In South Africa , the average rate of HIV prevalence in pregnant women attending antenatal clinics was about 25 percent. It is estimated that 5.3 million South Africans were living with HIV at the end of 2002. Because it is a relatively recent epidemic, and given current trends, AIDS deaths will continue to increase rapidly over the next five years.

In four neighboring countries, Botswana, Lesotho, Namibia and Swaziland, HIV prevalence has reached extremely high levels without signs of leveling off. Infection rates in Botswana and Swaziland are around 39 percent. HIV prevalence in antenatal sites in Namibia rose to over 23 percent in 2002. Lesotho’s most recent data shows median HIV prevalence among antenatal clinic attendees climbing to 30 percent. There are signs that the epidemic is leveling off in Zambia .

Uganda remains a relative bright spot. HIV prevalence fell to 8 percent in Kampala in 2002.

In West Africa, Cote d’Ivoire has the highest HIV prevalence with more than one in 10 pregnant women having HIV infections in some of the country’s regions.

Across most of Sub-Saharan Africa, HIV prevalence among pregnant women visiting antenatal clinics has been roughly level for several years. But this is because AIDS has killed as many people as have been infected with HIV each year. This hides a persistently high number of annual, new HIV infections.

:: Latin America & the Caribbean
More than 2 million people are now living with HIV in Latin America and the Caribbean, including the estimated 200,000 that contracted HIV in the past year. At least 100,000 people died of AIDS in the same period – the highest regional death toll after Sub-Saharan Africa.

National HIV prevalence rates are above 1 percent in 12 countries in the Caribbean Basin. The most recent national estimates showed HIV prevalence among pregnant women reaching or exceeding 2 percent in six of them; the Bahamas, Belize, the Dominican Republic, Guyana, Haiti and Trinidad and Tobago .

Brazil remains the country with the most HIV infected people. A strong prevention effort and an active program to treat people with HIV, has helped keep the HIV prevalence of pregnant women attending antenatal clinics below 1 percent.

Two of the most serious epidemics in the region are on Hispaniola Island – in Haiti and the Dominican Republic . AIDS claims 30,000 lives a year and the national HIV prevalence rate is 5–6 percent. Prevention efforts appear to have stabilized HIV infection in the Dominican Republic. Having climbed to 3 percent in 1995, it has fallen to less than 1 percent in pregnant women aged 15-24.

In Central America, national HIV prevalence is around 1 percent in Guatemala, Honduras and Panama .

The mode of HIV transmission tends to vary in different parts of the region. In the bulk of the South American countries, HIV is being transmitted chiefly through injecting drug use and sex between men. In Central America, most HIV infections appear to be occurring through sexual transmission (both heterosexual and between men) and in the Caribbean through heterosexual transmission.

:: Eastern Europe and Central Asia
The AIDS epidemic in Eastern Europe and Central Asia shows no sign of abating. About 230,000 people were infected with HIV in 2003, bringing the total number of people living with the virus to 1.5 million. AIDS claimed an estimated 30,000 lives in the past year.

The Russian Federation had acumulative 229,000 people who had been diagnosed with HIV by the end of 2002. Ukraine (cumulative total of 52,000) and the Baltic States (Estonia, Latvia and Lithuania) also have rising AIDS problems. HIV also continues to spread in Belarus, Moldova and Kazakhstan. More recent epidemics are emerging in Kyrgyzstan and Uzbekistan .

Driving these epidemics is widespread risky behavior – injecting drug use and unsafe sex – among young people. Injecting drug use has increased sharply in the past few years and condom use remains low. Prevention efforts targeting risky behaviors can halt these epidemics.

:: East Asia and the Pacific
While national HIV prevalence rates remain under 1 percent in the majority of the region’s countries, several provinces and states have series epidemics. There are increasing warning signs that series HIV outbreaks threaten several countries. Injecting drug use and sex work are so pervasive in some areas that even countries with currently low infection levels could see sudden surges in the epidemic.

China’s low national HIV prevalence rate obscures the fact that serious, concentrated epidemics are underway in certain regions such as Yunnan, Xinjiang, Guangxi, Sichuan, Henan and Guangdong. In parts of the country, for example, high rates of HIV prevalence have been found among injecting drug users.

Three Asian countries, Cambodia, Myanmar and Thailand , have already contended with serious nationwide epidemics. But Cambodia has stabilized its epidemic at 3 percent since 1997 and Thailand’s 100 percent condom program brought its rampant epidemic to heel in the 1990s, with national HIV prevalence hovering at about 2 percent in 2002.

