AIDS epidemic update
UNAIDS/WHO - 2002
Joint United Nations Programme on HIV/AIDS (UNAIDS)
World Health Organization (WHO)
(English original, December 2002)
Joint United Nations Programme on HIV/AIDS (UNAIDS) and
World Health Organization (WHO) 2002
All rights reserved. Publications
jointly produced by UNAIDS and WHO can be obtained from the
UNAIDS Information Centre. Requests for permission to
reproduce or translate UNAIDS publications—whether for
sale or for noncommercial distribution—should also be
addressed to the Information Centre at the address below, or
by fax, at +41 22 791 4187, or e-mail:
The designations employed and the
presentation of the material in this publication do not
imply the expression of any opinion whatsoever on the part
of UNAIDS or WHO concerning the legal status of any country,
territory, city or area or of its authorities, or concerning
the delimitation of its frontiers or boundaries.
The mention of specific companies or
of certain manufacturers’ products does not imply that
they are endorsed or recommended by UNAIDS or WHO in
preference to others of a similar nature that are not
mentioned. Errors and omissions excepted, the names of
proprietary products are distinguished by initial capital
UNAIDS and WHO do not warrant that
the information contained in this publication is complete
and correct and shall not be liable for any damages incurred
as a result of its use.
- 20 avenue Appia - 1211 Geneva 27 - Switzerland
(+41) 22 791 36 66 - Fax: (+41) 22 791 41 87
email@example.com - Internet: http:/www.unaids.or
Global summary of the HIV/AIDS epidemic
Number of people living with HIV/AIDS Total
Children under 15 years
newly infected with HIV in 2002 Total
Children under 15 years
deaths in 2002
Children under 15 years
AIDS epidemic claimed more than 3 million lives in 2002, and
an estimated 5 million people acquired the human
immunodeficiency virus (HIV) in 2002—bringing to 42
million the number of people globally living with the virus.
the world enters the third decade of the AIDS epidemic, the
evidence of its impact is undeniable. Wherever the epidemic
has spread unchecked, it is robbing countries of the
resources and capacities on which human security and
development depend. In some regions, HIV/AIDS, in
combination with other crises, is driving ever-larger parts
of nations towards destitution.
world stood by as HIV/AIDS swept through these countries. It
cannot be allowed to turn a blind eye to an epidemic that
continues to expand in some of the most populous regions and
countries of the world.
towards realizing the Declaration of Commitment
Declaration of Commitment on HIV/AIDS is a potential
watershed in the history of the HIV/AIDS epidemic. Adopted
by the world’s governments at the Special Session of the
United Nations General Assembly on HIV/AIDS in June 2001,
it established, for the first time ever, time-bound
targets to which governments and the United Nations may be
and its Cosponsors have established a set of yardsticks
for tracking movement towards those targets. Work on the
first report measuring progress against these indicators
starts in 2003, and will be based on progress reports
provided in March 2003 by the 189 countries that adopted
though, there is substantial evidence of progress. More
countries are recognizing the value of pooling resources,
experiences and commitment by forging regional initiatives
to combat the epidemic. Examples are multiplying, among
them the following:
Asia Pacific Leadership Forum, which is tasked with
improving key decision-makers’ knowledge and
understanding of HIV/AIDS and its impact on different
sectors of society.
of the Commonwealth of Independent States have developed a
regional Programme of Urgent Response to the HIV/AIDS
epidemic, which government leaders endorsed in May 2002.
mid-2002, the Pan-Caribbean Partnership against HIV/AIDS
signed an agreement with six pharmaceutical companies as
part of wider-ranging efforts to improve access to cheaper
sub-Saharan Africa, 40 countries have developed national
strategies to fight HIV/AIDS (almost three times as many
as two years ago), and 19 countries now have National AIDS
Councils (a six-fold increase since 2000).
