STAYING A STEP AHEAD OF AIDS

VOTERS in Tuesday's elections would be hard-pressed to find a single
candidate who has made AIDS a priority issue, even in San Francisco.
The disease has not gone away by any means, even if at times it seems
to have vanished from the center stage of U.S. concerns.

SARS, bird flu and mad cow disease, which together have killed 1,200
people worldwide, draw more public notice. Protests demanding better
AIDS care are gone. Books, television and movies tackled the subject
years ago -- and have long since moved on. "Philadelphia,"
Hollywood's once-daring look at AIDS and race, was made in 1993.

In a culture that focuses on the immediate, a 25-year-marking point
risks irrelevancy. New AIDS cases have held steady at 40,000 for 15
years in the United States after dropping by 75 percent from the
crest in the mid-1980s. Medical advances against the disease have let
memories fade.

But the AIDS era is an eventful and instructive history lesson. It
captured strands of American culture -- battles over gay rights, drug
research and political morality -- and combined them in ways that
touched millions of lives. The gay community turned fear into unified
strength. AIDS patients advocated for care and new medicine in ways
never seen before. Plain talk about drug use and sexual behavior
found its way into public discussion, often reluctantly. The results
are a modest success story achieved at great cost.

Now it is the job of this country and the rest of the world to take
these lessons and learn from them. The oft-repeated global numbers of
40 million infected and 25 million dead can't be allowed to grow. The
history of AIDS is marked with turning points and we're at another
one right now: Deadly and untamable as it is, there's a chance to rein in AIDS.

The odds are long. Global reports on the disease, such as the latest
one from the United Nations, are depressing data dumps. The increase
in new infections of the HIV virus that causes AIDS has shifted from
males to an increasingly female and young population. Barely 1 in 5
of those infected receives treatment, and only 8 percent of pregnant
women with AIDS get drugs that can block transmission to the child.
There are an estimated 15 million orphans who have lost one or both
parents to AIDS. Sub-Saharan Africa is dotted with countries where
the HIV rate in the population approaches 1 in 5.

As ugly as these numbers sound, they don't form a complete picture.
There is reason for hope.

Just as it did in this country, the global rate of AIDS infection is
flattening, ever so slightly. India, China and Russia, the big-three
dominoes predicted to topple into disaster, have put forth serious
AIDS initiatives. In Russia's case, spending has jumped twentyfold.
India, with 5.7 million AIDS cases, has launched its own programs.
China, which wouldn't discuss the pandemic a few years ago, has now
reported fewer than 1 million cases and begun discussing the disease
openly. The numbers in all three nations will likely worsen, but the
governments have reversed yearslong policies of neglect and
avoidance. At least, education and treatment now have a chance.

There are other improvements. Drug costs, which remained too high for
too long, are lower. After years of delays, which literally cost
millions of lives, American drug companies were shamed into allowing
cheaper generics into clinics and dispensaries. No gratitude is owed
to these firms for an overdue concession, but the change will deliver
life-extending medication at last.

After slumbering through the early years of AIDS, Washington has
finally wakened to the international challenge. Spending on research
is now at $2 billion per year. This year alone, President Bush's
foreign AIDS package will total $3 billion, more than any previous
administration. The United Nations launched a separate aid program,
bringing international spending to $8.3 billion.

Absent a disease-stopping drug, treatment and prevention remain the
two chief counters to AIDS. These programs are where the fight will
be won or lost. The United Nations is pushing the world's richest
nations to spend $22 billion by 2008 on these areas.

It's a huge spending increase, filled with risks. A past U.N. goal to
have 3 million people in treatment by 2005 fell short. Also, the
White House and United Nations have feuded over the content of
prevention programs, most notably over the U.S. emphasis on
abstinence as a preventive.

Further, the United States, now the biggest donor of aid, doesn't
want to be on the hook for a larger share. The latest debate,
surfacing at a U.N. conference days ago, pits socially conservative
nations -- chiefly Islamic countries in Africa -- against calls for
more rights for women and girls in obtaining AIDS care and legal protections.

U.N. Secretary-General Kofi Annan and his top AIDS expert, Dr. Peter
Piot, have forcefully argued the case for more aid and open,
accessible treatment. That stance may sound obvious, but if $22
billion is called for, there must also be strict accounting and,
above all, results for this huge outlay.

Slowing the spread of AIDS looked impossible five years ago. But it
can be done, over time, with steady financial support and education.
It's not pure optimism to think so. It's happening here.