The New York Times - December 1, 2005

The most troubling aspect of the report by the agency, Unaids, is its grim evidence that many large countries are still closing their eyes to limited AIDS epidemics that will soon explode into the general population. India is providing numbers no one believes. Russia has the world's fastest-growing epidemic, fueled by intravenous drug abuse. Drug abuse also now accounts for half of China's AIDS cases, and it is spreading AIDS infections rapidly in Vietnam, Indonesia and Pakistan.

There is a proven way to halt the spread of AIDS among intravenous drug abusers: provide them with clean needles so they need not share dirty ones. But many governments won't do it because they fear being seen as endorsing drug abuse. The United States prohibits the use of its money for needle exchanges and is actively trying to prevent anyone else from working on the issue. In Russia, whose epidemic is nearly entirely due to drug abuse, it's illegal even to advocate needle exchanges. The price of this shortsightedness will be AIDS epidemics that spread into the general population.

Unaids reports that a small handful of places are making some progress. Zimbabwe, despite all its problems, is seeing a lower rate of AIDS in pregnant women: from 26 percent in 2003 down to 21 percent in 2004, apparently in large part because of the increased use of condoms. Kenya and Burkina Faso have also apparently reduced the prevalence of the disease. And in Caribbean countries, the area with the second-worse AIDS problem, after Africa, the AIDS prevalence is stable or dropping.

It's heartening to see that work with community groups, the promotion of consistent condom use and less risky sexual behavior, and the expansion of testing can make a difference. Yet bright spots are few. The world has finally increased AIDS spending, much of it too recent to be reflected in the report's data. But the increases are not keeping up with the disease, and funds aren't being spent effectively.

A new study of programs in six key countries reports that efforts to save lives are undermined by bureaucratic infighting, government indifference, a lack of training and corruption. The World Health Organization set a goal of having three million people outside rich nations on treatment by the end of this year. The world will fall about two million short. Even cheap and easy programs to prevent mother-to-child transmission reach only a small percentage of those who need them.

Despite the lags, AIDS treatment will reach more and more people - many countries are just now getting started. But their success depends on the largess of wealthy nations. The leaders of rich countries who met in Scotland over the summer pledged that by 2010, everyone in the world needing AIDS treatment would get it. But at current financing levels, that goal is doomed.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, which is carrying out most of these programs (President Bush's program focuses on only 15 countries), is running so short of money that its officials don't know whether it will start a new round of grants in 2006. The United States, which has consistently pledged to contribute a third of the Global Fund's budget, is not doing so. Mr. Bush has asked Congress for far less than he has promised. Congress has added money, but is now threatening another cut.

The AIDS story this year is mostly one of failure: the failure of rich countries to give the promised money, the failure of poor nations to muster the political will. All around, it's a failure of leadership.

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