resources are being brought to bear by the new Global Fund
to Fight AIDS, Tuberculosis and Malaria, which has
approved an initial round of project proposals, totalling
US$616 million, about two-thirds of which is earmarked for
HIV/AIDS. Governments and donors have pledged more than
US$2.1 billion to the fund.
the world lags furthest behind in providing adequate
treatment, care and support to people living with
HIV/AIDS. Fewer than 4% of people in need of
antiretroviral treatment in low- and middle-income
countries were receiving the drugs at the end of 2001. And
less than 10% of people with HIV/AIDS have access to
palliative care or treatment for opportunistic infections.
many countries, especially in sub-Saharan Africa and Asia,
competing national priorities inhibit allocation of
resources to expand access to HIV/AIDS care, support and
treatment. Unaffordable prices remain the most commonly
cited reasons for the limited access to antiretroviral
drugs. Insufficient capacity of health sectors, including
infrastructure and shortage of trained personnel, are also
major obstacles to health service delivery in many
Eastern Europe and Central Asia, the number of people living
with HIV in 2002 stood at 1.2 million. HIV/AIDS is expanding
rapidly in the Baltic States, the Russian Federation and
several Central Asian republics.
In Asia and the Pacific, 7.2 million people are now living with HIV. The
growth of the epidemic in this region is largely due to the
growing epidemic in China, where a million people are now
living with HIV and where official estimates foresee a
manifold increase in that number over the coming decade.
There remains considerable potential for growth in India,
too, where almost 4 million people are living with HIV.
several countries experiencing the early stages of the
epidemic, significant economic and social changes are giving
rise to conditions and trends that favour the rapid spread
of HIV—for example, wide social disparities, limited
access to basic services and increased migration.
Best current projections suggest that an additional 45 million people
will become infected with HIV in 126 low- and middle-income
with concentrated or generalized epidemics) between 2002 and
2010—unless the world succeeds in mounting a drastically
expanded, global prevention effort. More than 40% of those
infections would occur in Asia and the Pacific (currently
accounts for about 20% of new annual infections).
down HIV trends
most common measure of the HIV/AIDS epidemic is the prevalence
of HIV infections among a country’s adult
population—in other words, the percentage of the adult
population living with HIV. Prevalence of HIV provides a
good picture of the overall state of the epidemic.
Think of it as a still photograph of HIV/AIDS. In
countries with generalized epidemics, this image is based
largely on HIV tests done on anonymous blood samples taken
from women attending antenatal clinics.
prevalence offers a less clear picture of recent trends
in the epidemic, because it does not distinguish between
people who acquired the virus very recently and those who
were infected a decade or more ago. (Without
antiretroviral treatment, a person might survive, on
average, up to 9–11 years after acquiring HIV; with
treatment, survival is substantially longer.)
A and B, for example, could have the same HIV prevalence,
but be experiencing very different epidemics. In country
A, the vast majority of people living with HIV/AIDS (the
prevalent cases) might have been infected 5–10 years
ago, with few recent infections occurring. In country B,
the majority of people living with HIV/AIDS might have
been infected in the past two years. These differences
would obviously have a huge impact on the kind of
prevention and care efforts that countries A and B need to
HIV prevalence rates might be stable in country C,
suggesting that new infections are occurring at a stable
rate. That may not be the case, however. Country C could
be experiencing higher rates of AIDS mortality (as people
infected a decade or so ago die in large numbers), and an increase
in new infections. Overall HIV prevalence rates would not
illuminate those details of the country’s epidemic.
a measure of HIV incidence (i.e. the number of new
infections observed over a year among previously
uninfected people) would help complete the picture of
current trends. Think of it as an animated image of the
problem is that measuring HIV incidence is expensive and
complicated—to the point of it being unfeasible at a
national level and on a regular basis in most countries.
of this means, however, that recent trends are a mystery.
Regular measurement of HIV prevalence among groups of
young people can serve as a proxy, albeit imperfect, for
HIV incidence among them. Because of their age, young
people will have become infected relatively recently.
