2004 Report on the global AIDS epidemic

Preface

The global AIDS epidemic is one of the greatest challenges facing our generation. AIDS is a new type of global emergency—an unprecedented threat to human development requiring sustained action and commitment over the long term. As this report shows, the epidemic shows no sign of weakening its grip on human society.

The AIDS crisis continues to deepen in Africa, while new epidemics are growing with alarming speed in Asia and Eastern Europe. No region of the world has been spared.

While there is a pressing need for additional resources and commitment, this report also documents some of the success stories that have been achieved—by groups of people living with or affected by HIV, as well as by governments, nongovernmental organizations, business people and religious leaders.

AIDS has been with us for more than 20 years. It will continue to challenge us for many decades to come. The most important lesson we have learned so far is that we can make a difference: we can prevent new infections, and we can improve the quality of care and treatment for people living with HIV.

Our greatest challenge is to extend the extraordinary examples of leadership recorded in this report to the mainstream of everyday life. In the absence of a cure, the mass mobilization of every sector of society remains our only weapon.

Kofi A. Annan

Secretary-General of the United Nations

Foreword

Every two years, on the occasion of the International Conference on AIDS, this Global Report sets out our current knowledge on the state of the epidemic based on the experiences of the Joint United Nations Programme on HIV/AIDS (UNAIDS), which comprises nine United Nations system agencies. It makes for sobering reading.

Far from levelling off, rates of infection are still on the rise in many countries in Sub-Saharan Africa. Indeed, in 2003 alone, an estimated 3 million people in the region became newly infected. Most alarmingly, new epidemics appear to be advancing unchecked in other regions, notably Eastern Europe and Asia.

Countries in Eastern Europe and East Asia are experiencing the fastest growing HIV epidemic in the world. The large, populous countries of China, India and Indonesia are of particular concern. General prevalence is low there, but this masks serious epidemics already under way in individual provinces, territories and states.

AIDS is the most globalized epidemic in history, and we are witnessing its growing ‘feminization’. Every year brings an increase in the number of women infected with HIV. Globally, nearly half of all persons infected between the ages of 15 to 49 are women. In Africa, the proportion is reaching 60%. Because of gender inequality, women living with HIV or AIDS often experience greater stigma and discrimination.

Yet this is a problem with a solution. As our report indicates, we know what works—successful approaches are evolving locally, nationally and globally. They are being helped by the growing momentum of international political leadership, by business workplace programmes, and by the dynamic mobilization of affected communities themselves—a key element that remains at the heart of our global response.

The good news is that the world is significantly increasing its commitments and resources. Yet as the number of governments, financial institutions and partners responding to AIDS increases, there is an urgent need for greater support for, and collaboration with, heavily affected countries. There is also a need to avoid duplication and fragmentation of resources.

Building on commitments made by leading donors in April 2004, we must not only raise more resources, but make sure that they are spent wisely to help countries mount sustainable and effective AIDS strategies. In particular, we must join forces to help countries strengthen their capacity to deliver these strategies.

A particularly welcome development is that the world has increasingly recognized the need to improve access to antiretroviral treatment for all people infected with HIV, regardless of the country in which they live. Treatment must be at the heart of every comprehensive AIDS strategy. However, prevention is equally important. We must never lose sight of doing everything we can to prevent people from becoming infected in the first place.

Over 20 years of AIDS provides us with compelling evidence that unless we act now we will be paying later—a trenchant message for the countries of Asia and the Pacific. AIDS demands that we do business differently; not only do we need to do more and do it better, we must transform both our personal and our institutional responses in the face of a truly exceptional global threat to security and stability.

AIDS is likely to be with us for a very long time, but how far it spreads and how much damage it does is entirely up to us.

Peter Piot

Executive Director

Joint United Nations Programme on HIV/AIDS

Total number of adults and children living with HIV: 38 million [35-42 million]
Number of people living with HIV	Total	37.8 million	[34.6–42.3 million]
	Adults	35.7 million	[32.7–39.8 million]
	Women	17 million	[15.8–18.8 million]
	Children <15 years	2.1 million	[1.9–2.5 million]
People newly infected with HIV in 2003	Total	4.8 million	[4.2–6.3 million]
	Adults	4.1 million	[3.6–5.6 million]
	Children <15 years	630000	[570 000–740 000]
AIDS deaths in 2003	Total	2.9 million	[2.6–3.3 million]
	Adults	2.4 million	[2.2–2.7 million]
	Children <15 years	490000	[440 000–580 000]