As the U.N. General Assembly gathered Monday to review progress since its 2001 special session, the report outlined shortfalls on numerous fronts including expanding access to drugs, caring for AIDS orphans, preventing discrimination and blunting mother to child transmissions of the disease.
Without additional money and more political will, it is unlikely the goals of having 3 million HIV-positive people in the developing world taking AIDS drugs by 2005 and halting and reversing the epidemic by 2015 will be met, experts said.
There are only 300,000 people in the developing world with access to medication, although between 5 million and 6 million individuals need the drugs, the report said. Brazil, which has a widely heralded AIDS program, accounts for more than one-third of the patients in the developing countries who are receiving treatment. In sub-Saharan Africa, only an estimated 50,000 people receive medication when 4.1 million require them.
Experts say there has been no slowdown in the progression of the disease, which affects 40 million people, about 29 million of them in Africa. If the response to the pandemic doesn't improve, UNAIDS estimates there will be 45 million new infections by 2010. China, India and Russia are among the countries were AIDS is rising rapidly.
There a few indications that the financial commitment is increasing enough to fight the epidemic. UNAIDS estimated there is a $1.6 billion gap this year between projected spending and what AIDS programs need.
"We are getting further and further behind because the demands for prevention and especially treatment for the disease is increasing faster than our resources," said Paul De Lay, director of monitoring and evaluation at UNAIDS, which wrote the Progress Report on the Global Response to the HIV/Epidemic.
The report was written using information submitted by 103 of the 189 countries that signed the Declaration of Commitment on HIV/AIDS that was adopted at the 2001 session.
The report renewed activists' accusations that the United States is failing to do its part to fight the pandemic. Although the Bush administration has promised $15 billion over five years to combat AIDS abroad, Congress has only earmarked $2 billion of the $3 billion available for 2004.
Moreover, President Bush has only requested $200 million for the Global Fund to Fight AIDS, Tuberculosis and Malaria. The fund, established after the 2001 AIDS meeting, is a major source of money for treatment and prevention programs. It has $4.6 billion in pledges through 2008, but only 23 percent of its needs through 2004 are met by those funds.
"For the U.S. to be sitting with a fiscal 2004 appropriation for the fund of $200 million absolutely makes no sense," said Jeffrey Sachs, an adviser to U.N. Secretary General Kofi Annan.
White House spokeswoman Suzy De Francis said new federal laws prevent the United States from giving more than one-third of the fund's money, and currently U.S. contributions account for 40 percent of its assets. She said the U.S. can't give the $200 million unless the rest of the world increases its share.
De Francis added the U.S. will only spend $2 billion instead of $3 billion on AIDS next year because the Bush administration wants to make sure there are policies and infrastructure available in the developing world to use the money wisely.
De Lay said there were some glimmers of hope in the report. The declaration required all countries to develop a national AIDS strategy by 2003. Ninety-three percent say they have accomplished that goal. Countries were also supposed to have a strategy to provide care for HIV-affected individuals by 2003, and 76 percent of countries had such policies in place.
The 2001 declaration resolved that by 2005 at least 80 percent of pregnant women should have access to information, counseling and treatment to prevent HIV transmission to their children. The report said, that except for Botswana, less than 1 percent of pregnant women in heavily effected countries have access to such services.
HIV and AIDS has left more than 14 million children under the age of 15 without at least one parent. The declaration said that by 2003 countries should have developed and by 2005 implemented policies to support the orphans. Yet, 39 percent of countries with epidemics have no national policy to support for these children.