A report released on the eve of the 12th World Aids Conference in Geneva says there is now a widening healthcare gap between rich and poor countries.

The report, prepared by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organisation (WHO), also highlights the failure of prevention campaigns in many of the developing nations.

As a result, it says there has been a levelling off or even a decline in the spread of HIV in rich countries and an alarming increase in infection rates in many other parts of the world.

Drug success

It hails the development of antiretroviral drugs - drugs that combat HIV in the body and delay the onset of Aids-related infections and cancer - for helping to reduce the number of Aids deaths in the industrialised world.

By the end of 1997, there were 30.6 million people worldwide living with HIV

But UNAIDS and WHO believe the widespread use of such drugs as AZT over the past two years has been the main cause behind the new healthcare gap.

They say the drugs are expensive and difficult to administer and, as such, are out of the reach of HIV patients living in underdeveloped economies.

Dr Peter Piot, Executive Director of UNAIDS, says this is typical of the inequality of access to care that exisits around the globe.

"This particular AIDS gap shines the spotlight on the have-nots of the epidemic. For nine out of ten people living with HIV, the overwhelming issue is access to care - not just antiretrovirals, but treatment for tuberculosis, diarrhoea and other AIDS-related conditions that would enable them to live in dignity and comfort."

Explosive HIV growth

UNAIDS and WHO estimate that by the end of 1997 there were 30.6 million people worldwide infected with HIV - 29.4 million adults and more than one million children.

The most severe HIV epidemics in the world are to be found in Africa south of the Sahara desert, where nearly 21 million people have the virus. Countries in this region now account for the 21 highest HIV prevalence rates in the world.

In Asia, Latin America and Eastern Europe, though national rates are lower, many countries have experienced a doubling or tripling of their infections since 1994. Asia, which saw HIV arrive in the late 1980s and early 1990s, accounts for one out of five of the global total of HIV infections.

The report found that in 13 countries - all of them located in sub-Saharan Africa - at least 10% of all adults nationwide are infected with HIV. Botswana and Zimbabwe have reached a prevalence rate of 25% - one out of every four adults in the country is infected. This is a new world high.

Prevention programmes

The report says effective prevention programmes are essential if countries are to control the epidemic.

Uganda has managed to cut prevalence by more than a quarter

It says a host of industrialised countries and a handful of developing nations have managed to stabilise their infection rates and even reverse epidemics that once seemed unstoppable.

Thailand and Uganda are the only developing countries where there is already nationwide evidence of declining HIV rates clearly linked to strong prevention programmes.

Uganda has managed to cut prevalence by more than a quarter, from almost 13% in 1994 to 9.5% in 1997. In Thailand, prevalence was reduced by almost 15% - from 2.7% in 1994 to 2.3% in 1997. Even in the industrialised world, reductions of this magnitude are virtually unheard of.

"Many other communities and countries have embarked on strong prevention programmes, though their HIV rates have not come down yet," says Dr Piot.