(September 2002) We are entering the third decade of what may be the most devastating epidemic in human history: HIV/AIDS. The disease continues to ravage families, communities, and countries throughout the world. In addition to the 20 million people who have already died of AIDS, most of the 40 million people now living with HIV are likely to die a decade or more prematurely. Each day, 14,000 people—12,000 adults and 2,000 children—become infected with HIV. At least 95 percent of these new infections occur in less developed countries; more than 50 percent afflict women and young adults. Unless the international community launches a coordinated and massive response to the epidemic, there will be 45 million new HIV infections by 2010.

In less developed countries, hard-earned improvements in health made over the last 50 years are being halted and, in some countries, reversed, as AIDS claims the lives of millions of young adults in their most productive years. Indicators of human development, such as child mortality, literacy, and food production, are also slipping as a result of the pandemic. The disease is crippling progress at the personal, familial, community, and national levels. In severely affected nations, economic growth and political stability are also threatened.

Sub-Saharan Africa is the hardest hit region in the world: More people die there of AIDS-related illness than of any other cause. South Africa has the highest absolute number of infections of any country in the world: 5 million. Botswana has the highest adult HIV prevalence rate: 39 percent of the country’s adults are infected with HIV. If Botswana’s current infection rate persists, the chance that a boy who was 15 years old in 2001 will eventually die of AIDS exceeds 80 percent.

While the scale and force of the epidemic have been worst in Africa, other regions face serious HIV/AIDS epidemics as well. The Caribbean, for example, has the second-highest adult HIV prevalence rate in the world. In Haiti, 6 percent of adults carry the virus. HIV prevalence is increasing fastest in eastern Europe and the former Soviet republics, where the breakdown of the health systems, economic crises, and wrenching social change have facilitated HIV infections, particularly through injecting drug use among young people.

HIV prevalence is also rising rapidly in many parts of eastern and southern Asia. China and India have relatively low overall prevalence rates, but the absolute numbers of infected people are staggering: at least 850,000 in China and nearly 4 million in India. These two countries will see millions of additional infections unless they launch large-scale, effective prevention programs. Epidemics have also surfaced in other Asian countries, including Myanmar (Burma), Nepal, and Cambodia.

Countries throughout the industrialized world face serious challenges from HIV/AIDS. Infection rates have not declined significantly in Western Europe or North America, where the epidemic is spreading from the gay male population to ethnic minorities, the poor, and other marginalized groups.

The global HIV/AIDS pandemic shows no sign of slowing, despite concerted efforts to control it. In 2001, more people contracted HIV and more died of AIDS than in any previous year: 5 million people became infected with the virus, and 3 million died of AIDS. Dr. Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), warns that the epidemic is still in its early stages.

Peter Lamptey is president of the Family Health International (FHI) Institute for HIV/AIDS. Merywen Wigley is an associate technical officer at the FHI Institute for HIV/AIDS, where she provides research, technical, and writing support. Dara Carr is a technical director for health communication at the Population Reference Bureau (PRB). Yvette Collymore is a senior editor at PRB.