Significant changes in HIV prevalence among 15–19- or
15–24-year-olds can therefore reflect important new
trends in the epidemic.
steadily dropping HIV prevalence levels in
15–19-year-olds in Uganda, for example, indicate a
reduction in recent infections among young people, and
provide a more accurate picture of current trends in the epidemic (and, in this instance, of the
effectiveness of prevention efforts among young people).
outcomes can be avoided. Implementation of a full prevention
package by 2005 could cut the number of new infections by 29
million by 2010. It could also help achieve the target of
reducing HIV prevalence levels among young people by 25% by
2010 (as set in the Declaration of Commitment on HIV/AIDS,
which the world’s governments adopted in June 2001). But
any delay in implementing a full prevention package will
slash the potential gains.
that involve and treat young people as a priority pay off,
as evidence from Ethiopia, South Africa, Uganda and Zambia
shows. HIV prevalence levels among young women in Addis
Ababa declined by more than one-third between 1995 and 2001.
Among pregnant teenagers in South Africa, HIV prevalence
levels shrank a quarter between 1998 and 2001. Prevalence
remains unacceptably high, but these positive trends confirm
the value of investing in responses among the young.
future trajectory of the global HIV/AIDS epidemic depends on
whether the world can protect young people everywhere
against the epidemic and its aftermath.
as certain sectors of society are at particular risk of HIV
infection, certain conditions favour the epidemic’s
growth. As the current food emergencies in southern Africa
show, the AIDS epidemic is increasingly entangled with wider
humanitarian crises. The risk of HIV spread often increases
when desperation takes hold and communities are wrenched
apart. At the same time, the ability to stall the
epidemic’s growth also suffers, as does the capacity to
provide adequate treatment, care and support.
is vital that HIV/AIDS-related activities become an integral
part of wider-ranging efforts to prevent and overcome
humanitarian crises, as this publication shows (see
‘HIV/AIDS and humanitarian crises’).
Regional HIV/AIDS statistics and features, end of 2002
% of HIV- Main
children newly prevalence positive adults
of transmission (#)
infected with HIV
who are women for adults living
Sub-Saharan late ’70s
North Africa late
& Middle East
late ‘80s 1.2
IDU, hetero, MSM
Latin America late ‘70s
MSM, IDU, hetero
Eastern Europe early ‘90s 1.2
& Central Asia
Western Europe late ‘70s
North America late ‘70s
MSM, IDU, hetero
Australia & late
* The proportion of adults (15
to 49 years of age) living with HIV/AIDS in 2002, using 2002
# Hetero (heterosexual
transmission), IDU (transmission through injecting drug
use), MSM (sexual transmission among men who have sex
The window of opportunity for bringing the HIV/AIDS epidemic under
control is narrowing rapidly in Asia.
1 million people in Asia and the Pacific acquired HIV in
2002, bringing to an estimated 7.2 million the number of
people now living with the virus—a 10% increase since
2001. A further 490 000 people are estimated to have died of
AIDS in the past year. About 2.1 million young people (aged
15–24) are living with HIV.
the exception of Cambodia, Myanmar and Thailand, national
HIV prevalence levels remain comparative-ly low in most
countries of Asia and the Pacific. That, though, offers no
cause for comfort. In vast, populous countries such as
China, India and Indonesia, low national prevalence rates
blur the picture of the epidemic.
Both China and India, for example, are experiencing serious, localized
epidemics that are affecting many millions of people.
