U.N. Forecasts Big Increase in AIDS Death Toll
AIDS will claim an additional 65 million lives by 2020, more than triple the number who died in the first 20 years of the epidemic, unless more countries vastly expand their prevention programs, says the United Nations' first long-range forecast of the epidemic.

The forecast is a departure from earlier estimates, which had predicted that the epidemic may have reached its peak in some countries by 2000. It is part of a grim report that was issued today in advance of the 14th International AIDS Conference, which begins here on Sunday.

The epidemic is still in its early stages, the United Nations warned, with H.I.V. being transmitted in almost every part of the world, including countries where rates had been very high and others where they had been stable.

The alarming extent of spread is disproving theories that the number of infections might reach a plateau in heavily hit countries as the number of individuals at risk for H.I.V., declines.

The report also includes the first analysis of access to anti-H.I.V. treatment by region of the world. Of the 40 million H.I.V.-infected people, only 700,000, or 1.75 percent, were receiving such drugs at the end of 2001.

The overwhelming majority of these, 500,000, live in high-income countries where combinations of anti-H.I.V. drugs have prolonged the lives of many people. In these countries, in 2001, fewer than 25,000 people died of AIDS. But in Africa, fewer than 30,000 of the 28.5 million infected people were receiving anti-H.I.V. treatment at the end of 2001.

Preparation of the forecast was aided in large part by development of improved scientific methods to create models of epidemic patterns as well as the collection of large amounts of recent information about AIDS and patterns of sexual behavior from affected countries, said Dr. Peter Piot, the director of the United Nations AIDS program.

Earlier, five year projections underestimated the extent of the spread of H.I.V., the AIDS virus, in Africa by one-third to one-half, Dr. Piot and Dr. Neff Walker, a United Nations epidemiologist, said in news conference conducted by telephone.

"We've constantly underestimated the kind of levels the epidemic can reach," Dr. Walker said in discussing the report, which estimated numbers of people infected, AIDS orphans and a variety of other statistics about H.I.V. in every country.

One reason for the earlier miscalculations is that the AIDS epidemic seems far more complex than that of virtually all other diseases, Dr. Walker said. Mass migrations, economic upheavals and other social factors have increased the number of people at risk of H.I.V., making accurate predictions difficult.

Individuals may move in and out of high-risk groups at different periods of life, such when large numbers of couples break up or when one partner seeks work outside the community, the United Nations officials said. Under such circumstances, men may take on new and multiple sex partners and more women may become prostitutes to pay for food.

Dr. Piot said that despite the gloomy trend there are new signs of hope that transmission of H.I.V. is being curbed in some areas.
http://www.nytimes.com/2002/07/03/health/03AIDS.html