December 1st marks the 18th annual World AIDS Day. AIDS affects every continent, every country. More than 40 million people live with HIV, the virus that causes AIDS, or with AIDS itself. There were five million new cases this year - more than half were in sub-Saharan Africa and more than half were among young people.
Eighteen years ago, world health ministers decided a global effort would be needed to stop the spread of AIDS. AIDS has claimed the lives of at least 25 million people. And it has touched the lives of many, many more.
AIDS has orphaned 15 million children; Carol Mackay is one of them.
"I was 9-years-old when I learned my father had HIV. That was, in effect the end of my childhood."
She told the UN General Assembly that at age 9 she began caring for her father, "He was unable to work so we often couldn't afford much medicine. I didn't have money for school supplies and often couldn't even buy food for dinner."
Knowledge of the disease, methods and medications to contain it have not come fast enough for those millions and their families, but Dr. Anthony Fauci, an AIDS expert at the U.S. National Institutes of Health, says in the past 18 years, countries have learned how the virus is transmitted, how to diagnose the disease, how to protect blood supplies, and countless lives have been saved with anti-viral drugs.
"Still, the major issue that has not been resolved is the issue of a vaccine and that is a major problem."
Dr. Fauci says more anti-viral drugs are now available to the poor, especially to those in developing nations.
"We went from virtually nothing to now a considerable number of people, still, not nearly the proportion we would like it to be, but nonetheless, it's going in the right direction."
The epicenter of the disease continues to be sub-Saharan Africa. That's where two-thirds of all people infected with HIV and AIDS live. But the epidemic continues to grow and is spreading at alarming rates in other areas, according to Peter Piot who heads UNAIDS. "The fastest growth is in Eastern Europe and Central Asia in the countries of the former Soviet Union, where the number of people living with HIV has increased 20-fold in less than 10 years."
In countries where condom use and safe sex have been encouraged, new infections have declined.
Where treatment and AIDS education programs are available, the disease is less stigmatized.
HIV and AIDS is still an extraordinary public health challenge according to Dr. Fauci.
"And it's not going in the right direction as a whole. There are some regions and some countries that are doing better this past year, but for the most part, we're still in a very dire situation."
The inescapable fact is as more people are infected with HIV, more people will die of AIDS.