The global response to HIV/Aids is falling far short of what is needed to turn around the pandemic, with only a tiny minority of those affected receiving treatment and prevention programmes patchy, UNAids warned yesterday.
Two reports from UNAids at the Bangkok International Aids conference revealed that Aids prevention programmes had yet to have a significant impact on the spread of the virus.
Only 7% of those with HIV who need drugs to stay alive over the next two years are getting them, and a mere 8% of babies whose mothers are HIV-positive are being protected by one pill given to the woman while in labour and another to the child after it is born.
Although the numbers on treatment have gone up by more than half, to an estimated 440,000, and the number of pregnant women being tested for HIV has doubled to 5.5 million, with 71,000 receiving drugs to avoid passing the virus to their baby, the gains are small in proportion to the scale of the need, says UNAids.
Only 3.6% of injecting drug users in 2003 had access to help to avoid HIV infection or to treatment. Even condom provision is too low 12bn are needed each year for protection from the virus, but of the 6.9bn used last year, only 2.7bn were used for disease prevention. The one real gain was in Aids education, available now to about half of all secondary schoolchildren worldwide and two-thirds in Africa.
The picture is not clear on support for orphans, but statistics from national governments suggest that about 700,000 are receiving some sort of state help probably only 5% of the total.
"Access to these and other prevention and care services still falls far short of the millennium development goals," said John Stover of Futures Group International, one of the authors of the reports.
Much more money is needed to step up the response to the pandemic, says UNAids. In 2001 the UN special session in New York called for $9.2bn (#4.9bn). UNAids has now increased that estimate to $12bn by 2005, and $20bn by 2007.
Of the $20bn, it says, $10bn is needed for prevention, $7bn for treatment, $2bn for orphan care and $1bn for policy, advocacy and administration. The estimate includes drug treatment for just over 6 million people around 52% of those who will need it by then.
But the chances of raising that level of funding look remote. This year $6bn will be available when the need is $8bn. In 2005, UNAids predicts that $8bn will be raised of the $12bn needed. By 2007 there will be a 50% shortfall, with only $10bn of the required $20bn forthcoming.
"There is an increasing gap between what is needed and what is available," said Paul DeLay, director of evaluation at UNAids.
Earlier the Ugandan president, Yoweri Museveni, said he doubted that promoting condoms over abstinence was the best method of preventing HIV infection.
"The principle of condoms is not the ultimate solution," said Mr Museveni. It was important that loving relationships were based on trust. "Let the condom be used by people who cannot abstain, cannot be faithful or are estranged."
The president is widely admired for his leadership in confronting the Aids epidemic in Uganda and bringing the infection rate down through public education campaigns.
But his remarks surprised many by chiming with the US philosophy of ABC abstinence, be faithful and (lastly) condoms. Many who work in HIV/Aids in Africa say abstinence is not possible for women, whose first sexual experience is often young and forced.
Tim Brown of the East-West Centre in Hawaii, which is involved in mapping the epidemic, disagreed.
"Condoms are greatly short-changed in Africa as a prevention method," he said. "If you increase condom use by 50%, I guarantee you that HIV will go down by 50%."