Progress on AIDS Is Focus of Assembly

By 2010, paying for people already in care, adding others who need treatment, running prevention activities and providing for orphans will cost $20 billion to $23 billion a year -- far more than any country or funding agency is prepared to spend.

Of the total spent last year, needy countries provided $2.5 billion, according to UNAIDS's 629-page report on the epidemic, the most comprehensive compendium ever produced. Other large sources include the Global Fund to Fight AIDS, Tuberculosis and Malaria, which disbursed $1.5 billion, and the President's Emergency Plan for AIDS Relief, which spent about $1 billion. The World Bank was also a major funder of programs in the developing world.

The United States is the largest single donor, committed to $15 billion over five years, but the Bush program, known by the acronym PEPFAR, is likely to come under considerable fire because of its emphasis on abstinence-based prevention messages and its opposition to needle-exchange programs. Yet even some of its harshest critics acknowledge its importance.

"I think that any program that commits substantial amounts to care can't be called part of the problem. But there are problematic parts of PEPFAR that need to be changed," said Asia Russell of the activist organization Health Global Access Project.

In the immense diversity of the AIDS epidemic around the world, there is evidence of progress by nearly every type of intervention, data presented here showed.

In eight of 11 sub-Saharan countries, the percentage of young people having intercourse before age 15 declined -- an achievement of abstinence messages. Condom use also rose. In all, six of 11 heavily affected African countries reported declines of 25 percent or more in the prevalence of HIV, the virus that causes AIDS, in 15- to 24-year-olds.

There has also been a substantial downward revision of the severity of the epidemic in numerous countries as epidemiologists have gotten better estimates of the virus's prevalence in the entire population. Earlier figures were based on easily measured groups, such as pregnant women, and turned out to yield overly scary estimates.

For example, in South Africa, the prevalence of infection among people ages 15 to 49 is now put at 19 percent, down from the 30 percent estimate based on data from prenatal clinics in 2003. In Botswana, the estimate has fallen from 39 percent to 24 percent.

In some places, the revised figures also reflect an actual drop in the rate of infection. That is the case of Ethiopia, where the rate among pregnant young women fell from 15 to 12 percent. Testing of other populations cut the overall adult prevalence from more than 8 percent to well below 4.

But as delegates gathered for Wednesday's meeting, perhaps the sharpest contrast with 2001 is the widespread acceptance that it is untenable not to attempt to provide treatment to AIDS patients everywhere.

Such a goal was hard even to imagine in 2001, when Andrew S. Natsios, then the newly installed director of the U.S. Agency for International Development, argued against large-scale spending on antiretroviral therapy in Africa because many patients would not be able to take the pills on schedule. "People do not know what watches and clocks are. . . . They do not use Western means for telling time," he said then.