Programs Help Reduce HIV Rates in Parts of Africa, Report Says

Prevalence of the disease in city dwellers 15 to 24, who make up a key demographic gauge of the epidemic's trajectory, has fallen by at least 25 percent in Zimbabwe, Malawi, Kenya, Botswana, Burundi, Rwanda and Ivory Coast. In Zimbabwe, Kenya, Botswana and Tanzania, the rate fell a similar amount among rural people.

In Uganda, the national prevalence is 6.7 percent -- a steep decline from a decade ago, attributed to fewer sex partners, later "sexual debut" by teenagers, increased condom use and rising AIDS mortality through the 1990s. Now, however, AIDS prevalence is rising in some populations, such as rural men (up from 5.6 to 6.5 percent) and rural women (6.9 percent to 8.8 percent), according to recent surveys.

Piot said Uganda also suffered from a period of "decreased credibility" of condoms, the consequence of messages by some fundamentalist groups, a run of defective condoms and then a shortage of condoms.

In Thailand, HIV infection used to be seen almost exclusively in prostitutes and their male clients. The spread of the virus was nearly halted by a national campaign for "100 percent condom use" in commercial sex transactions. Now, however, the epidemic is spreading to married women, who accounted for one-third of new infections last year. It is also becoming far more prevalent in male homosexuals -- up from 17 percent in Bangkok in 2003 to 28 percent in 2005.

In Western Europe, just over one-third of the new HIV infections last year occurred in "men who have sex with men," the term preferred by epidemiologists, because many men infected that way do not consider themselves to be homosexual. The Netherlands, Britain, Portugal, Switzerland and Belgium reported steep increases in the number of infections in that population since 2000.

About 55 percent of new infections in Europe were acquired through opposite-sex intercourse, with three-quarters occurring in immigrants or migrants. The report noted the need to target prevention programs to them.

A major sign of progress is that since 2002, 2 million years of life have been gained by the use of antiviral drugs in low- and middle-income countries. In Africa, 790,000 years of life have been gained, most in the past two years.

Lifesaving combinations of antivirals became widely used in rich countries beginning in 1996. The idea that a decade later they might be used by more than a handful of people in poor countries was viewed by most as unrealistic and possibly dangerous.

Piot said the report demonstrates that policymakers such as himself "need to safeguard early successes like Uganda." He added: "You develop complacency, and the attention moves to something else. That is completely human. The job is never finished, particularly when you have had some successes."