studies in several African countries, UNAIDS said. Many AIDS experts have assumed that more women were infected than men in Africa. But documentation was not possible because much of the data was not broken down by sex, Dr. Bernhard Schwartlander, an epidemiologist for the agency and a principal author of the report, said in an interview.
Another factor in the shifting demographics in Africa, the report said, is the different age patterns of H.I.V. infection in men and women. Studies in several countries have found that African girls 15 to 19 are 5 to 6 times as likely to have the virus as boys their own age. Men tend to be more promiscuous, and "older men, who often coerce girls into sex or buy their favors with sugar-daddy gifts, are the main source of H.I.V. for the teenage girls," the report said.
To reduce the risk to women, Dr. Piot said, health workers need to devise strategies to change men's actions, starting with sex education among boys. Another goal is to reduce the cost of female condoms, so they can be used more widely.
Although Africa is by far the continent most affected by the virus, with nearly 70 percent of the infected people in the world living in the countries below the Sahara, AIDS remains an unabated epidemic in many countries. This year, an estimated 5.6 million adults and children became infected with the virus, bringing to more than 50 million the worldwide total since the AIDS epidemic was first recognized in 1981. Thirty-three million infected people are alive today. But AIDS has killed 16 million; 2.6 million of them died in 1999, a record for any year.
"AIDS remains a fatal disease" despite the availability of newer combinations of drugs, Dr. Piot said, and "the threat of H.I.V. has not diminished in any country."
How high will the number of AIDS cases reach worldwide? Dr. Schwartlander said the answer would depend on the number of infections in Asia, a number that cannot be determined now. Because the factors that influence changes in sexual behavior are difficult to predict and because risk factors like injecting drugs vary, he said, UNAIDS cannot predict when AIDS will peak.
Even if prevention programs completely stopped new infections, deaths would increase for years, because third world countries cannot afford drugs to fight the virus, and their health systems are overwhelmed by related illness.
The steepest curve in rising infection rates in 1999 was in the newly independent states of the former Soviet Union, where drug use by injection is increasingly common among unemployed people and schoolchildren. In the Russian federation, nearly half of all reported cases of H.I.V. infection since the start of the epidemic were recorded in the first nine months of 1999 alone.
In Moscow, three times as many cases were reported in the first nine months of 1999 as in all previous years combined. Towns around Moscow have even sharper increases, with more than five times as many infections in the first nine months of 1999 as in previous years combined.
H.I.V. rates in adults are about 2 percent in the Caribbean, the highest outside sub-Sahara Africa, where it is 8 percent.
"AIDS has emerged as the single greatest threat to development in many countries of the world," Dr. Piot said.
Life expectancy in southern Africa, which climbed to 59 in the early 90's from 44 in the early 50's, is expected to drop back to 45 in 10 years. Fewer than 50 percent of the South Africans now alive can expect to reach 60, compared with 70 percent for developing countries and 90 for industrialized countries.
A survey of commercial farms in Kenya found that illness and death now rivaled old-age retirement as the leading reason why employees left work. Some life insurance companies have found that a third or more of deaths are related to H.I.V., even in plans that require a negative test as a condition of acceptance.
UNAIDS noted some bright spots. Strong prevention efforts have had sustanined success in lowering or stabilizing rates in the Philippines, Thailand and a few other countries.
Dr. Piot said that political efforts were increasing in a number of countries, but that it took five years before statistics showed improvement.
Dr. Seth Berkley, head of the International AIDS Vaccine Initiative, said, "A vaccine is the world's best hope for ending the pandemic."
The New York Times
