AIDS in a New Millennium [Schwartlander B, et al. Science 2000; 289: 64]: The authors provide an "AIDS Special Report" as another review in what appears to be an epidemic of reports about the state of the world with respect to HIV infection. Among the more important observations are the following:

• Africa: Sub-Saharan, Africa accounts for 24.5 million of the global total of 34.3 million persons living with HIV infection. About 9% of the adult population aged 15-49 years are infected. Nine countries (Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia and Zimbabwe) have a seroprevalence rate exceeding 20% in persons aged 15 - 49 years. The projection is that, in these seven African countries, at least 40% of children now 15 years of age will die of AIDS. By 2020, there will be more women in their 60s and 70s than in their 40s and 50s. It is noted that "never before has the world experienced death rates of this magnitude among young adults of both sexes and across all social strata."
• High-income countries: The prevalence ranges from 0.02% in Japan to 0.6% in the U.S. It is noted that therapy to reduce viral load will notably decrease transmission, but must be given early in the course and maintained for prolonged periods. A concern is recent reports of high-risk behavior with increasing rates of rectal gonorrhea among gay men in San Francisco.
• Latin America: The epidemiology is similar to that noted in North America. Haiti has the highest rate, a prevalence of 5% and is the worst affected country outside of Africa.
• Asia: Prevalence is highly variable. Indonesia, the fourth most populous country, has a rate of about 0.05%, which is about the same for the Philippines. The rate in India is about the same as the U.S. at 0.7%, but India accounts for 3.7 million persons with HIV infection because of its high population. China has an evolving problem. The Chinese government declared sexually transmitted diseases were eliminated in 1964, but recent studies have shown a prevalence of gonorrhea as high as 0.9% among women in the Yunnan Province.

Despite the grim statistics, there are some notable success stories, and they all reflect a "strong, committed, multi-sectorial response to the epidemic, as well as a willingness by government and community leaders to make difficult and often unpopular decisions." Examples of success stories are Uganda, Zambia, Senegal, Thailand and the Indian state of Tamil Nadu. The potential for explosive epidemics is illustrated by the experience in South Africa where HIV prevalence increased from 1% in 1990 to about 20% 10 years later. One of the major impediments to progress has been the fact that the epidemic is initially silent so that overt disease and mortality is not seen until after many years of infection. The implication is that difficult and expensive decisions are often necessary to prevent an epidemic that will not be clinically expressed until several years later and is not readily apparent as a priority when important decisions need to be made. posted 8/3/2000