Much of the six-day conference on humanity's worst pandemic focused on the politics of getting more lifesaving antiretroviral medicine to the millions of HIV-infected people who need it in the developing world, especially in Africa.
The United States — the most generous donor nation on AIDS — came under intense criticism at the 15th International AIDS Conference for its drug-funding policy and for tying much of its money to programs that emphasize abstinence over the trusted HIV-blocking method of using condoms.
U.N. Secretary-General Kofi Annan and democracy icon Nelson Mandela delivered vigorous calls for more donations to U.N. efforts to fight the disease. Software magnate Bill Gates' foundation and the European Union announced new grants totaling $102 million.
This year's conference, drawing more than 17,000 people, not only boosted awareness of HIV but raised the accountability of world leaders, said Mechai Viravaidya, the most prominent AIDS campaigner in host country Thailand.
"The message is clear: Leaders watch out. We are going to come after you. The media and the people who are involved are going to say, 'What's your commitment?'" Mechai told The Associated Press. "How can you afford to let your people become sick and die in larger numbers than by so-called enemies in wars?"
The next big breakthrough on AIDS, a vaccine, remained elusive. Experts called for urgent work and more funding on alternatives for prevention in the interim, including HIV-killing gels to protect women who lack the power to insist their sex partners use condoms.
"Gender inequality is driving new infections among women and girls like never before," Irene Khan, secretary-general of Amnesty International, told the last plenary session of the conference.
An estimated 38 million people are infected with HIV, 25 million of them in sub-Saharan Africa. Experts say nearly half of all people with HIV now are women, and their infection rates in many regions are climbing much faster than men's. In the Caribbean, for example, 70 percent of new infections are in women.
In a United Nations development report issued Thursday, the spread of AIDS was partly blamed for abetween Africa and the rest of the world. African counties held 27 of the 30 lowest-rankings. In some, life expectancy has been eroded to the mid-30s.
In Asia, 7.2 million people are infected, and epidemiologists at the conference warned that much of the region faces a critical watershed with infections spreading from injecting drug users to sex workers.
Prostitution is considered the main engine of spread for Asia, many experts said, warning that epidemics could explode unless condom use is boosted.
"Now, hopefully, the painful lessons that we have learned will put us in better stead for the Asian experience," said Dr. Anthony Fauci, director of U.S. National Institute for Allergy and Infectious Diseases. "Asia is such a populous region that even small increases in the percentage of infected individuals" would translate to huge numbers, he said.
Since the last AIDS conference in Barcelona in 2002, the number of people being treated for the disease has doubled in the developing world to 440,000. At the same time, 6 million people died from the virus and 10 million more became infected, WHO figures show.
Only about 7 percent of the 6 million people in poor countries who urgently need antiretroviral treatment are getting it. In the past two years, there has been no overall improvement in the proportion of people getting treatment and prevention services versus the total number infected, the United Nations says.
"We are all going to walk away from this meeting knowing that we have a long way to go with regard to access, because the countries that have the greatest need still have the least access," Fauci said.
President Bush in 2002 launched a $15 billion AIDS-fighting plan, mainly directed toward 14 countries in Africa and the Caribbean, plus Vietnam. Critics say the United States should instead give much of that money to the U.N.-sponsored Global Fund, which reaches out to 128 countries.
The U.S. money comes with strings attached — one-third of the money earmarked for prevention goes to abstinence-first programs. Also, the money currently can only buy brand-name drugs, made by companies in rich countries, shutting out cheaper generic medicines from countries such as India, Brazil and Thailand.
Global Fund money can go toward generic drugs.
Activists launched daily protests against Mr. Bush's stance on AIDS, shouting slogans such as "Bush lies. Condoms save lives."
AIDS experts argued against Washington's policy of blocking money for generic AIDS drugs that lack U.S. agency approvals, saying that by routing more of the U.S. spending to WHO-approved generic drugs — already widely in use — more HIV-infected people could be treated.
U.S. officials say they would allow generic drugs if the Food and Drug Administration rules they are effective, and so far no generic drug makers have applied for the approval.
From the start of the epidemic through 2002, the Centers for Disease Control and Prevention recorded more than 880,000 cases of AIDS in the United States and more than 500,000 deaths.