About 45 million more people worldwide will be infected with the AIDS virus in the next eight years, a huge increase that can be averted only with drastic action, experts say.

In research released today ahead of next week's International AIDS Conference in Barcelona, Spain, scientists estimate 29 million of the cases, about two-thirds, could be prevented.

But they said achieving that goal would cost $27 billion — about $1,000 per infection avoided — between now and 2010.

Annual worldwide spending on HIV prevention will have to quadruple from $1.2 billion to $4.8 billion by 2005, experts said. The true costs could be higher if the money is not used effectively in all countries, they added.

"It's clearly an expensive program," said John Stover, one of the researchers. "But the cost of not doing it, or of delaying the startup, would be even greater."

He said a three-year delay would result in half as many infections being averted by 2010.

Majority of Infections Avoidable

The projections are made this week in The Lancet medical journal by a group of experts from the U.N. AIDS agency, the World Health Organization, the U.S. Census Bureau, Imperial College in London and The Futures Group International.

A separate report by the Global HIV Prevention Working Group, an independent panel of 40 of the world's leading HIV-prevention experts, also was published today to coincide with the Lancet article. That document offers a blueprint for how to prevent those 29 million infections over the next decade.

The work was prompted by a U.N. special session on HIV/AIDS in June 2001, which resulted, among other things, in a target of reducing by 25 percent the global prevalence of HIV infection by 2010.

Scientists estimate that about 60 million people have been infected with HIV since in the last 20 years or so. About 20 million have died as a result. Most of the HIV cases have been in developing countries where the virus is still spreading rapidly and where people don't have access to the drug cocktails that have led to a dramatic decline in AIDS deaths in the United States.

"With going on, business as usual, we would expect another 45 million new infections between now and 2010," said Dr. Bernhard Schwartlander, a World Health Organization epidemiologist and one of the authors of the Lancet report. "If we scale up interventions starting now, rapidly and aggressively, we could avoid the majority of these infections."

The experts say that a package of 12 common prevention strategies needs to be expanded. Those include condom distribution; mass media campaigns; promotion and social marketing; voluntary testing and counseling; blood screening; school- and work-based programs; programs for youth out of school; treatment of sexually transmitted diseases; peer counseling for prostitutes and homosexuals; and safety programs for drug addicts that use needles.

‘HIV Prevention Works’

In the United States, such prevention programs have cut annual HIV infections by two-thirds since the mid-1980s. Prevention efforts have also contained the epidemic in countries such as Senegal, Thailand and Uganda. In Cambodia, HIV among pregnant women has dropped by one-third in the last three years as a result of a comprehensive prevention program.

"HIV prevention works, and in many ways the key challenge is access to effective prevention," said Dr. Helene Gayle, of the Bill and Melinda Gates Foundation, who co-chaired the prevention working group.

"Estimates are that only one in five people at risk have access to prevention. There's a huge gap in access to prevention when 80 percent of the people who need it are not getting it," Gayle said.

The prevention strategy will only work if broader issues such as the training of local health-care workers and the ability to reach rural communities, as well as wider social problems such as poverty, the stigma of HIV infection and women's lack of empowerment, are tackled at the same time.

"All of these issues are critical for making sure that the programs have an effective environment in which to work," Gayle said.

Some Countries Prove Prevention Possible

Schwartlander said the estimates assume that those factors are tackled.

"Clearly, it's very ambitious and optimistic to assume that every country can implement the whole program," said Stover, a scientist at the Futures Group International, an organization that works on critical development issues in developing countries.

But countries such as Uganda, Thailand, Brazil and Senegal have been able to bring together the money, the people and the political commitment to make the programs work, Stover said.

"It's not going to happen in all these countries, but we think it's feasible for any country to do this, and we hope that the aggregate of all the efforts going on the country level would achieve something like what we have described," Stover said.

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