Progress on AIDS Is Focus of Assembly

UNITED NATIONS, May 30 -- Five years after the United Nations' historic first general assembly on AIDS, the world has seen a huge increase in money and attention going to the 25-year-old epidemic, as well as evidence that the disease has stabilized in many areas and is retreating in more than a few.

The number of people getting AIDS drug treatment in needy countries has risen more than fivefold in five years, and the number of sites providing it has jumped tenfold in just the past year. At least a quarter-million people are alive today who would not be without the money, effort and expertise expended just since 2003, according to U.N. estimates released Tuesday.

With those achievements in the background, thousands of AIDS activists, diplomats, health ministers and heads of state are gathering here Wednesday to tackle the more difficult task of extending the recent gains. They also will have to face the reality that the world did not come close to putting 3 million low-income AIDS patients on treatment by the end of 2005 -- the "3 by 5" target proclaimed in 2003 -- and that far fewer than half the people who need antiretroviral drugs immediately are getting them.

Nevertheless, today "the context is completely different" from the first general assembly session in August 2001, Peter Piot, the Belgian physician who directs UNAIDS, said in an interview before the meeting. "In 2001 we were at the height of despair. Today we have more than just proof of concept -- we are beginning to see results."

That success -- which is far more than what even many optimists had thought possible -- now presents the world's wealthy countries with a serious responsibility: The lives of perhaps 1 million people on AIDS therapy in low- and middle-income countries are now directly dependent on foreign aid.

How to sustain that therapy without interruptions of even days or weeks, while not turning the United States and Europe into the health insurers of millions of people in the developing world, is expected to be the chief issue at the U.N. meeting.

"We must move from what up to now is crisis management of the epidemic to a sustainable and strategic response to it," Piot said.

Over the next three days, delegates will try to come up with a blueprint for reaching the new goal of providing "universal access" to AIDS care and prevention by 2010.

There will also be many presentations by grass-roots organizations describing the needs of various populations and risk groups, particularly women, who account for 17.3 million of the 38.6 million people infected with HIV worldwide but who outnumber infected men 3 to 2 in sub-Saharan Africa, the worst-hit region.

"Today, AIDS has a woman's face, and this is where we really need to be vigilant and work hard," U.N. Secretary General Kofi Annan said Tuesday in a brief encounter with reporters.

UNAIDS estimates about $8.3 billion was spent last year in treatment, prevention and care of orphans in low- and middle-income countries. That meets the $7 billion to $10 billion target set five years ago.

Although the number of people getting AIDS drugs increased from 240,000 in 2001 to about 1.4 million last year, of people worldwide whose disease has advanced to the point of needing the drugs, only one in five gets them. By next year, $18 billion will be needed to pay for drug treatment, but only $10 billion will be available, according to U.N. estimates, and the gap will continue to grow.