The New York Times

               November 26, 2003, Wednesday, Late Edition - Final

SECTION: Section A; Page 8; Column 1; Foreign Desk

LENGTH: 903 words

HEADLINE: Spread of AIDS Fast Outpacing Response



   While the pace of the battle against AIDS is picking up, efforts to stem the
epidemic are "entirely inadequate" for the health emergency, which is
"continuing to spiral out of control," the director of the United Nations AIDS
program said yesterday.

   The epidemic shows no sign of abating, said the director, Dr. Peter Piot,
adding, "Measured against the scale of the global epidemic, the current pace and
scope of the world's response to AIDS fall far short of what is required."

    The toll from AIDS this year is expected to be the highest ever, with the
virus infecting 5 million people and killing 3 million, he said. Comparable
figures for 2002 were 4.8 million infections and 2.7 million deaths.

   The agency said it used more precise measures in revising downward its
estimate of the number of infected people around the world, to 40 million, from
42 million in 2002. The revision does not signal a decline in the epidemic, the
report said.

   In releasing the agency's annual report in advance of World AIDS Day on
Monday, Dr. Piot acknowledged that more money and stronger political commitments
had moved the battle into a higher gear.

   But he chided nations that were way behind in tackling AIDS -- though not, in
every case, by name. "Many countries do not take AIDS seriously, and that is
particularly the case of Russia, all the countries of the former Soviet Union,
and several Asian countries," Dr. Piot said in a teleconference.

   An estimated million Russians are infected and "the epidemic is growing at a
fearsome rate," the report said.

   Russia did not make the political commitment other countries have made
against the disease, Dr. Piot said, noting that it budgets "only a few million
dollars for AIDS and still deals with it at the level of a deputy minister of

   The spread of AIDS to about 4.5 million people in India is "the biggest
concern in Asia," he said. Although India's overall infection rate is small, it
has reached a worrying 5 percent in some districts, he said.

   The United Nations is encouraging health officials in India to improve their
methods to monitor H.I.V. infection rates so they can focus on prevention

   The report describes serious outbreaks in China, and Dr. Piot noted that the
shock of the SARS epidemic had encouraged China to monitor the virus more

   Among other concerns, Dr. Piot said, is that in many countries, "the people
providing the services are dying while the demand for services is increasing
because of AIDS."

   He warned that "the most devastating social and economic impacts of AIDS are
still to come" and said the focus on treatment could cause prevention efforts to
be overlooked.

   The report also said only 1 percent of pregnant women in heavily infected
countries had access to the testing and counseling services needed to protect
them and to prevent mother-to-child transmission.

   But there was some positive news.

   "For the 12th consecutive year, in Uganda H.I.V. prevalence was lower than
the preceding year," he said. Another favorable sign was the stabilization of
the prevalence of infection in Cambodia, at 3 percent.

   Thailand's push for condom use has made the sex industry safer and reduced
the incidence of new infections by 85 percent.

   But there is an increase in virus transmission among young people and drug
addicts who use needles.

   "So it shows the fantasy of thinking that one can control the AIDS epidemic
by just focusing on so-called high-risk groups," Dr. Piot said. "We need to do

   Dr. Piot said he was encouraged by the increased spending from affected and
donor countries, which is expected to reach $4.7 billion this year. But that is
less than half the $10 billion that economists say is needed.

   Dr. Piot said he welcomed the South African government's new plan to provide
antiretroviral drugs to patients, as well as an earlier announcement by former
President Bill Clinton that he had brokered an agreement with drug companies to
lower the price of AIDS drugs for many countries. The World Health Organization
plans to deliver antiretroviral drugs to three million people by 2005.

   For a number of reasons, the epidemic and the increased money to fight it are
aggravating a shortage of nurses in many affected countries, and leaving some
clinics with no nurses, Dr. Piot said.

   Some nurses have stopped working because they are distraught over seeing
patients die for lack of antiretroviral therapy. Many nurses, lacking sterile
needles and other equipment, fear getting infected.

   In Kenya, the United Nations found that 4,000 nurses were not practicing
because of ceilings on the number of public service employees, Dr. Piot said.

   Worsening the shortage, some nurses have gone to help fill shortages in the
United States and elsewhere, leaving nonprofessionals to care for patients.

   "This crisis will get worse and worse," Dr. Piot said. "We have to look far
beyond medical solutions. This is going to become a fundamental political

   Information about the number of infections in Africa has improved because
several countries "have become very aggressive in expanding" monitoring for
H.I.V., particularly in rural areas, Dr. Piot said.

   The world has a clear choice, he said: "Either we inch along making piecemeal
progress, or we now turn the full weight of our knowledge, resources and
commitment against this epidemic."