U.N. FORECASTS BIG INCREASE IN AIDS DEATH TOLL

ARCELONA, Spain, AIDS will claim an additional 65 million
lives by 2020, more than triple the number who died in the first 20
years of the epidemic, unless more countries vastly expand their
prevention programs, says the United Nations' first long-range
forecast of the epidemic.

The forecast is a departure from earlier estimates, which had
predicted that the epidemic may have reached its peak in some
countries by 2000. It is part of a grim report that was issued today
in advance of the 14th International AIDS Conference, which begins
here on Sunday.

The epidemic is still in its early stages, the United Nations warned,
with H.I.V. being transmitted in almost every part of the world,
including countries where rates had been very high and others where
they had been stable.

The alarming extent of spread is disproving theories that the number
of infections might reach a plateau in heavily hit countries as the
number of individuals at risk for H.I.V., declines.

AIDS is the fourth-leading cause of death in the world. Without a
sharp drop in the number of new infections, the AIDS death toll by
2020 will rival the number of people killed in wars in the entire 20th
century.

The report also includes the first analysis of access to anti-H.I.V.
treatment by region of the world. Of the 40 million H.I.V.-infected
people, only 700,000, or 1.75 percent, were receiving such drugs at
the end of 2001.

The overwhelming majority of these, 500,000, live in high-income
countries where combinations of anti-H.I.V. drugs have prolonged the
lives of many people. In these countries, in 2001, fewer than 25,000
people died of AIDS. But in Africa, fewer than 30,000 of the 28.5
million infected people were receiving anti-H.I.V. treatment at the
end of 2001.

Preparation of the forecast was aided in large part by development of
improved scientific methods to create models of epidemic patterns as
well as the collection of large amounts of recent information about
AIDS and patterns of sexual behavior from affected countries, said Dr.
Peter Piot, the director of the United Nations AIDS program.

Earlier, five year projections underestimated the extent of the spread
of H.I.V., the AIDS virus, in Africa by one-third to one-half, Dr.
Piot and Dr. Neff Walker, a United Nations epidemiologist, said in
news conference conducted by telephone.

"We've constantly underestimated the kind of levels the epidemic can
reach," Dr. Walker said in discussing the report, which estimated
numbers of people infected, AIDS orphans and a variety of other
statistics about H.I.V. in every country.

One reason for the earlier miscalculations is that the AIDS epidemic
seems far more complex than that of virtually all other diseases, Dr.
Walker said. Mass migrations, economic upheavals and other social
factors have increased the number of people at risk of H.I.V., making
accurate predictions difficult.

Individuals may move in and out of high-risk groups at different
periods of life, such when large numbers of couples break up or when
one partner seeks work outside the community, the United Nations
officials said. Under such circumstances, men may take on new and
multiple sex partners and more women may become prostitutes to pay for
food.

Dr. Piot said that despite the gloomy trend there are new signs of
hope that transmission of H.I.V. is being curbed in some areas.

"Nations with accelerating epidemics must move quickly to adapt proven
responses from countries that have succeeded in turning the epidemic
around," Dr. Piot said. "The essential elements of these are frank,
widespread H.I.V. prevention, including access to voluntary counseling
and testing, leadership at the highest levels of government, and
access to care for people infected and affected by AIDS."

Without such action, Dr. Piot said, the spread of H.I.V. will continue
unabated as it has in Botswana, the African country that has had the
highest H.I.V. infection rates in the world since 1996.

In Botswana, nearly 39 percent of adults are H.I.V.-infected, a rise
of 3 percent since 2000. One-third of adults in two other African
countries, Zimbabwe and Swaziland, were infected at the end of 2001,
up from about 25 percent in 1999. In Cameroon, H.I.V. transmission is
accelerating rapidly, rising to 12 percent now compared with a range
of 4.5 to 9 percent from 1988 through 1996.

In Indonesia, the world's fourth-most-populous country, infection
rates are now rising rapidly following a decade of consistently low
infections rates. New information suggests that there has been a surge
in H.I.V. infections among prostitutes in some areas of Indonesia. The
fastest growing epidemic is in Russia and Eastern Europe, where H.I.V.
is now moving from injecting drug users into the wider population, Dr.
Piot said. In Ukraine, nearly one in four new infections now occurs
through heterosexual sex.

The Caribbean is the second-most-affected area in the world. Infection
rates are 6 percent in Haiti and 4 percent in the Bahamas.

The epidemic in China is now spreading through heterosexual sex.
Earlier, nearly all H.I.V. infections were transmitted through
injecting drug use and unsafe use of blood.

Worldwide, 15- to 24-year-olds account for half of all new infections.
Almost 12 million young people now have H.I.V., and an additional
6,000 young adults become infected every day.

The number of children left orphaned by AIDS continues to increase
sharply. About 14 million children living today have lost one or both
parents to AIDS. The number will continue to grow rapidly, as up to
one-half of today's new mothers are likely to die of AIDS in the worst
affected countries.

A number of countries have experienced new successes in slowing the
spread of H.I.V., and in some cases have made progress to make access
to H.I.V. treatment more available for those infected, providing
models for action for other countries.

Zambia may soon become the second African country, following Uganda,
to reverse a widespread epidemic, Dr. Piot said. In cities in Zambia,
H.I.V. prevalence is falling among young women, to 24 percent in 1999
from 28 percent in 1996. In rural areas, the comparable rates have
fallen to 12 percent from 16 percent.

In Uganda, the prevalence of H.I.V. continues to decline, Dr. Piot
said. In 2001, the number of people living with H.I.V. had fallen to 5
percent from 8.3 percent in 1999.

The Polish government has successfully curtailed an epidemic among
injecting drug users and prevented it from gaining a foothold in the
wider population by mounting a strong national response, he said.

In Cambodia, Dr. Piot said that strong political will and large-scale
prevention programs have helped lower H.I.V. prevalence among adults
to 2.7 percent at the end of 2000 from more than 4 percent in 1999.

Dr. Piot said that although many countries, including some of the
world's poorest, have significantly increased their AIDS budgets, they
still fall far short of the $9 billion needed annually to combat the
epidemic in heavily infected countries "But so far, these countries
are the exception, and not the rule," Dr. Piot said.

The report will be available at www.unaids.org.