The number of people living with the AIDS virus (search) has risen in every region of the world. Last year, 5 million people became infected — more than in any single year since the crisis began. Nine out of 10 who urgently need treatment are not getting it and prevention is still only reaching one in five people who should have it, the report said.
"The virus is running faster than all of us," UNAIDS (search) chief Dr. Peter Piot told The Associated Press. The agency compiles a global AIDS report every two years.
This year's report provides the most accurate picture yet of HIV's march across the planet. It says new epidemics seem to be spreading unchecked in Eastern Europe and Asia. To tackle the pandemic, $12 billion a year is needed by next year, instead of the $10 billion that was predicted earlier.
In more revised estimates based on better information than was previously available, the U.N. AIDS agency figures that about 38 million people are infected. Until now, experts had put the ranks of the HIV afflicted at about 40 million.
The cost estimates have increased at the same time that the estimated size of the problem has decreased partly because of the price of delaying action, but also because the planned campaign is now more comprehensive than it has ever been, Piot said.
"We didn't really fully appreciate the importance of a number of things, like the danger of spreading HIV through normal medical equipment. That's a new cost. Also, protecting health care workers is more expensive than we thought and ... the cost of taking care of orphans was grossly underestimated before," Piot said.
However, there have been triumphs.
Many countries, including Brazil, Uganda and Thailand, have reduced HIV infection. Drug prices have dropped dramatically and money is beginning to flow in for the global effort. More politicians are showing commitment to the fight and drugs are becoming increasingly available in poor countries.
Among the major challenges are women and young people's vulnerability to the disease; ensuring the virus doesn't become immune to drugs; keeping health workers in the developing world; and tackling stigma and looking after children orphaned by the disease. In some places the size of the health work force needs to quadruple, the report found.
Money remains a significant problem. Funding has increased to about $5 billion a year in 2003, but that is still less than half of what is needed.
By 2007, $20 billion a year will be needed to tackle the problem in developing countries. That money would provide drugs for 6 million people, AIDS tests for 100 million adults, HIV education in schools and care for 22 million AIDS orphans, the report said.
More than 20 million people have died since the disease was first diagnosed in 1981 and about 3 million people are dying each year, the report said.
AIDS remains untamed in Africa. The continent is still seeing increasing rates of infection in the poorest countries, but the disease is spreading fastest in Eastern Europe and Asia, which is home to 60 percent of the world's population.
In Asia, the disease is confined mostly to drug addicts, homosexual or bisexual men, prostitutes and their clients, and the sexual partners of people who frequent prostitutes.
Countries such as Thailand that are targeting high-risk behavior have been more successful in fighting HIV, but although visits to brothels are down, casual sex is on the rise, more schoolchildren are having sex, and condom use is consistently low.
India has the highest number of people with HIV outside South Africa — 5.1 million, the report said. Worryingly, knowledge about the disease is still paltry and experts believe the statistics may mask an underlying problem of bisexual men infecting women.
Progress against HIV in Africa has been mixed. Prevalence is still rising in countries such as Madagascar and Swaziland, but declining in Uganda.
In sub-Saharan Africa, the number of people living with HIV appears to have leveled off at about 25 million. However, that stability is deceptive. In fact, both deaths and new infections are up.
In North Africa and the Middle East, experts believe the situation is not being tracked fully. There is concern the disease may be spreading silently among homosexuals there because homosexuality is widely condemned and illegal in many places.
The epidemics in Eastern Europe and Central Asia are still expanding, fueled by injecting drug users. About 1.3 million people there have HIV, compared with 160,000 in 1995. More than 80 percent of the infected are under the age of 30.
In Latin America, the epidemic is concentrated among drug addicts and homosexuals. Countries have low infection rates overall, but pockets are bad.
In the Caribbean, the disease is mainly spread through heterosexual sex and in many places is focused around prostitution. The worst-affected country is Haiti, which has the highest infection rate outside Africa with 5.6 percent of the population afflicted.
Infections are on the rise in the United States and Western Europe, particularly among homosexual or bisexual men.
Women continue to be on the front lines of the epidemic.
In sub-Saharan Africa, the infection gap between men and women has widened. There are on average 13 infected women to every 10 infected men, up from 12 for 10 in 2002, the report found.