PROGRESS ON AIDS IS FOCUS OF ASSEMBLY

Meeting at U.N. Seeks to Balance Treatment, International Funding Sources

UNITED NATIONS - 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.

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.