In Poor Nations, a New Will to Fight AIDS

"On the eve of next week's International AIDS Conference in Barcelona, a new report from the United Nations AIDS program states that at current infection rates, AIDS, the deadliest epidemic in human history, will kill 68 million people in the 45 most affected countries over the next 20 years -- more than five times the number claimed by AIDS in those nations in the past 20 years. In some of these nations, AIDS could kill half of today's new mothers.

"This need not happen. HIV prevention campaigns work, and there is overwhelming evidence that the AIDS epidemic can be controlled -- but only when governments make fighting AIDS a priority.

"A handful of developing countries are proving this. Uganda... has also been ravaged by one of the highest HIV prevalence rates in Africa. But after infection rates in... Kampala reached more than 30 percent in 1990, leaders in Parliament, urban neighborhoods and villages began to talk... about HIV and AIDS. ... Today Kampala's HIV prevalence rate is 11 percent and falling.

"Zambia may become the second African nation to reverse its epidemic with education and prevention campaigns... by government and local communities. The prevalence of HIV has fallen among young women... to 24 percent in 1999 from 28 percent in 1996 and to 12 percent from 16 percent in the countryside.

"In Cambodia, a society that is still emerging from genocide and conflict, large-scale education and prevention programs (including steps to counter the stigma of HIV and AIDS) have led to a decline in adult HIV infection rates.... And in Brazil, where access to HIV/AIDS treatment is constitutionally guaranteed, the number of AIDS deaths is plummeting and prevention programs are succeeding in some of the groups that are at the highest risk for infection.

"There are other hopeful signs. Almost 100 countries now have national AIDS strategies. Governments have signed a UN declaration pledging to achieve specific global targets in fighting AIDS....

"What's missing? Money, for one thing. By 2005, $10 billion will be needed annually to finance a basic response to HIV and AIDS in developing countries alone. ... What's needed to get to $10 billion is an increase of 50 percent a year in funds directed at fighting AIDS -- in each of the next three years.

"...But the [Global Fund to Fight AIDS, Tuberculosis and Malaria] alone cannot bridge the resource gap. That will require a collective effort: country-to-country assistance programs, participation by foundations and business, increased government spending in developing countries and international debt relief programs to allow increased spending.

"...Uganda, Zambia, Cambodia, Brazil and other developing nations have demonstrated that AIDS is a problem with a solution. Now the world must match this leadership and commitment with the resources needed to get on with the job. Otherwise, the new spirit of hope and vigor in the AIDS fight will be dashed. The costs of that are too devastating to contemplate."

The author is executive director of UNAIDS.

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