Aids becomes 'disease of women' as worldwide spread accelerates

The worst epidemic in human history is spreading round the world at an accelerating rate and is increasingly affecting women.

The worst epidemic in human history is spreading round the world at an accelerating rate and is increasingly affecting women.

Latest figures show that 4.8 million people became infected with HIV last year - the highest number in any year since the Aids epidemic began. The total living with HIV/Aids rose to 37.8 million and there were 2.9 million deaths.

Peter Piot, executive director of UNAids, which published its fourth biennial report on the disease yesterday, said Aids was becoming "more and more a disease of women". Having largely affected men in its early stages, the proportion of women infected had risen to almost 50 per cent globally and to 57 per cent in sub-Saharan Africa.

In every country of the world, from North and South America to Eastern Europe and Central Asia, the proportion of women infected is growing. The 200-page report highlights the "feminisation" of the epidemic, which it says presents a major challenge to policy makers.

Dr Piot said HIV/Aids started as a disease of gay men in the West, men who visited prostitutes in Africa and injecting drug users in Russia and the Far East, who were also chiefly male. But as the course of the epidemic lengthened from years into decades there had been a gradual build-up of infections in women.

Among people aged 15 to 24 in South Africa, twice as many women and girls are infected as men. Women are more biologically susceptible than men, because they are exposed to a larger dose of virus during sex, and their first sexual experience - often non-consensual - is likely to be with a man five to 15 years older, who may already be infected, Dr Piot said. "That is what is really driving the epidemic in South Africa," he added. "If sexual intercourse started between boys and girls of the same age the epidemic would die out."

One of the main planks of the Aids prevention strategy - the ABC message (Abstain, Be faithful or use a Condom) - would have to be re-thought because it was "pretty irrelevant" for many young girls and women, he said. "We have got to revisit some of our prevention strategies. When sex is violent and non-consensual, abstention is not an option for women. Fidelity has to apply to both sides, and asking for a condom when you are married is difficult in any culture."

Dr Piot said the strategy had to be focused on changing the behaviour of men while relying on technology - especially the development of microbicides - to protect women. "In order to make sure women become less infected we have to target men. That is fundamental. We have got to have long-range efforts to change the norms in society," he said.

Efforts to develop microbicides - creams placed in the vagina before intercourse which would kill the HIV virus - had reached the trial stage, he said, and held out greater promise for protecting women than an Aids vaccine.

"That would dramatically change the course of the epidemic like the contraceptive pill did for birth control," he said.

He added that efforts to empower women by improving their educational opportunities and social position were also essential, and where to place the focus of prevention efforts was an area of continuing debate.

The report, released a week before the opening of the International Aids conference in Bangkok on 11 July, highlights the growth of the epidemic in Asia, which now accounts for almost one in four of all new infections in the world.

The fastest-growing epidemic is in Eastern Europe, where it is driven by the use of injectable illicit drugs. There has been a rapid growth of women infected in the region. The age of those infected is also low, with 80 per cent under 30.

In Western Europe and the United States infections are also on the rise, but only 30 per cent are aged under 30.

Worldwide funding for HIV/Aids has risen fifteenfold in the past seven years and the numbers with access to anti-retroviral drugs has doubled. But the numbers are still low, with only 7 per cent of people in developing countries on drug treatment.

Hilary Benn, Britain's International Development Secretary, announced £116m new funding for UN agencies to tackle Aids yesterday.

Dr Piot said there was some good news from sub-Saharan Africa, where the epidemic is stabilising as the number of people becoming infected is no longer outstripping the number dying. "There is a slowing down, especially in East Africa," he said. "From Addis Ababa [in Ethiopia] to Lilongwe [in Malawi], we are seeing a decline in new infections, especially among young people."

The experience of Thailand showed that Aids was "a problem with a solution," he said. In 1991 there had been 140,000 new infections, which had dropped to 21,000 last year. That had been due to the "massive promotion of condoms and encouraging men to reduce their partners and use of commercial sex workers".