San Francisco Chronicle - November 22, 2005

The global disease has lost none of its power, and despite prevention plans and new medicine, it continues to spread.

A United Nations report this week tries to highlight the positives in the AIDS fight, such as a handful of countries that have cut infection rates. But everywhere else the numbers are overwhelmingly gloomy: Just as prevention efforts take hold, so do infection rates.

Worldwide, 40 million people are infected and 25 million have died since the infection was isolated in 1981. A total of 5 million new cases were recorded this year.

But there is no quitting this fight. A positive test for the HIV virus that leads to AIDS is no longer a short-run death sentence, thanks to new drugs slowly reaching poor-country clinics. Without this medicine, the death rate would have climbed by 300,000.

Also, prevention advice can cut down infection rates. The UN report found that educating young people to delay sex, cut down on partners and use condoms dropped infection rates in Africa, South America and the Caribbean. Dispelling myths and ignorance with facts pays off.

Globally, AIDS is expanding. Dirty syringes and sex-for-sale are key pathways to infection. Women and girls are the majority of those infected. Playing into the problem are stigma and ignorance, which hobble governments from taking action.

For the past decade, Africa was the top worry spot because its ramshackle health and education systems could do little to stem the spread. But now AIDS has jumped to Asia and Eastern Europe, where it has taken root in bigger populations.

These so-called "second wave'' countries include China, India and Russia, countries not used to taking outside advice or financial aid on internal problems. These nations, each equipped with strong governments and health systems, can tamp down AIDS -- or ignore the problem until it's too late.

There's also a fatigue factor. Since the problem is so huge, why not sit back and wait for a surefire curative or a vaccination? In addition, clear data from many countries is often lacking, making it hard to map out health campaigns.

Waiting isn't a strategy in this war. Rich-country aid will pour an estimated $9 billion into AIDS causes next year. It's a major step toward spending the $15 billion the United Nations thinks is needed. Dark as the future appears, the fight to stem AIDS must go on.

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