San Francisco Chronicle - Sunday, June 4, 2006

SARS, bird flu and mad cow disease, which together have killed 1,200 people worldwide, draw more public notice. Protests demanding better AIDS care are gone. Books, television and movies tackled the subject years ago -- and have long since moved on. "Philadelphia,'' Hollywood's once-daring look at AIDS and race, was made in 1993.

In a culture that focuses on the immediate, a 25-year-marking point risks irrelevancy. New AIDS cases have held steady at 40,000 for 15 years in the United States after dropping by 75 percent from the crest in the mid-1980s. Medical advances against the disease have let memories fade.

But the AIDS era is an eventful and instructive history lesson. It captured strands of American culture -- battles over gay rights, drug research and political morality -- and combined them in ways that touched millions of lives. The gay community turned fear into unified strength. AIDS patients advocated for care and new medicine in ways never seen before. Plain talk about drug use and sexual behavior found its way into public discussion, often reluctantly. The results are a modest success story achieved at great cost.

Now it is the job of this country and the rest of the world to take these lessons and learn from them. The oft-repeated global numbers of 40 million infected and 25 million dead can't be allowed to grow. The history of AIDS is marked with turning points and we're at another one right now: Deadly and untamable as it is, there's a chance to rein in AIDS.

The odds are long. Global reports on the disease, such as the latest one from the United Nations, are depressing data dumps. The increase in new infections of the HIV virus that causes AIDS has shifted from males to an increasingly female and young population. Barely 1 in 5 of those infected receives treatment, and only 8 percent of pregnant women with AIDS get drugs that can block transmission to the child. There are an estimated 15 million orphans who have lost one or both parents to AIDS. Sub-Saharan Africa is dotted with countries where the HIV rate in the population approaches 1 in 5.

As ugly as these numbers sound, they don't form a complete picture. There is reason for hope.

Just as it did in this country, the global rate of AIDS infection is flattening, ever so slightly. India, China and Russia, the big-three dominoes predicted to topple into disaster, have put forth serious AIDS initiatives. In Russia's case, spending has jumped twentyfold. India, with 5.7 million AIDS cases, has launched its own programs. China, which wouldn't discuss the pandemic a few years ago, has now reported fewer than 1 million cases and begun discussing the disease openly. The numbers in all three nations will likely worsen, but the governments have reversed yearslong policies of neglect and avoidance. At least, education and treatment now have a chance.

There are other improvements. Drug costs, which remained too high for too long, are lower. After years of delays, which literally cost millions of lives, American drug companies were shamed into allowing cheaper generics into clinics and dispensaries. No gratitude is owed to these firms for an overdue concession, but the change will deliver life-extending medication at last.

After slumbering through the early years of AIDS, Washington has finally wakened to the international challenge. Spending on research is now at $2 billion per year. This year alone, President Bush's foreign AIDS package will total $3 billion, more than any previous administration. The United Nations launched a separate aid program, bringing international spending to $8.3 billion.

Absent a disease-stopping drug, treatment and prevention remain the two chief counters to AIDS. These programs are where the fight will be won or lost. The United Nations is pushing the world's richest nations to spend $22 billion by 2008 on these areas.

It's a huge spending increase, filled with risks. A past U.N. goal to have 3 million people in treatment by 2005 fell short. Also, the White House and United Nations have feuded over the content of prevention programs, most notably over the U.S. emphasis on abstinence as a preventive.

Further, the United States, now the biggest donor of aid, doesn't want to be on the hook for a larger share. The latest debate, surfacing at a U.N. conference days ago, pits socially conservative nations -- chiefly Islamic countries in Africa -- against calls for more rights for women and girls in obtaining AIDS care and legal protections.

U.N. Secretary-General Kofi Annan and his top AIDS expert, Dr. Peter Piot, have forcefully argued the case for more aid and open, accessible treatment. That stance may sound obvious, but if $22 billion is called for, there must also be strict accounting and, above all, results for this huge outlay.

Slowing the spread of AIDS looked impossible five years ago. But it can be done, over time, with steady financial support and education. It's not pure optimism to think so. It's happening here.
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