U.N. officials are hailing a growing awareness among African leaders about the need for strong action to counter the global AIDS pandemic. At the same time, the largest contributor to AIDS prevention and treatement programs is devising a "smaller is better" strategy.
A quarter of a century after AIDS was first recognized, U.N. officials say they are encouraged that many world leaders are waking up to the global AIDS menace.
Opening a high-level U.N. meeting on AIDS Wednesday, Secretary-General Kofi Annan said that in 25 years, HIV/AIDS has gone from local obscurity to global emergency.
"It took the world far too long to wake up. Denial dogged the response to AIDS. Millions paid with their lives. But in recent years, that has changed. The response has gained genuine momentum," he said.
Mr. Annan told reporters afterward that he is particularly encouraged by a change in attitude among leaders in Africa, where HIV infection rates in some cases are among the highest in the world.
"I recall in earlier years, African leaders did not even want to hear me mention the word condom. One of them told me you should not even mention the word, much less try and convince me to promote it with my people," he said.
UNAIDS Executive Director Dr. Peter Piot says over the past decade, he has witnessed a complete turnaround among African leaders in attitudes and actions toward AIDS.
"I remember when I got into this job, nearly 10 years ago, we started with UNAIDS, with a few exceptions, there was no top African leader who would take this on," he said.
Dr. Piot says more than eight billion dollars was spent on AIDS treatment and prevention programs in low and middle income countries last year. That meets a target set five years ago. He is hoping to set a new target this week of $20 billion a year by 2010.
But the United States, the largest single donor to the AIDS fight, has served notice it will oppose large international targets. Acting U.S. Global AIDS Coordinator Dr. Mark Dybul says the Bush administration's five-year, $15-billion initiative is geared to bottom-up programs tailored to the needs of individual countries.
"It is impossible to ask two countries who are much different capacity to achieve the same level of access to treatment in the same four-year period," he said. "It just doesn't happen. Just as we see countries like Botswana, and Uganda, moving much more rapidly than other countries, because the infrastructure is now there. So we're not in favor of international targets writ large that impose something on countries."
Dr. Dybul says the United States is contributing roughly half of all international donations to AIDS treatment and prevention programs. He called that situation "unsustainable", and urged other donors to increase their contributions.
The three-day AIDS conference has drawn more than 1,000 delegates to U.N. headquarters in New York. U.S. First Lady Laura Bush will lead the American delegation at Friday's open general session.