By Sarah Boseley
    The Guardian UK

    Wednesday 22 November 2006

    The spread of the HIV/AIDS pandemic continues unabated, with the number of people infected rising once more in some countries which had been thought to be beating the disease, according to the UN.

    There are now 39.5 million living with HIV infection, according to the annual UNAIDS report, released ahead of World AIDS Day on December 1, and 4.3 million of those were infected in 2006. That is 400,000 more than were infected in 2004.

    Most alarming is the increased prevalence in Uganda, long held up as a showcase to the world of what could be achieved in Africa with campaigning, education and widespread condom use. The report shows a rise from a low of 5.6% infection among men and 6.9% among women in 2000 to 6.5% in men and 8.8% in women in 2004.

    The reasons for the increase are not clear, but there has been a shift in the message from Uganda's leadership. Between the early 1990s and early 2000s, HIV prevalence fell sharply in major cities among pregnant women - the group most commonly monitored because they have contact with health services - as President Yoweri Museveni worked to raise awareness of the dangers of HIV and put the authority of his office behind condom use.

    But in recent years the message on condoms has been diluted in favour of greater emphasis on sexual abstinence until marriage - in line with the thinking of the Bush administration, which is spending millions of dollars on HIV prevention and treatment. Critics say many women are not in a position to abstain from sex and that many are infected by their husbands.

    The report says further research is needed to validate the apparent trend "but the current findings do hint at the possible erosion of the gains Uganda made against AIDS in the 1990s". There is evidence of erratic condom use and more men having sex with multiple partners.

    In Mali also the epidemic could be growing after remaining stable for some years, with HIV prevalence among pregnant women rising from 3.3% in 2002 to 4.1% in 2005. While Kenya's epidemic is in decline, the report says there are suggestions that this could be because of the high death rate and "the saturation of infection among people most at risk".

    In North America and western Europe also, the gains made by programmes aimed at preventing infection have not been maintained. The number of infections in the US, with a far greater proportion in African-Americans and Hispanics, is stable but not declining. In the UK, there is a steady rise.

    In western Europe, says the report, "the largest increases have been reported in the UK, where HIV remains one of the principal communicable disease threats". New diagnoses are increasing in areas other than London, which has the most cases. Most of those with HIV were infected in sub-Saharan Africa. Fear of stigma and discrimination is discouraging Africans in the UK from being tested, says the UN.

    Peter Piot, UNAIDS's executive director, was concerned by the trends. "This is worrying - as we know increased HIV prevention programmes in these countries have shown progress in the past, Uganda being a prime example ... Countries are not moving at the same speed as their epidemics."