As AIDS Summit Begins, Rate Of Progress Decried

The 17th International AIDS Conference begins today in Mexico City. The world's experts gather as a new study shows a slight decline in AIDS infections worldwide. But some say the rate of decline is too slow — and question whether international agencies are doing enough to battle the epidemic.

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The 17th International AIDS Conference begins today in Mexico City. An estimated 22,000 participants are expected. A report this past week from the Joint United Nations Program on HIV and AIDS, or UNAIDS, found progress in treatment in an epidemic that's outpacing treatment efforts. NPR's Brenda Wilson reports.

BRENDA WILSON: Dr. Peter Piot, the executive director of UNAIDS, has had the unenviable task of presenting reports on the AIDS epidemic since 1995.

Dr. PETER PIOT (Executive Director, UNAIDS): This is definitely the most positive report that we've ever published in UNAIDS. And when you look at the fact that three million people are now on anti-retrovirus therapy in poor countries, that's up from basically zero five years ago. We now have also a number of countries, particularly in Africa, that are seeing less people becoming newly infected.

WILSON: Take Botswana, which had one of the highest rates of HIV in Southern Africa. And the government and international organizations put in strong prevention and treatment programs. Prevalence among teen girls dropped from 25 percent to 18 percent.

Dr. PIOT: This good news, but with a "however."

WILSON: The "however" is there are still an estimated 33 million people globally infected with HIV. UNAIDS did report a decline in infections, but it was slight. Three million new infections a year, down to 2.7 million a year. That's double the number of people being enrolled in treatment each year. Stephen Lewis, who was the special UN envoy to AIDs until last year, doesn't like to sound like a curmudgeon, but...

Mr. STEPHEN LEWIS (Former UN Secretary-General's Special Envoy for HIV/AIDS): Frankly, we have failed lamentably.

WILSON: He sees a growing gap between the need and the goal of universal access to treatment by 2010 that was promised by Western countries.

Mr. LEWIS: How is it possible that we could have only three million in treatment when we require 10 million? How is it possible that the prevention programs we talked of have been so slow in rolling out, that they're already billions of dollars short?

WILSON: 10 billion dollars is now spent each year on the global AIDS epidemic. The estimate is another eight billion a year is needed. Lewis blames the agency responsible for coordinating the world's response to AIDS.

Mr. LEWIS: I'm inclined to think that UNAIDS, generally - I don't want to attribute it to any one person - should have been more energetic in its advocacy, in the way in which it took the pandemic on internationally and brought it to the attention of the world and demanded a response.

WILSON: Dr. Piot of UNAIDS.

Dr. PIOT: I'm interested in results. I mean, and then everybody has their style. And I think that in terms of the fight against AIDS, there is no doubt that we have results. We could have had more results faster, I think, say, if we would have gone more directly political 10, 20 years ago. But the stars have to be aligned, in a sense, to make progress. But you know, there are always surprises. Who would have predicted that President Bush in 2003 in the State of the Union would announce a PEPFAR?

WILSON: As in, the President's Emergency Plan for AIDS Relief. Just this past week, President Bush signed into law a reauthorization bill that expands funding under the program to 48 billion dollars. And some analysts think Piot deserves some credit for that. On the other hand, prevention appears to have stymied the best minds. Piot says governments make it impossible.

Dr. PIOT: You need to concentrate your efforts there where the people are at highest risk, injecting drug users, men who sex with men, sex workers. The problem is that this happens in a certain political context. Homosexuality is against the law in many countries. So we have a number of obstacles that are not technical but purely political.

WILSON: For people with AIDS on the front line, coming in from villages and towns all over the world, this week's conference in Mexico City is an opportunity to further this debate. Brenda Wilson, NPR News.

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