India’s national adult HIV prevalence rate of less than 1% offers
little indication of the serious situation facing the
country. An estimated 3.97 million people were living with
HIV at the end of 2001—the second-highest figure in the
world, after South Africa. HIV prevalence among women
attending antenatal clinics was higher than 1% in Andhra
Pradesh, Karnataka, Maharashtra, Manipur, Nagaland and Tamil
behavioural studies in India suggest that prevention efforts
directed at specific populations (such as female sex workers
and injecting drug users) are paying dividends in some
states, in the form of higher HIV/AIDS knowledge levels and
condom use (see box). However, HIV prevalence among these
key groups continues to increase in some states, underlining
the need for well-planned and sustained interventions on a
epidemic in China shows no signs of abating. Official
estimates put the number of people living with HIV in China
at 1 million in mid-2002. Unless effective responses rapidly
take hold, a total of 10 million Chinese will have acquired
HIV by the end of this decade—a number equivalent to the
entire population of Belgium.
the number of reported new HIV infections rose about 17% in
the first six months of 2002. But HIV incidence rates can
soar abruptly in a country marked by widening socioeconomic
disparities and extensive migration (an estimated 100
million Chinese are temporarily or permanently away from
their registered addresses), with the virus spreading along
There is a vital need to
expand activities that focus on people
most at risk of infection. But targeted interventions alone
will not halt the epidemic. More extensive HIV/AIDS
programmes that reach the general population are essential.
HIV epidemics are being observed among certain population
groups in various parts of this vast country. Serious
localized HIV epidemics are occurring among injecting drug
users in nine provinces, as well as in Beijing Municipality.
lessons from India
new national behavioural survey conducted in 2001–2002
in India highlights important facets of the country’s
bid to curtail its epidemic. The survey shows clearly that
where interventions have occurred and been sustained,
behavioural change has been possible. But it also points
to the difficulties in reaching some key groups (such as
men who have sex with men), and large sections of the
wider population (notably women living in rural areas).
awareness of HIV/AIDS is high, with roughly three-quarters
of adult Indians (aged 15–49) aware that correct and
consistent condom use can prevent sexual transmission of
in general, awareness and knowledge of HIV/AIDS remain
weak in rural areas and among women. More than 80% of
urban men recognized the protective value of consistent
condom use, compared to just over 43% of rural women.
There are marked exceptions, though, such as in Andhra
Pradesh and Kerala, where awareness levels among women and
men are approximately the same. Yet, even in those states,
women report low levels of condom use (37% and 22%,
respectively)—an indication that many are not able to
negotiate safer sex with male partners. The gender divide
survey data show that Indians who cannot read are six
times less likely to use a condom during casual sex than
are their compatriots who are educated beyond secondary
school. And rural residents are half as likely as their
urban peers to use a condom with casual partners.
too, are the high levels of awareness and knowledge about
HIV/AIDS, and the evidence of high condom use among
vulnerable populations in states that have mounted
efforts. For example, Maharashtra is home to a
longstanding, generalized epidemic. There,
HIV/AIDS responses appear to have resulted in higher
levels of awareness and behavioural change among female
sex workers, their clients and injecting drug users (66%,
77% and 52% of whom, respectively, said they consistently
use condoms—among the highest rates in India). This may
have helped prevent the state’s epidemic from spinning
out of control.
Gujarat’s focused programmes have helped ensure that
some three-quarters of female sex workers used condoms the
last time they had sex with a commercial or casual
partner. But the state also reminds that HIV/AIDS
responses have to reach the wider population if the
epidemic is to be kept under control. (Knowledge levels
among women and rural inhabitants, for example, are very
low: only about 8% had no misconceptions about how HIV is
transmitted.) By contrast, where interventions for general
and marginalized populations have taken place
together—as in Kerala—they have helped keep HIV
survey shows that a significant proportion of men who have
sex with men in India also have sex with women (almost 31%
had sex with female partners in a six-month recall
period), and many (36% during a month’s recall) have sex
with commercial male partners—hitherto hidden facets of
the epidemic. Condom use rates, though, were low both with
commercial partners (39% during last sexual intercourse)
and with female partners (36%). This points to the need
for urgent action, given the potential for wider and more
rapid HIV spread through such multiple sexual networks.
