The report from the U.N. Program on HIV/AIDS said that tough campaigns in countries like Uganda, Brazil, India and Thailand have shown it is possible to slow the epidemic. But it said there must be a massive increase in political will and financial resources at a global level.
"Unless action against the epidemic is scaled up drastically, the damage already done will seem minor compared with what lies ahead," warned UNAIDS in a report issued to coincide with a U.N. social summit.
The Report on the Global HIV/AIDS Epidemic warned against complacency in wealthy countries.
And it cited studies in Australia and the United States showing that increasing numbers of young homosexual men are indulging in risky behavior with unprotected sexual intercourse and frequent partners.
Worldwide, 5.4 million people were newly infected last year with the Human Immunodeficiency Virus, which causes AIDS. A total of 13.2 million children have been orphaned since the disease first spread.
There are now 16 countries where more than one-tenth of the population aged 15-49 carries the AIDS virus, all in sub-Saharan Africa. In seven of these, at least one adult in five is infected. Women are harder hit than men.
The southern African nation of Botswana has the highest rate, with 36 percent of adults infected. In South Africa, which has a 20 percent infection rate, there are 4.2 million people living with the virus - the largest single national total in the world.
Life expectancy rates are being slashed: In Zimbabwe, a male who was 15 in 1983 had a 15 percent chance of dying before reaching his 50th birthday. This likelihood rose to 50 percent for those turning 15 in 1997.
The report described the infection rates in teen-agers and young women in some African countries as "frighteningly high." Nearly six out of 10 women under 24 in the South African town of Carletonville tested positive, according to a 1998 study cited by UNAIDS.
"AIDS has become a full-blown development crisis," the report said.
Denial continues to be a problem. The report cited a 1999 survey in a hard-hit Kenyan rural community among 72 minors orphaned by AIDS. Although all knew of the disease, none of them believed their parents had died of it and most thought witchcraft or a curse was to blame.
In an otherwise grim picture, there are a few success stories. The infection rate in Uganda has fallen to around 8 percent of the adult population from a peak of 14 percent in the early 1990s thanks to strong prevention campaigns and increased condom use.
Despite earlier fears of an epidemic sweeping Asia, the general rate of infection remains generally low.
In Thailand, the heterosexual epidemic has been curbed, although the virus is spreading fast through shared needles and unprotected sex between men.
Vigorous campaigns in India have helped contain the disease in high-risk groups and boosted hopes that the densely populated nation may be able to avert mass heterosexual infections.
Brazil's policy of prevention coupled with treatment with locally produced alternatives to high-cost patented drugs has also worked, it said.
UNAIDS praised recent moves by big drug companies to cut the cost in Africa of AIDS drugs and said there should be more negotiations with pharmaceutical concerns to reduce prices.
It also demanded steps to improve access to essential drugs to kill pain and treat diseases which feed off the AIDS virus, like pneumonia, TB and mouth fungus.
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