If black America were a country, it would rank 16th in the world in the number of people living with the AIDS virus, the Black AIDS Institute, an advocacy group, reported Tuesday.The report, financed in part by the Ford Foundation and the Elton John AIDS Foundation, provides a startling new perspective on an epidemic that was first recognized in 1981.
Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.
Those and other disparities are "staggering," said Dr. Kevin A. Fenton, who directs H.I.V. prevention efforts at the Centers for Disease Control and Prevention, the federal agency responsible for tracking the epidemic in the United States.
"It is a crisis that needs a new look at prevention," Dr. Fenton said.
In a separate report on Tuesday, the United Nations painted a somewhat more optimistic picture of the worldwide AIDS epidemic, noting that fewer people are dying of the disease since its peak in the late 1990s and that more people are receiving antiretroviral drugs.
Nevertheless, the report found that progress remained uneven and that the future of the epidemic was uncertain. The report was issued in advance of the 17th International AIDS Conference, which begins this weekend in Mexico City.
The gains are partly from the Bush administration's program to deliver drugs and preventive measures to people in countries highly affected by H.I.V.
The Black AIDS Institute took note of that program in criticizing the administration's efforts at home. The group said that more black Americans were living with the AIDS virus than the infected populations in Botswana, Ethiopia, Guyana, Haiti, Namibia, Rwanda or Vietnam - 7 of the 15 countries that receive support from the administration's anti-AIDS program.
The international effort is guided by a strategic plan, clear benchmarks like the prevention of seven million H.I.V. infections by 2010 and annual progress reports to Congress, the group said. By contrast, it went on, "America itself has no strategic plan to combat its own epidemic."
In a telephone interview, Dr. Fenton said, "We recognize this is a crisis, and clearly more can be done."
The institute, based in Los Angeles, describes itself as the only national H.I.V./AIDS study group focused exclusively on black people. Phill Wilson, the group's chief executive and an author of the report, said his group supported the government's international anti-AIDS program. But Mr. Wilson's report also said that "American policy makers behave as if AIDS exists 'elsewhere' - as if the AIDS problem has been effectively solved" in this country.
The group also chided the government for not reporting H.I.V. statistics to the United Nations for inclusion in its biannual report.
Dr. Fenton said the C.D.C. had ensured that its data were forwarded to officials in the Department of Health and Human Services and was investigating why the data were not in the United Nations report.
Others speaking for the agency said the answer would have to come from the State Department, which did not respond to an inquiry.
Dr. Helene Gayle, president of CARE and a former director of H.I.V. prevention efforts at the disease control centers, told reporters on Tuesday that the United States needed to devote more resources to care for people with sexually transmitted diseases. Such infections can increase the risk of H.I.V. infection.
The federal government and communities needed to promote more testing among all people, particularly blacks, to detect H.I.V. infection in its earliest stages when treatment is more effective, Dr. Gayle said.
Also, she said, more needed to be done to promote needle exchange programs, which have proved effective in preventing H.I.V. infection among injecting drug users but that are illegal in many places.
The United Nations report said that in Rwanda and Zimbabwe, changes in sexual behavior had led to declines in the number of new H.I.V. infections.
Condom use is increasing among young people with multiple partners in many countries and more young people are postponing their initial sexual intercourse before age 15.
The percentage of pregnant women receiving antiretroviral drugs to prevent transmission of H.I.V. to their infants increased to 33 percent in 2007 from 14 percent in 2005. During the same period, the number of new infections among children fell to 370,000 from 410,000.
The United Nations report affirmed treatment gains in Namibia, which increased treatment to 88 percent of the estimated need in 2007, from 1 percent in 2003; and in Cambodia, where the percentage rose to 67 in 2007 from 14 percent in 2004. Other countries with high treatment rates are Botswana, Brazil, Chile, Costa Rica, Cuba and Laos.
In most areas of the world, more women than men are receiving antiretroviral therapy, the report said.
Despite inadequate monitoring systems in many countries, data suggest that most of the H.I.V. epidemics in the Caribbean appear to have stabilized. A few have declined in urban areas in the Dominican Republic and Haiti which have had the largest epidemics in the region.
Increased treatment was partly responsible for a decline in AIDS-related deaths to an estimated 2 million in 2007 from 2.2 million in 2005.
The AIDS epidemic has had less overall economic effect than earlier feared, the report said, but is having profound negative effects in industries and agriculture in high-prevalence countries.
The United Nations has set 2015 as the year by which it hopes to reverse the epidemic. But even if the world achieved that goal, the report said, "the epidemic would remain an overriding global challenge for decades."
To underscore the point, the United Nations said that for every two people who received treatment, five people became newly infected.
© 2008 The New York Times