major challenge for India now is that of rapidly expanding
the coverage of its HIV/AIDS programmes to all vulnerable
groups. Flanking that is the broader challenge of ensuring
that the response reaches young, illiterate populations
and rural communities, especially women.
on Nationwide Behavioural Surveillance Survey of general
population and high-risk groups, 2001–2002, National
AIDS Control Organization, India/ORG MARG)
most recent reported outbreaks of HIV among injecting drug
users have been in Hunan and Guizhou provinces (where
sentinel surveillance among users has revealed HIV
prevalence rates of 8% and 14%, respectively). There are
also signs of heterosexually transmitted HIV epidemics
spreading in at least three provinces (Yunnan, Guangxi and
Guangdong) where HIV prevalence in 2000 was as high as 11%
among sentinel sex worker populations.
dangerous new trend in Indonesia
social and economic upheavals in Indonesia appear to be
fuelling a sharp rise in injecting drug use—and, with
it, the risk of rapidly increasing HIV spread.
unknown in Indonesia just a decade ago, drug injection is
now a growing phenomenon in urban areas. Official
estimates suggest that between 124 000 and 196 000
Indonesians are now injecting drugs. And data from the
largest drug treatment centre in Jakarta reveal that HIV
prevalence is rising very steeply in this population, as
the graph below shows.
estimates indicate that some 43 000 injecting drug users
are already infected with HIV. With needle-sharing the
norm, HIV is likely to spread much more widely throughout
this population in the next few years. If current
high-risk injecting behaviour continues, it is estimated
that the number of injecting drug users living with HIV
could almost double in 2003, accounting for more than 80%
of new HIV infections nationwide.
RSKO hospital and Indonesian
Ministry of Health, Directorate General of Communicable
Disease Control and Environmental Health, 2002.
vast majority of injectors are male, and behavioural data
indicate that over two-thirds of them are sexually active.
Already, an estimated 9000 women have been infected
sexually by men who inject drugs.
onward sexual transmission of HIV by people who became
infected when they sold their blood to collecting centres
that ignored basic blood-Alternative Treatments safety procedures poses a
massive challenge, as does the need to provide them with
treatment and care. Signalling the gravity of the situation,
one 2001 survey in rural eastern China found alarmingly high
HIV prevalence—12.5%—among people who had donated
plasma. Most of the country’s estimated 3 million paid
blood donors live in poor rural communities, and those now
living with HIV/AIDS in provinces such as Henan (as well as
Anhui and Shanxi, where similar tragedies might have
occurred) face limited access to health-care services while
having to endure severe stigma and discrimination.
is a clear need for urgent action. By expanding prevention,
treatment and care efforts across the entire nation, China
can avert millions of HIV infections and save millions of
lives in the coming decade. The five-year AIDS action plan
promulgated in mid-2001 signalled a growing commitment to
take up that challenge, as did the recent moves towards
negotiating affordable antiretroviral treatment with
HIV infection rates are being discovered among specific
population groups (chiefly injecting drug users, sex
workers, and men who have sex with men) in countries across
the length and breadth of Asia and the Pacific.
Cambodia’s epidemic appears to be stabilizing, thanks to sustained
prevention programmes that link government and civil society
and that span various sectors of society.
the region, injecting drug use offers the epidemic huge
scope for growth. Upwards of 50% of injecting drug users
already have acquired the virus in parts of Malaysia,
Myanmar, Nepal, Thailand and in Manipur in India, while HIV
infections among Indonesia’s growing population of
injecting drug users is soaring (see box, page 9). Very high
rates of needle-sharing have been documented among users in
Bangladesh and Viet Nam, along with evidence that a
considerable proportion of street-based sex workers in Viet
Nam also inject drugs (a phenomenon detected in other
countries, too). If the epidemic is to be stemmed, it is
vital that injecting drug users gain access to harm
reduction and other prevention services.
