High-level delegations from around the world gather at the UN in
New York this week for a five-year review of global efforts against
AIDS that will highlight both progress and worrying trends.
An encouraging note will be sounded by reports that infection
rates are falling in some heavily affected African countries, at
least in part as a result of modified behavior among African youths.
But with the overall number of HIV cases still increasing - 5
million new ones last year - alarms will be sounded. Chief among
them is concern over the growing concentration of the disease among
women - with some experts demanding that global prevention and
treatment efforts be more seriously focused on them.
"Twenty-five years into this pandemic, it is having a
disproportionate impact on girls and women," says Adrienne Germain,
president of the International Women's Health Coalition (IWHC) in
New York. "We need to change our policies and budgets to reflect"
this evolution, "and the UN meeting is a major opportunity to do
Five years after the last major international stocktaking of AIDS
- and 25 years after researchers first diagnosed an emerging global
health challenge - the world has reached an uneasy consensus on the
need for more and better AIDS prevention and treatment programs.
The United States in particular has boosted HIV/AIDS funding,
with the Bush administration paying special attention to the impact
of AIDS in Africa - and Congress regularly approving higher spending
on AIDS than what the administration requests. But that does not
mean this week's meeting will be free of the kind of controversy
that has marked similar international gatherings in recent years.
For one thing, many development and health groups focused on
Africa are critical of US policy. They say it favors a wasteful,
unilateral approach instead of joining existing AIDS programs.
Beyond that, they argue that US policy harbors an ideological
"abstinence only" bent in prevention work that is undermining the
widely favored "ABC" approach - abstinence, be faithful, use
But in particular, some international health and development
organizations are demanding a greater linkage of AIDS prevention and
treatment campaigns with international reproductive-health efforts.
That faces stiff opposition from antiabortion groups, who see the
campaign as a backdoor effort to expand abortion rights.
"What this language of 'reproductive health' is really about is
the relentless ideological effort to make certain things a part of
universally recognized human rights, and specifically abortion,"
says Austin Ruse, president of the Catholic Family and Human Rights
Institute (C-Fam) in Washington.
Proponents of the linkage say it is a matter of efficiency-
reaching more women at a crucial point in the evolution of AIDS.
Thoraya Ahmed Obaid, executive director of the United Nations
Population Fund, says there are practical reasons for linking AIDS
prevention efforts and reproductive-health programs around the
world: "Scaling up" prevention and treatment programs would be
easier and more efficient if existing reproductive-health networks
Women especially would be better served by a "one-stop shopping"
approach, she says.
But beyond practicalities, Ms. Obaid says linking the two efforts
has become imperative as AIDS has increasingly affected women, in
particular those in developing countries. "ABC is a package that is
having an impact in many places, but it is not enough when a growing
number of infections are among women, and young married women," she