The New York Times - October 1, 2009
Celia W. Dugger

The ranks of people taking antiretroviral drugs in the developing world rose by more than a million to surpass four million people globally, the United Nations reported Wednesday in its 2009 progress report on H.I.V. and AIDS.

The vast international effort on AIDS, financed by the United States, European countries and other donors, also ensured that growing numbers of children with AIDS, who had largely been left to die quick, unheralded deaths in past years, also benefited from the life-saving drug therapies. Their number rose to 275,700 in 2008 from 198,000 just a year earlier.

And the portion of mothers who got medicines to prevent them from infecting their babies with H.I.V. also rose markedly, to more than half those in need, in the parts of Africa hardest hit by the disease. "In the space of one year, you're seeing a huge ramping up of AIDS services," said Mark Stirling, regional director for the United Nations' efforts against AIDS in eastern and southern Africa. "It's unprecedented. In the acceleration and intensification of reach, 2008 was an extraordinary year."

But the United Nations' progress report on AIDS also contained sobering news. While more than a million people were put on drugs in the past year -- drugs they will need for the rest of their lives -- 2.7 million people were newly infected with H.I.V. in 2007, the latest year for which there were estimates.

"We are walking backward on the treadmill," said Prof. Salim S. Abdool Karim, who runs the Center for the AIDS Program of Research in South Africa, based in Durban. "We're not going to treat our way out of this problem."

The United Nations report, published by the World Health Organization, Unicef and the United Nations AIDS program, stressed that African countries this past year laid the groundwork to broadly offer men circumcisions. The removal of the foreskin has been shown to cut a man's risk of H.I.V. infection by more than half.

But health officials, experts and advocates said that political leaders, particularly in Africa, would have to be far more outspoken about how having more than one long-term sexual partner fueled the epidemic and that circumcision cut the risk of infection. "I'm worried," Mr. Stirling said. "I don't hear the most senior political leaders talking about concurrent partners or male circumcision, not enough."

South Africa, which has more H.I.V.-positive citizens than any other nation, exemplified both the progress on treatment and the uncertain prospects for prevention, experts said.

The number of people getting antiretroviral drugs last year grew by more than half, faster than in any other country. South Africa now has by far the largest AIDS treatment program in the world. The United Nations estimated that more than 700,000 South Africans were getting the medicines, though advocates here have said the number is actually closer to 600,000 after discounting those who have died or dropped out.

Even with the gains, however, less than half those here who need the drugs are getting them, advocates say. And South Africa lacks a male circumcision policy. It is still overcoming setbacks from the years when its president at the time, Thabo Mbeki, denied the scientific consensus that H.I.V. caused AIDS and that antiretroviral drugs were essential to treat the disease.

The country's new leaders have broken cleanly with those views but still need to act with greater urgency on H.I.V. prevention, said Mark Heywood, executive director of the AIDS Law Project and deputy chairman of the South African National AIDS Council, which advises the government.

"South Africa will get its act together, but it hasn't at the moment," he said.
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