Male-to-male sex occurs in all countries of the region and features
significantly in the epidemic. Countries that have measured
HIV prevalence among men who have sex with men have found it
to be high—14% in Cambodia in 2000 and roughly the same
level among male Thai sex workers. Homophobia or dominant
cultural norms mean that many men who have sex with men hide
that aspect of their sexuality. Many might marry or have
sexual relationships with women.
the Pacific Island countries and territories, Papua New
Guinea has reported the highest HIV infection rates. New
surveillance data reveal an HIV prevalence of 1% among women
attending antenatal clinics in the capital Port Moresby,
indicating that a broadened epidemic is under way in the
city. Among people seeking treatment for other sexually
transmitted infections in the capital, HIV prevalence was 7%
in 2001 (double the level in 2000). Very low levels of
condom use and wide sexual networking (amid low awareness
and knowledge of HIV/AIDS) mean the country could be facing
a severe epidemic. Heightening that prospect are findings
that 85% of surveyed sex workers in Port Moresby and in Lae
did not use condoms consistently in 2001, and that rates of
other sexually transmitted infections ranged as high as 36%.
There is a dire need for rapid expansion of prevention
Thailand, meanwhile, recent modelling sug-gests that the
main modes of transmission have been changing. Whereas most
HIV transmission in the 1990s occurred through commercial
sex, half of the new HIV infections now appear to be
occurring among the wives and sexual partners of men who
were infected several years ago. There are also indications
that unsafe sexual behaviour is on the increase among young
Thais. This underlines the need to expand and revitalize
strategies that can prevent this highly adaptable epidemic
from spreading further in Thailand. In addition, adequate
treatment and care should remain priority.
Asian country with the highest adult HIV
prevalence—Cambodia—has reported stabilizing levels of
infection, along with still-decreasing levels of high-risk
behaviour. HIV prevalence among pregnant women in major
urban areas declined slightly from 3.2% in 1996 to 2.8% in
2002, according to the latest available data. Prevalence
among sex workers declined from 42% in 1998 to 29% in 2002,
according to the latest surveillance data, with the decline most
pronounced among sex workers under 20. Given the high
turnover of sex workers in Cambodia (almost three-quarters
engage in sex work for less than two years), this steady
de-cline suggests that prevention efforts focused on sex
workers are yielding positive results
among the succession of
new entrants into sex work. Consistent condom use by sex
workers appears to be the most important behavioural change
achieved; it rose from 37% in 1997 to 90% in 2001.
efforts that protect vulnerable populations against HIV/AIDS
are important and cost-effective. Alone, though, they cannot
halt the epidemic. It is vital that AIDS responses
everywhere extend also into the wider population, imparting
the knowledge and providing the services that people need to
protect themselves and each other against HIV/AIDS.
Despite sweeping epidemics among injecting drug users, minimum services
that can protect those drug users against HIV infection are
not available in most of the region.
that many of the factors facilitating HIV transmission
(including periodic economic upheaval and high rates of
population mobility) are rife throughout this region, no
country is immune to a rapidly spreading and wide-scale
epidemic. Most countries, though, still have a window of
opportunity for mounting and sustaining HIV/AIDS initiatives
that could avert such an outcome.
Europe and Central Asia
The epidemic continues to expand rapidly in most countries
of this vast region.
unfortunate distinction of having the world’s
fastest-growing HIV/AIDS epidemic still belongs to Eastern
Europe and Central Asia. In 2002, there were an estimated
250 000 new infections, bringing to 1.2 million the number
of people living with HIV/AIDS.
recent years, the Russian Federation has experienced an
exceptionally steep rise in reported HIV infections. In less
than eight years, HIV/AIDS epidemics have been discovered in
more than 30 cities and 86 of the country’s 89 regions. Up
to 90% of the registered infections have been attributed
officially to injecting drug use, reflecting the fact that
young people face high risks of HIV infection as occasional
or regular drug injectors. Indeed, almost 80% of registered
new infections in the Commonwealth of Independent States
between 1997 and 2000 were among people younger than 29. In
the Russian Federation, the total number of reported HIV
infections climbed to over 200 000 by mid-2002—a huge
increase over the 10 993 reported less than four years ago,
at the end of 1998.
must be noted that registered HIV cases likely underestimate
the number of people living with HIV by a large margin.
