<strong>AIDS</strong> in a new millennium: a grim picture <strong>with</strong> glimmers of hopesentinel surveillance system, depicted in Figure 2, show that the percentage ofpregnant girls aged 15–19 infected <strong>with</strong> <strong>HIV</strong> in the capital, Lusaka, has on averagedropped by almost half in the last six years.Comparisons between studies of sexual behaviour conducted in 1990, 1992, 1996<strong>and</strong> 1998 suggest that these falling <strong>HIV</strong> rates are due in part to a decrease in theprevalence of some types of risky sexual behaviour in urban areas. For example, farfewer young women in Lusaka were having sex be<strong>for</strong>e marriage in 1996 than in 1990,<strong>and</strong> the percentage of unmarried women who were sexually active fell from 52% to35% over that period. Among young men, according to nationwide studies, thechange came later; in 1998 just over half of unmarried men said they had not had sexin the past year, compared <strong>with</strong> just over a third two years earlier, <strong>and</strong> the proportionof men reporting two or more casual partners in the past year also fell. However,there was no evidence at the national level that either girls or boys were postponingthe start of their sex life.Elsewhere in the region too, there are signs that young <strong>people</strong> are avoiding the patternsof behaviour which led their parents <strong>and</strong> older siblings to such high levels of<strong>HIV</strong> infection. Condom use, <strong>for</strong> example, is increasing among young <strong>people</strong> (seepages 59-64) <strong>and</strong> there are indications that, among the better-educated, sex <strong>with</strong>casual partners may start later <strong>and</strong> be less frequent (see pages 43-44). But thesechanges are taking place against a background of very high infection rates, especiallyin young African women.Figure 3 shows frighteningly high prevalence rates of infection among teenagers <strong>and</strong>women in their early 20s in various urban <strong>and</strong> rural areas in Africa. The rates amongteenage girls <strong>and</strong> especially among women under 25 defy belief: in 7 of the 11 studies,more than one woman in five in her early 20s was infected <strong>with</strong> the virus; a largeproportion of them will not live to see their 30th birthday. Close to 6 out of 10 womenin this age group in the South African town of Carletonville tested positive <strong>for</strong> <strong>HIV</strong>.The infection rates in young African women are far higher than those in young men.In the 11 population-based studies presented here, the average rates in teenagegirls were over five times higher than those in teenage boys. Among young <strong>people</strong>in their early 20s, the rates were three times higher in women. In large measure, thisenormous discrepancy is due to age-mixing between young women <strong>and</strong> older men,who have had much more sexual experience <strong>and</strong> are much more likely to be exposingthe girls to <strong>HIV</strong>. It is also because girls are more easily infected during vaginalintercourse <strong>with</strong> an infected partner than boys are.The fact that, in Africa, women’s peak infection rates occur at earlier ages than men’shelps explain why there are an estimated 12 women <strong>living</strong> <strong>with</strong> <strong>HIV</strong> <strong>for</strong> every 10 menin this region of the world. Not only do the young age groups account <strong>for</strong> a biggerproportion of the population, but individuals who are infected at a younger age tendto survive longer <strong>and</strong> continue to be counted among those <strong>living</strong> <strong>with</strong> <strong>HIV</strong>.11
Report on the global <strong>HIV</strong>/<strong>AIDS</strong> epidemic – June 2000Figure 3.<strong>HIV</strong> prevalence rate among women in their teens <strong>and</strong> early twenties,various African studies, 1995-199870<strong>HIV</strong>-infected (%)6050403020women 15-19women 20-24100Mutasa District, Zimbabwe, 1998 (rural)Carletonville, South Africa, 1998 (urban)Kisumu, Kenya, 1997 (urban)Lusaka, Zambia, 1995 (urban)Mposhi, Zambia, 1996 (rural)Ndola, Zambia, 1997 (urban)Kisesa, Tanzania, 1997 (rural)Yaoundé, Cameroon, 1997 (urban)Cotonou, Benin, 1997 (urban)Fort Portal, Ug<strong>and</strong>a, 1995 (urban)Masaka, Ug<strong>and</strong>a 1996 (rural)Asia holds <strong>HIV</strong> at bay – but <strong>for</strong> how long?In comparison <strong>with</strong> the rates of <strong>HIV</strong> infection in Africa, those in the general populationsof Asia are low. The prevalence among 15–49-year-olds exceeds 1% in onlythree countries – Cambodia, Myanmar <strong>and</strong> Thail<strong>and</strong>; in other countries, the prevalencerate is often far lower. In Indonesia, the world’s fourth most populous country,fewer than 5 <strong>people</strong> in 10 000 are <strong>living</strong> <strong>with</strong> <strong>HIV</strong>. In the Philippines, the rate of <strong>HIV</strong>infection is only slightly higher, at 7 per 10 000.These figures do not tell the whole story, however. Within the largest Asian nations,some geographic regions have far more inhabitants than most African countries <strong>and</strong>have <strong>HIV</strong> prevalence rates far greater than the national average. In Asian countriesin which the epidemic is concentrated in certain groups, such as injecting drugusers, it is misleading to focus solely on the prevalence in the general population.China <strong>and</strong> India between them account <strong>for</strong> around 36% of the world’s population.With such huge populations, even low <strong>HIV</strong> prevalence rates mean that huge numbersof <strong>people</strong> live <strong>with</strong> the virus. Indeed, in India, where only 7 adults in 1000 areinfected <strong>with</strong> <strong>HIV</strong>, 3.7 million <strong>people</strong> were <strong>living</strong> <strong>with</strong> <strong>HIV</strong>/<strong>AIDS</strong> at the beginning of themillennium – more than in any other country in the world except South Africa. India’sepidemic is highly diverse: while some states show almost no <strong>HIV</strong> infection, othershave reached adult <strong>HIV</strong> prevalence rates of 2% <strong>and</strong> above.12