Rural Center for AIDS/STD Prevention

RAP Time

(Volume 2, No. 1, January 9, 1998)

Issue Contents

Global HIV Infections Rise with Over 90% of Cases Occurring in Developing Countries

An estimated 30.6 million persons globally are living with HIV or AIDS, according to a newly released report by UNAIDS OJnited Nations AIDS) and the World Health Organization. An additional 11.7 million persons have died of AIDS, bringing the cumulative number of cases to over 42 million.

Major findings of the report include that globally:

  • One in every 100 persons between ages 15 and 49 are infected with HIV.
  • Over 90 percent of HIV/ AIDS cases occurred in developing countries.
  • AIDS cases are declining in Western Europe and the United States.
  • About 9 percent more HIV infections occurred this year than last year and the number of people living with HIV has grown by 13 percent.
  • About one in five of those with HIV became infected in 1997.
  • About 16,000 new HIV infections occur each day.
  • At least 50 percent of the cases were contracted before age 25.
  • At least 40 percent of the cases occurred among women.
  • At least 8 million children have lost their mother or both parents to AIDS.
  • At least 90 percent of those living with HIV/AIDS are not aware of their HIV positive status.
  • Recent gains in life expectancy in many developing countries have been cancelled by the effects of HIV/AIDS.

Africa and Asia Most Affected
In sub-Saharan Africa and Asia HIV is spread primarily by heterosexual contact. About 88 percent of all persons with HIV/AIDS globally live in these areas.

Estimates reflect an increase of HIV/AIDS cases in Southern Africa. For example, Botswana has reported a doubling of adult HIV cases in the last five years. In Zimbabwe, one of every five adults was infected with HIV in 1996. In one town near the South African border, seven of every 10 pregnant women tested HIV positive in 1995. Throughout Southern Africa, HN infection rates in cities are only slightly higher than in rural areas.

The epidemic is newer in Asia than in Africa. The Government of China estimated that at the end of 1996 up to 200,000 people were living with HIV/AIDS. According to some estimates, this figure may have doubled by the end of 1997.

Successful Prevention Efforts
HIV infection rates in Uganda declined by 20 percent this past year. UNAIDS attributes this decline to open and concerted efforts to prevent HIV infection through education-based interventions. The decline was most significant in the younger age group. Stud;es indicated that they are initiating sex later in life, have sex with fewer partners, and using condoms more often.

UNAIDS reported that quality sexuality education helps delay first intercourse and lowers teen pregnancy and STD rates.

HIV counseling and testing are recommend as pan of the overall intervention effort. Further, HIV prevention education is vital in developing countries, particularly in the rural areas.

SOURCE: UNAIDS/WHO. (1997). Report on the Global HIV/AIDS Epidemic. Geneva, Switzerland.

Rural AIDS Cases among MSM Rising

An analysis of AIDS cases from the Centers for Disease Control and Prevention indicate the epidemic has increased in Black and Hispanic men who have sex with men (MSM), especially in rural and small metropolitan areas of the United States.

AIDS incidence rates between 1990 and 1995 among MSM increased from 15 to 18 percent in all areas expect the West where the rates decreased by two percent. However, both rural and small metropolitan areas experienced a 34 percent increase in MSM AIDS rates.

AIDS rate increases of 132 percent and 100 percent for Black MSM and Hispanic MSM, respectively, were reported for rural areas. Rural Indians/ Alaskan Natives MSM also had an increase in AIDS rates.

The study indicates a need for prevention programs targeting minority populations of MSM in rural areas and small towns. Prevention programs must address the cultural barriers to discussing homosexuality, sexual behavior, and HIV infection.

SOURCE: Sullivan, P. S. et a. (1997). Changes in AIDS incidence for men who have sex with men, United States, 19901995. AIDS, 11, 1641-1646.

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Condom Intervention Program Effective

A group of more than 3000 injecting drug users IDUs) in Long Beach, California received an educational program designed to increase condom use. The intervention program included media messages and role model stories from a network of peer volunteers.

IDUs in a similar community did not receive an intervention. The intervention increased condom carrying, whereas no such increase occurred in the nonintervention group. The intervention also increased use with secondary partners, but not with main partners. Given that about two-thirds of the IDUs in this study reported sexual intercourse with other partners in the prior 30 days, this finding has strong implication for HIV prevention.

The study supports the value of using existing peer networks to increase HIV preventive behaviors among IDUs.

SOURCE: Jamner, M. S., Wolitski, R. J., & Corby, N. H. (1997). Impact of a longitudinal community HIV intervention targeting injecting drug users' stage of change for condom and bleach use. American Journal of Health Promotion, 12, 15-23.

HIV Risk Behavior Not Reduced by Pregnancy

Results from 151 pregnant adolescents and young mothers revealed that most engaged in sexual behaviors that increased ' their risk for acquiring HIV. Neither having a pregnancy nor knowing about HIV transmission was sufficient to reduce risk behaviors in this sample.

SOURCE: Koniak-Griffin, D., & Brecht, M. (1997). AIDS risk behaviors, knowledge, and attitudes among pregnant adolescents and young mothers. Health Education & Behavior, 24, 613-624.

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STD Treatment Cost Effective in Reducing HIV Incidence

A study in Tanzania showed that treatment of STDs prevents HIV infection. The costs of these programs is about ten dollars for each year of life saved.

SOURCE: Gilson, L., et al. (1997). Cost-effectiveness of improved treatment services for sexually transmitted diseases in preventing HIV-1 infection in Mwanza Region, Tanzania. Lancet, 350, 1805.