Vietnam ’s prevalence rate remains under 1 percent. But it faces the possibility of a serious epidemic. In 2002, Sentinel surveillance found more than 20 percent of injecting drug users in most provinces were HIV positive and there are signs that sex workers are also becoming infected. HIV prevalence rates of 11 percent and 24 percent have been detected among sex workers in Can Tho and Ho Chi Minh City respectively. Infection rates among sex workers stand at 15 percent in Hanoi and 8 percent in Hai Phong.

In Indonesia , despite an increase in condom social marketing and AIDS-awareness campaigns, condom usage remains low, even in commercial sex. Estimates suggest that fewer than 10 percent of the seven to 10 million men who frequent sex workers use condoms consistently. But injecting drug users are the major driver of Indonesia’s epidemic. Over 90 percent of injecting drug users have been found to use unclean injecting equipment in three major cities.

Papua New Guinea has the highest reported rate of HIV infection in the Pacific with an estimated prevalence rate of almost 1 percent among pregnant women attending antenatal clinics in Port Moresby.

:: South Asia
South Asia’s epidemic continues to be dominated by the enormous number of people infected with HIV in India. However the epidemic could quickly explode in other parts of the region because of a high incidence of risky behavior.

India had between 3.82 and 4.58 million people infected with HIV by the end of 2002. In the past year, at least 300,000 acquired HIV and serious epidemics are now underway in several states – including Maharashtra and Tamil Nadu where HIV prevalence of over 50 percent has been found in sex workers in some cities and in Manipur where HIV prevalence among injecting drug users ranges between 60 percent and 75 percent.

In Bangladesh and Nepal , national HIV prevalence has remained under 1 percent but risky behavior in parts of the population is so extensive that it could spark a wider epidemic.

In Pakistan, the few available HIV surveillance studies suggests HIV prevalence among injecting drug users and sex workers has been low. But there is evidence that injecting drug use is increasing and low knowledge about HIV transmission creates the potential for sharp a increase in the epidemic.

:: Middle East and North Africa
Latest estimates indicate that 55,000 people acquired HIV infection in the past year, bringing to 600,000 the total number of people living with HIV/AIDS in the Middle East and North Africa. AIDS killed a further 45,000 people in 2003. There is the potential for a considerable rise in the number of HIV infections in the region.

Sudan is the most seriously affected country in the region with a national adult HIV prevalence of more than 2 percent. Conflict is hampering both the surveillance of the epidemic and the country’s ability to mount an effective response. The epidemic is mainly heterosexual and more concentrated in the south.

The epidemic threatens to expand along diverse routes including through blood transfusions and blood collection. Also of concern is the rise in HIV infections among injecting drug users, particularly in Bahrain, Libya and Iran. This form of transmission is also linked to infections in Algeria, Egypt, Kuwait, Morocco, Oman and Tunisia and Iran . Sex workers and men who have sex with men are also highly vulnerable in this region.

Effective prevention is needed speedily across the regions, designed to target both vulnerable groups and groups that could be drawn into the next phase of the epidemic. But at present, even basic activities such as condom promotion are largely absent in the region.

But there are some encouraging exceptions to what appears to be a general pattern of official denial in the region. Algeria, Lebanon, Iran and Morocco are developing more substantial prevention programs and some countries (Iran and Libya ) appear more willing to acknowledge and tackle epidemics associated with injecting drug use.

:: High-Income Countries
The total number of people living with HIV continues to rise in high-income countries, largely due to widespread access to antiretroviral treatment. It is estimated that 1.6 million people are living with HIV in these countries – a figure that includes the 80,000 newly infected in 2003. AIDS claimed about 18,000 lives in the past year.

In the United States , around half of the 40,000 new infections annually are occurring among African-Americans. An increasing number of women are being infected by their male partners who have sex with men or use injecting drugs. AIDS is now the leading cause of death for African-American women aged 25-34.

In Germany, Greece and the Netherlands, sex between men is an important aspect of transmission. In the US (in 2002) and Australia (in 2001) it accounted for 42 percent and 86 percent of new HIV diagnoses respectively.

Of concern is a resurgence of other sexually transmitted diseases in Australia, Japan, Western Europe and the US , which points to an increase in high-risk behavior, including among men who have sex with men.

Japan is seeing a steady increase in the number of reported HIV infections. The number of new HIV cases reported annually has doubled since the 1990s to more than 600 in 2001 and 2002.