DURBAN, South Africa -- The AIDS pandemic is worse than anyone ever thought and will cause populations in the hardest-hit countries to actually shrink, the U.S. government said on Monday.
The U.S. Census Bureau and U.S. Agency for International Development kicked off an international AIDS conference with some of the starkest figures to come out yet, showing life expectancy falling to below 30 years in some places.
The AIDS epidemic is spreading faster than even the most pessimistic projections had predicted, the agencies told a news conference at the 13th International AIDS Conference.
"We underestimated the scope of it, how it has moved from urban to rural areas," Dr. Paul DeLay of USAID said.
"And most importantly we underestimated the severity," he added. "No one would have believed ... that we would see countries with a prevalence of over 30 percent."
The conference, held every two years, is in Africa for the first time. Organizers had hoped to bring attention to the severity of the problem, especially in southern Africa, which is hardest-hit by the epidemic.
Of the more than 34 million people infected by the AIDS virus, 24.5 million live in sub-Saharan Africa. AIDS is the No. 1 cause of death in Africa and the fourth globally, USAID said.
USAID said that over 8.6 percent of all adults in sub-Saharan Africa are HIV-positive, compared with 0.6 percent of Americans. Seven countries now have an estimated HIV rate of 20 percent or greater: Botswana, Lesotho, Namibia, South Africa, Swaziland, Zambia and Zimbabwe.
Karen Stanecki of the U.S. Census Bureau said this had had a staggering effect on populations, especially because AIDS kills infants and young adults.
"By the year 2003, we estimate Botswana, South Africa, and Zimbabwe will be experiencing negative population growth," Stanecki said.
The Census projected the population would be shrinking at a rate of 0.1 to 0.3 percent. "Without AIDS, these countries would have been experiencing a growth rate of 2 percent or greater," Stanecki added.
Experts had already said that AIDS was reversing all the gains in life expectancy made by African countries, but the USAID-Census report showed figures were getting even more grim.
"In Botswana we have some of the most explosive epidemics occurring," Stanecki said.
In Botswana, life expectancy is now 39 instead of 71, the report said. By 2010, many countries in southern Africa, including Botswana, Namibia, Swaziland and Zimbabwe, will see life expectancies falling to near 30 years of age.
AIDS mortality will continue to result in falling life expectancies in Latin America, the Caribbean and Asia, USAID added.
The report supports earlier findings that young women, infected heterosexually, are the worst-hit.
Meanwhile, South African President Thabo Mbeki came under fresh criticism from AIDS activists Monday after he ducked an opportunity to end a damaging debate over the causes of the disease.
Mbeki, attacked by activists and health experts for appearing to give credence to so-called AIDS dissidents who deny the HIV virus causes AIDS, was back in the firing line after his opening speech to the AIDS conference Sunday.
The eagerly awaited speech gave no insight into whether Mbeki, who succeeded former President Nelson Mandela last year, believed that HIV led inevitably to AIDS.
Similarly, Mbeki made no direct reference to his controversial decision to deny the antiretroviral drug AZT in the country's public health system to pregnant mothers and to rape victims on cost grounds.
Denouncing his critics, Mbeki instead launched a broadside against those who questioned his right to appoint "dissidents" to his own advisory panel on the disease and focused on the devastating impact of poverty on the continent.
The speech repeated much of his government's commitment to fight HIV, which has already infected 4.2 million South Africans and is on course to infect a total of nearly 8 million by the end of the decade.
