World AIDS Day observance highlights plight of women, girls.

WORLD AIDS Day 2004, observed Dec. 1, marked the 17th time advocates commemorated an international day of recognition for those living with and fighting HIV/AIDS. Rising infection rates among women and girls as well as continued racial disparities were among the top concerns highlighted during this year's observance.

In the United States, HIV/AIDS diagnosis rates remained steady in 2000-2003, with an estimated 950,000 Americans living with HIV. But the number of new cases among black women was 18 times higher than among white women and almost five times higher than among Hispanic women, according to the Centers for Disease Control and Prevention. Women and girls make up 47 percent of all people infected with HIV worldwide.

A World Health Organization report released just before World AIDS Day showed the number of women living with HIV spiked 56 percent during the past two years in East Asia and 46 percent in Eastern Europe and Central Asia. The WHO report also said HIV cases are at their highest ever, with 39.4 million people infected in 2004, up from 36.6 million in 2002.

"The continued scourge of AIDS magnifies the significance of World AIDS Day," said APHA Executive Director Georges Benjamin, MD, FACP, in an Association news release. "We must remain vigilant and devote the necessary resources to fight this disease that has taken the lives of millions of men, women and children. More effective treatment and prevention, along with better access to therapies, are particularly needed across the globe to address this devastating epidemic."

Two U.S. advocacy groups were outspoken on Dec. 1 in their criticism of the government's handling of AIDS programs. The Washington-based Human Rights Campaign issued a "report card," giving the United States a failing grade in the AIDS fight for its inaction on funding comprehensive sexual education programs, needle exchanges and other prevention strategies. Human Rights Watch, a non-profit group based in New York, also said policies that criticize condoms and restrict people's access to them are hamstringing AIDS prevention efforts in countries worldwide, including the United States.

"Governments should be promoting condom use, not treating condoms like contraband," said Jonathan Cohen, a researcher with Human Rights Watch's HIV/AIDS Program. "The clear result of restricting access to condoms will be more lives lost to AIDS."

According to the group, less than half of people worldwide who were at risk of sexual transmission of AIDS had access to condoms in 2003.

As always, funding is a continued issue in the HIV/AIDS fight, with some programs seeing their budgets shrink dramatically during the past decade. Even so, global spending on the disease has tripled since 2001 to $6.1 billion, half of which comes from non-governmental donors. Advocates said World AIDS Day is a chance to highlight the continued need for funding, research, treatment and prevention programs.

"World AIDS Day is both a day of remembrance and one of hope for the future," said HIV/AIDS Section member and Action Board representative Kathye Gorosh, MBA, executive director of the Chicago-based Core Foundation. "It's an opportunity to renew our commitment that we need to remain vigilant in our work to provide prevention and care services -- in the United States and throughout the world. Although a global focus is critical to putting an end to this pandemic, people often forget that the United States is part of that global effort."

A CDC report published in the Dec. 3 Morbidity and Mortality Weekly Report showed the number of newly diagnosed HIV infections in gay and bisexual men has risen in many states, with an overall 11 percent rise in infections among men who had sex with men. The study looked at HIV infections in 32 states from 2000-2003 and found blacks made up 51 percent of all new infections.

Officials with the National Institutes of Health spoke on World AIDS Day of broadening HIV/AIDS research. NIH funding for topical microbicide research, for example, will rise from $47 million in fiscal year 2001 to an estimated $70 million in fiscal year 2005.

"We have hope that the future will be brighter for the 40 million people worldwide who are currently living with HIV/AIDS," said APHA HIV/AIDS Section Chair-elect George Clifford, PhD. "We continue to make improvements in the care and treatment of people who are HIV-infected, but the benefits of these improvements are severely limited based on where you live, whether you have access to care and whether you can afford the life-saving therapies currently available."

Other topics of concern raised on Dec. 1 included the need for comprehensive sexual education, better access to effective treatments and a continued worldwide response to the epidemic.

"While the number of new infections worldwide in 2003 is staggering at an estimated 5 million, we must work together to reduce the number of new infections by using known interventions that reduce the risk of transmission," said Susan Fulmer, MPH, MS, CPP, immediate past chair of APHA's HIV/AIDS Section and planning coordinator for the South Carolina Department of Health and Environmental Control's STD/HIV Division. "Ultimately, we hope that a cure will be found that will put an end to this terrible pandemic -- one that has decimated countries around the world, but most significantly in sub-Saharan Africa."