U.N. REPORTS DECREASE IN NEW H.I.V. INFECTIONS

Fewer people are being infected with the virus that causes AIDS than
at the epidemic's peak, but progress against the disease is still
halting and fragile, the United Nations' AIDS-fighting agency reported Tuesday.

In its new report on the epidemic, Unaids said 2.6 million people
became newly infected with H.I.V., the virus that causes AIDS, in
2009 -- almost 20 percent fewer than in the late 1990s.

But progress is spotty. About 25 countries are doing better at
prevention, including several in southern Africa with sky-high AIDS rates.

South Africa, which has the world's worst epidemic, has benefited
from the changeover from the presidency of Thabo Mbeki, which was
hostile to the distribution of AIDS drugs, to that of Jacob Zuma, who
has publicly taken an AIDS test and urged citizens to do the same.
Still, it faces an estimated 350,000 to 500,000 new infections annually.

In one area, progress has been heartening: giving mothers drugs to
prevent the infection of their babies at birth or through breastfeeding.

"We've had a 50 percent reduction of infections among young people in
South Africa, which is a huge reservoir," Michel Sidibe, executive
director of Unaids, said in an interview in Manhattan last week.

Mr. Sidibe gave several reasons for the change.

"Relations between parents and children over discussing sexuality are
changing," he said. "Previously, no one would talk about it. Now,
more people are willing to talk to their children."

Also, he said, people are sleeping around somewhat less. "In 59
countries we surveyed, only 25 percent said they had had more than
one partner in the last year," he said. "That is a big shift."

And, he said, while posters urging everyone to use condoms are not
particularly effective, government health agencies have gotten better
at "concentrating on hot spots" like sex workers and long-haul truckers.

In countries like Senegal and Malawi, Mr. Sidibe said, "there has
been a sea change in attitudes toward men who have sex with men."

In countries that jailed homosexuals or simply denied that there were
any, gay men have been released from prison. Instead of driving gay
men underground, some governments are trying to reach them with
safe-sex education and condoms.

At the same time, some countries are becoming worse, especially those
in Eastern Europe and Central Asia, where the epidemic is
concentrated among heroin-injectors and their sexual partners. As
Afghan and southeast Asian heroin spreads along new distribution
routes, more addicts are created, increasing AIDS infections in
countries with little history of dealing with them.

There are exceptions. In Iran, Mr. Sidibe said, he accompanied a
woman in a chador who was handing out condoms in prison.

"I was shocked," he said. "In Iran, the prisons had one of the most
progressive programs. There was methadone maintenance; there was
condom distribution. They even had conjugal visits for prisoners --
five hours in a private room every three months with your wife. With condoms."

There is also both good and bad news on the treatment front. About
5.2 million people are getting antiretroviral drugs -- more than ever
before, thanks to the multinational Global Fund to Fight AIDS,
Tuberculosis and Malaria and its strictly American counterpart, the
President's Emergency Plan for AIDS Relief. But 10 million more still
need the treatment immediately, and it seems unlikely that donors
will give enough money to keep them all alive.

Also, some people have developed resistance to first-line drugs, but
the money for more expensive second- and third-line drugs is not there.

It is now nearly 30 years since the epidemic began, and an estimated
33.3 million people are living with H.I.V. That number has never been
higher, and its growth is due to a combination of new infections and
the receipt of life-prolonging treatment by more of the sick.

But a comparison illustrates how much progress still needs to be made
before it can be said that the world is winning the war on AIDS: in
its previous report, Unaids estimated that for every 100 people put
on treatment each year, 250 became newly infected. Now, it estimates
that for every 100 on treatment, 200 become infected.