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These statistics, however, are only part of the story. Given the large populations in Asian countries, even the low percentages translate into huge numbers of HIV-infected individuals. There are now an estimated 7 million people in Asia living with HIV. Experts find the trend in HIV incidence in Asia at least as troubling as the actual numbers.

The question is no longer whether Asia will have a major epidemic, but rather how massive it will be.


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In some areas, the HIV incidence in these groups is at least 20 percent and can be as high as a staggering 80 percent. Such high rates of infection mean that serious HIV outbreaks could happen at any time. According to UNAIDS, "Injecting drug use and sex work are so pervasive in some areas that even countries with currently low infection levels could see epidemics surge suddenly.

Although sexual intercourse is the major means of HIV transmission in Asia, many people do not know to take basic precautions such as using condoms during intercourse to prevent the spread of HIV. However, in the countries that have taken measures to educate the public, there has been notable success. In Thailand and Cambodia, where large government-sponsored programs to promote the use of condoms are in effect, HIV incidence is actually on the decline. As is the case with Asia, there is an overall low rate of HIV infection in Latin America , but experts feel that an epidemic may explode at any time.

WHO | Obesity: preventing and managing the global epidemic

A study reported that though HIV is still concentrated in high-risk populations, such as prisoners, intravenous drug users, commercial sex workers, and homosexual men, the virus is slowly spreading to the general population. In some places such as Honduras and southeastern Brazil, HIV is already present in the population at large.

The countries of the Caribbean do not account for a large number of worldwide HIV infections , but as a percentage of the population, HIV now infects over 2 percent of the adults in the region. Certain countries are far more beleaguered by the disease; Haiti, for example, reports HIV incidence levels of 5 percent to 6 percent. In general, the virus is poised to spread to the larger Caribbean population if effective prevention programs are not put into place. In many of these areas where HIV is becoming increasingly problematic, social isolation and discrimination prevent adequate treatment or education.

Homosexual men and commercial sex workers, for example, often are stigmatized and as a result tend to be overlooked by those offering HIV care or counseling. Developing nations face the dual challenge of overcoming social stigmas accompanying high-risk lifestyles as well as misconceptions surrounding HIV in order to keep the spread of the virus in check.

A Global Epidemic

Throughout the developing world, women are at the highest risk of contracting HIV. In part, this is due to social custom. Heterosexual contact is the primary mode of HIV transmission in these areas, and in what are often male-dominated cultures, women are often ignored if they demand that their partners use condoms during intercourse. In addition, some of the most reliable preventive measures can stigmatize those who use them. According to Karungari Kiragu of Johns Hopkins University, "If women demand condoms to be used, [it] means they must have been running around.

The higher risk for women is especially pronounced in Africa. Cultural traditions such as wife inheritance, whereby a brother-in-law marries his brother's widow, also place women at greater risk. Said Kiragu, "The problem is, if the new husband has HIV, the woman may not know and may not have a choice [to refrain from sexual activity] anyway. Another reason that women are particularly at risk is that it is much easier to transmit the virus from a man to a woman than the other way around.

The sensitive tissues of the vagina and cervix can easily be bruised and torn during intercourse; these small cuts and abrasions make it easier for HIV to enter the body. On the other hand, penile tissue does not sustain the same amount of damage and therefore does not as often present open cuts through which the virus can enter. Even in areas where some types of HIV transmission have been stemmed, women remain at risk. For example, through well-funded and politically supported prevention programs, Thailand reduced the number of new HIV infections from , in to 29, in Women, however, are still disproportionately infected during heterosexual contact with their husbands, boyfriends, and, in the case of sex workers, clients.

Many of these women are the partners of intravenous drug users who have contracted HIV through infected needles.

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Though this is a large problem, the Thai government has yet to prioritize prevention programs for drug users, and HIV continues to spread in the population of drug users and their sexual partners. HIV can be transmitted from an infected mother during pregnancy, during childbirth, or after birth through contaminated breast milk. The risk of transmission is approximately 15 percent to 30 percent, even if a mother does not breast-feed her infant.

When infected mothers breast-feed, however, the risk of HIV transmission to their babies rises to 25 percent to 50 percent. Approximately six hundred thousand HIV-infected infants are born each year around the world, with over 90 percent of these infections taking place in sub-Saharan Africa. There is hope, however, for curbing MTCT. In fact, through education, counseling, access to antiretroviral drugs, safe delivery practices, and the availability of breast-milk substitutes, MTCT has been virtually eliminated in the developed world.

Taking antiretroviral drugs, including nevirapine and AZT, can reduce the risk for MTCT dramatically when administered during pregnancy, during labor, and soon after birth. In addition, the use of breast-milk substitutes eliminates the risk of MTCT through breast milk. Unfortunately for the women at greatest risk, that is, women in the developing world, drugs are not always available, and often the women do not even know to seek treatment. In addition, many of them do not have access to clean water for mixing infants' formula, thus limiting their ability to avoid breast-feeding. Along with counseling and education, drugs such as nevirapine are now being offered free of charge to developing countries.

This is vital to the effort to stop the spread of HIV and could potentially save the lives of three hundred thousand children each year.

Obesity: preventing and managing the global epidemic

In light of the wealth of new information about HIV's incidence and treatment, many developing countries have stepped up their efforts to address the AIDS crisis. Tedros was equal parts emphatic and grave as he spoke: The world remains vulnerable. What is the cause of this great vulnerability?


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Is it our inability to stave off Ebola? Rising incidents of rabies in animal populations? The threat of a global pandemic comes from our apathy, from our staunch refusal to act to save ourselves — a refusal that finds its heart in our indifference and our greed. Almost million are pushed into extreme poverty because of the cost of paying for care out of their own pockets. And in the United States, which is presently enduring a flu season of record-breaking severity , the Centers for Disease Control and Prevention CDC recently announced they would be cutting their epidemic prevention programs back by 80 percent.

It might seem a bit obtuse. Aside from the obvious — avoiding a global pandemic that ravages humanity — healthy societies are advantageous for reasons that are more economic than epidemiological.

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