Indeed, the first community survey of injecting drug
users—in Togliatti City—has revealed shockingly high HIV
prevalence (see box). In addition, the reported cases might
not accurately reflect the possible changes in the patterns
of HIV transmission (in terms of the modes of transmission,
and the gender and age groups of people who are being
infected). The inadequacy of sentinel surveillance and
voluntary counselling and testing services means that most
HIV tests occur as part of routine screening of people who
encounter the law enforcement system or use health-care
huge problem slips into focus
clearer picture of the HIV epidemic has emerged in the
Russian city of Togliatti, revealing the true scale of the
country’s HIV/AIDS epidemic.
study in late 2001 among injecting drug users recruited
from their communities (the first of its kind in the
Russian Federation) has revealed a very recent and
explosive HIV/AIDS epidemic among injecting drug users in
this city of 1 million inhabitants. Fully 56% of the users
participating in the study were found to be HIV-positive,
and a large share of them had acquired the virus in the
previous two years. The survey revealed that
three-quarters of those found to be living with the virus
were unaware of their status. In addition, 40% of female
sex workers who injected drugs did not use condoms
consistently with their regular partners, and about 25%
failed to do so with commercial sexual partners.
study lends further credence to concerns that the HIV/AIDS
epidemic in Russian cities could be considerably more
severe than the already-high official statistics indicate.
Harm reduction and other HIV prevention programmes have
proliferated in the past two years; yet, their coverage
remains narrow and, in cases like Togliatti City,
inadequate. Authors of the study have stressed the need to
expand access to sterile injecting equipment, and to step
up efforts to reduce the risk of sexual transmission of
HIV between injecting drug users and their partners.
Eastern Europe and Central Asia, young people are
particularly hard-hit by the epidemic. It is estimated that
up to 1% of the population of those countries is injecting
drugs, placing these people and their sexual partners at
high risk of infection. Those injecting drugs can be very
young—some a mere 13–14 years old. One study among
Moscow secondary-school students revealed that 4% had
Uzbekistan is experiencing explosive growth—in the first
six months of 2002, there were almost as many new HIV
as had been recorded in the whole of the previous decade.
the Russian Federation, and in many of the Central Asian
Republics, the wave of injecting drug use is closely
correlated with socioeconomic upheavals that have sent the
living standards of tens of millions of people plummeting,
amid rising unemployment and poverty levels. Another factor
has been the four-fold increase in world production of
heroin in the past decade, along with the opening of new
trafficking routes across Central Asia.
epidemic is growing in Kazakhstan, where a total of 1926 HIV
infections had been reported by June 2001. More substantial
spread of HIV is now also evident in Azerbaijan, Georgia,
Kyrgyzstan, Tajikistan and Uzbekistan. In the latter two
republics, recent evidence of rising heroin use heightens
concerns that they could be on the brink of larger HIV/AIDS
epidemics. Already, a steep rise in reported HIV infections
has been noted in Uzbekistan, where 620 new infections were
registered in the first six months of 2002—six times the
number of new infections registered in the first six months
HIV incidence is rising sharply elsewhere. In Estonia,
reported infections soared from 12 in 1999 to 1474 in 2001.
(Relative to population size, Estonia now has the highest
rate of new HIV infections in this region—50% higher than
the Russian rate). A burgeoning epidemic is visible, too, in
Latvia, where new reported infections rose from 25 in 1997
to 807 in 2001, and where a further 308 new HIV cases had
been registered by the end of June 2002.