World AIDS Day: HIV Pandemic Surging

Everybody worries about bird flu. Does anybody still worry about AIDS?

Worldwide, bird flu has killed 68 people. It might kill tens of millions if it ever becomes a human epidemic. Yet AIDS continues to spiral out of control -- even in parts of America.

As of Dec. 1 -- the 18th World AIDS Day -- the global AIDS epidemic has killed 25 million people. Last year saw 3.1 million AIDS deaths. If they don't get AIDS drugs, 6 million more people will die in the next year or two.

New HIV infections have surged to a record high: an estimated 40,300,000 people. That's 5 million more than last year. The U.N. has a stated "millennium development goal" of reversing this tide by the year 2015. That's only 10 years away, notes Paul De Lay, MD, director of monitoring and evaluation for the United Nations Program on HIV/AIDS (UNAIDS).

"We are generally not surprised by the relentless increase in scale of the AIDS epidemic," De Lay tells WebMD. "Everyone is hopeful we will start to see the corner being turned and see the epidemic level eventually come down. We are showing increases in the ability to prevent infections and treat people. But the rate of scaling up is just not fast enough."

Yet De Lay sees glimmers of hope. He's not alone, says Carlos del Rio, MD, chief of medicine at Atlanta's Grady Memorial Hospital and former AIDS czar for Mexico.

"We are not still in a period of total pessimism," del Rio tells WebMD. "It is a mixed bag. The AIDS epidemic is gaining ground, but there is also increasing international awareness and recognition of the importance of the problem. Even though an incredible number of people are infected daily, we are making progress. You would like to see more, but there are hopeful signs on the horizon."

U.S.: Sick Patients Fill City AIDS Wards

It may surprise you to hear one of the things that most troubles De Lay.

"One discouraging development is what's happening in high-income places, such as the U.S. and Australia," he says. "We see epidemics that were under pretty good control starting to surge. That is because of complacency and reduction in resources. If you go off your guard and let good programs slip, it doesn't take long for the AIDS epidemic to come back."

At Atlanta's Grady Memorial Hospital, del Rio sees too many patients who find out they have HIV only when they come down with the devastating infections that signal full-blown AIDS.

"In the U.S., we have gone from a period of a lot of successes to a period of not so many successes," del Rio says. "The epidemic in this country continues strong. It is increasingly affecting people who are poor and underserved, people with substance-abuse and mental-health issues, people who are hard to get in care and keep in treatment."

Other inner-city hospitals see the same thing. Michael Kolber, MD, PhD, is director of adult HIV services in the University of Miami department of medicine. The vast majority of patients he sees are poor. And most are black Americans.

"I am not optimistic," Kolber says of the U.S. AIDS epidemic. "The HIV infection rate keeps rising without an infusion of new money. We've had the same dollars for four or five years being spread out among increasing numbers of individuals. Our outreach program has diminished. And the population we treat has other social needs -- housing, child care, mental health, food. HIV -- when they have it -- they don't worry about it because of all these other things."

The irony, del Rio says, is that he's optimistic about the world AIDS situation but pessimistic about AIDS in America.

"The news about U.S. AIDS may be more negative than positive," he says. "More people are living with HIV than ever before. The number of new infections has not decreased. It has stayed about the same -- 40,000 a year. Maybe that is where it is always going to be, but to me that is an unacceptable level. More needs to be done."

The central problem, del Rio and Kolber agree, is twofold. Prevention messages somehow must find their way to the most disenfranchised people in the nation. And people who already have limited access to health care must somehow get tested for HIV, and, if infected, get treated.

"In the US, the cost of AIDS drugs is on the order of $15,000 a year," Kolber says. "They are still very expensive. I understand the need for paying these companies for their research and development. But this cost is a dramatic cost, and in parts of the U.S., people are not getting medications they need."

Forward, Step by Step

It's easy to get discouraged by the huge numbers needed to describe the global AIDS situation. It's discouraging that AIDS appears ready to boil over in populous places such as Pakistan and Indonesia. It's scary to think about what might happen if AIDS expands its foothold in China. And it's horrible to count the number of AIDS deaths that cannot be avoided in the coming years.

Yet progress is being made, even if it's of the one-step-forward variety.

Thanks to a huge five-year effort, 1 million of the world's 6 million desperately ill people now get lifesaving treatments. True, the World Health Organization's plan to treat 3 million people by 2005 fell 2 million people short. But this year there were 300,000 fewer AIDS deaths than there would have been. And next year the impact should be even greater.

"There should be a dramatic and reassuring reduction in AIDS deaths," De Lay says. "But we are not going to see a reduction in new infections in the next several years."

It's a lofty goal, but De Lay hasn't given up on the U.N.'s goal of seeing the AIDS tide ebb by 2015.

"We have in the next 10 years an opportunity to do this," he says. "But we need more resources. And money is only part of the problem. We need clinics with bigger waiting rooms. We need refrigerators in the laboratories. We need hospitals with running water. This is very basic stuff. If we do this, we may very well see the 'millennium goal' achieved."

By Daniel J. DeNoon, reviewed by Brunilda Nazario, MD

SOURCES: Joint United Nations Program on HIV/AIDS, "AIDS Epidemic Update," December 2005. Paul De Lay, MD, director of monitoring and evaluation, UNAIDS, Geneva. Carlos del Rio, MD, chief of medicine, Grady Memorial Hospital, Atlanta. Michael Kolber, MD, PhD, director, adult HIV services; associate professor, University of Miami. News release, United Nations. News release, UNAIDS. News release, CDC. CDC web site. WHO web site.