San Francisco Chronicle - November 24, 2006

That's the bewildering message contained in the latest U.N. report. The document is a chart-filled data dump that points up the unpredictable nature of the HIV virus that has infected 39.5 million people.

This towering number -- a little bigger than the population of California -- is a blessing and a curse. More people are living longer, thanks to better treatment drugs. But infection rates bump up and down around the globe as the virus is checked in old strongholds and surges upward in new surroundings.

This welter of numbers is confusing. Too much death and despair makes the problem sound unsolvable. Too sunny a depiction can produce inaction.

The statistics should remind decision-makers and health planners that the battle must continue. There are both successes and failures in the AIDS fight. Neither complacency nor despair are warranted.

Take Africa as an example. Seven countries in the sub-Sahara region have an infection rate that's declining. Heavy education and prevention programs emphasizing condoms, sexual risks and knowledge about AIDS are paying off. Yet the infection rate may be taking off in Uganda, once considered a model country, with higher numbers in rural areas distant from health programs.

The real worry is among new groups unfamiliar with AIDS. Central Europe and Russia, where prevention and treatment are taking baby steps, are experiencing skyrocketing rates. Here, the virus starts from contaminated needles shared by drug users, who then have unprotected sex with other men and women.

In Asia, prevention emphasizes condom use among prostitutes, a much-lauded campaign that junked moralizing over the sex trade in favor of results. But this single-minded effort hasn't stopped a rising AIDS rate in the general population.

In the United States, there are 1.2 million infected in a population of 300 million, a small percentage, but still a sizable caseload. Here the problem is different in another way. Treatment built on life-prolonging drugs is among the best in the world. AIDS has moved from gays, where it caught notice 25 years ago, to other subgroups such as blacks and Latinos living in the South. The virus is spreading among these groups at a rate of 40,000 new cases per year.

As different as all these trends sound, there are common themes. It is cheaper to prevent AIDS than treat it. More money, not the current spending levels of $12 billion to $15 billion per year, is needed. A flexible approach, tailored country by country, may work best. The answers, like the virus itself, keep changing.

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Always watch for outdated information. This article first appeared in 2006. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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