The rate of new HIV infections is slowing in a number of countries, but the AIDS epidemic is not over in any part of the world, and is gaining pace in some.
This was the message UNAIDS officials drove home as the agency released new data, giving the most up-to-date snapshot of the global epidemic and the world's response.
The 2008 Report on the Global AIDS Epidemic notes that the number of people living with HIV around the world has stabilised at around 33 million.
There is some evidence that prevention campaigns have played a role, but the plateau in prevalence is also the result of deaths due to AIDS occurring at a similar rate to new HIV infections. About 2 million adults and children died from AIDS-related illnesses in 2007, but 2.7 million were newly infected; down slightly from 3 million in 2001.
"This is not the time for complacency," warned Elizabeth Mataka, the UN special envoy on AIDS, at the launch of the report in Johannesburg on Tuesday.
Heterosexual intercourse is still driving the epidemic in sub-Saharan Africa, which shouldered two-thirds of the global AIDS burden and three-quarters of all AIDS-related deaths in 2007. In other parts of the world HIV is mainly affecting people who inject drugs, men who have sex with men, and sex workers.
Nine countries in southern Africa are bearing the brunt of the AIDS crisis, accounting for one-third of global infections.
The epidemics in Malawi, Zambia and South Africa appear to have stabilised, and in Botswana and Zimbabwe they have started to decline, but Mozambique's epidemic is growing.
In East Africa, the epidemics in most countries have receded or remained at about 5 percent. It is too soon to determine whether a slight increase in Kenya's HIV infection rate represents a trend or a temporary blip.
The data shows that young women in many African countries are much more at risk of infection than young men. In South Africa, for example, women accounted for 90 percent of new infections among people aged 15 to 24.
"Unless we can reverse these trends, unless we can empower women and recognise women's human rights and deal with gender-based violence, we are unlikely to make significant progress in the fight against HIV and AIDS," said Mataka.
Reducing women's vulnerability to HIV would have to include tackling social norms, such as inter-generational sex and tolerance of male promiscuity, Mataka noted. "I think the time has come for us to say, 'yes, culture is what defines us', but if culture is killing us, then we need to be bold enough to say that."
Mark Stirling, director of UNAIDS for Eastern and Southern Africa, described the achievements of countries like Namibia and Botswana in improving the quality and coverage of antiretroviral (ARV) treatment and prevention of mother-to-child transmission (PMTCT) services as setting a "gold standard" for other countries around the world.
"Where there's clear and strong commitment, and a mobilisation of national and international resources, African states can demonstrate world leadership in their response around AIDS," he said.
By the end of 2007, nearly 3 million people in low- and middle-income countries were receiving ARV treatment - double the number being reached a year before - but still only about 30 percent of those estimated to be in need of the drugs.
"The intensity of the epidemic ... means we're far away from realising our goal for universal access by 2010," said Mataka. "For every person put on treatment, more get infected; we cannot sustain a successful response if we do not get on top of prevention."
In recent months UNAIDS has been accused of inflating previous estimates of the size of the AIDS epidemic in order to sustain donor funding levels, but an attachment to the 2008 report explains that the latest estimates should not be compared with those published in previous years because of constantly improving methods of collecting and compiling data.
Some public health experts still argue that funding directed to AIDS could better be spent on strengthening public health systems and addressing other deadly infectious diseases.
In 2007, US$10 billion was spent on the global AIDS response, but UNAIDS estimated that an additional US$8.1 billion was needed.
Stirling told IRIN/PlusNews there was no contradiction between an effective AIDS response and stronger health systems. "Is AIDS funding adequate?" he asked. "The answer is no. But there also needs to be greater scrutiny of how the money is spent."
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