UNAIDS report for 2003: most deaths and new infections ever; some good news.

Three million people died of AIDS this year compared with 2.7 million last year, and five million were newly infected--both more than ever before, according AIDS Epidemic Update. December 2003, compiled and published by UNAIDS, the United Nations Joint Programme on HIV/AIDS. Forty million people are now living with HIV, up slightly from last year.

There is good news from a number of individual countries, as well as increased commitment from many governments, and increased total resources worldwide devoted to the epidemic. Some prevention programs have worked well. But many countries are at a critical stage where they could abort a major epidemic if they act now. Unfortunately some of their governments are still not serious about AIDS.

AIDS Epidemic Update: December 2003 is available at: http://www.unaids.org

A few situations, among hundreds of others:

* Swaziland, in Southern Africa, shows how last HIV can spread. In 2002 almost 39% of the entire adult population age 15-49 had HIV. Ten years before it was 4%. (Imagine what this means for Eastern Europe, many parts of Asia, and other places where governments are not dealing with an early epidemic that could still be stopped, if only people mobilize in time.)

* In Africa, fewer than 2% of those who need treatment now can get it. In heavily affected countries, only about 1% of women have access to services for prevention of mother-to-child transmission.

* In many African countries, HIV prevalence seems to be stabilizing at a high level--but this is not really good news. The reason the percentage infected is not higher is that more people are dying.

* In the U.S., about half of the 40,000 new infections this year are of African-Americans (who make up 12% of the population)--often women who avoid high-risk behavior themselves but get HIV from men who are secretly having risky sex or sharing needles--just one of many illustrations of how stigma and discrimination make AIDS control more difficult.

* Successes include Kampala, Uganda (about 8% of pregnant women now have HIV, an indicator of prevalence in the general adult population--a "remarkable feat" according to the report). No other country has done as well, although big drops have also occurred in Ethiopia and Rwanda.

* "Globally, the AIDS response is moving into a new phase. Political commitment has grown stronger, grass-roots mobilization is becoming more dynamic, funding is increasing, treatment programmes are shifting into gear, and prevention efforts are being expanded." (AIDS Epidemic Update, December 2003).

Total public and private global spending on AIDS prevention, treatment, and care is now about $4.7 billion dollars ($4,700,000,000) a year, compared to a need of $10 billion--better than before, but scandalously low for an epidemic killing 3,000,000 people per year and likely to kill tens of millions more.

* As programs scale up, another critical shortage is trained personnel. HIV treatment is needed now to keep medical and other trained people alive. Also, despite critical shortages, thousands of nurses in Africa are now unemployed due to caps on spending for public services.

Facts like these hint at what individuals and organizations can do. Many of the problems are local, and can only be handled by those directly involved. But many others (especially the lack of resources) are global. And many problems in the developing world originate in the U.S. and other rich countries.