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AIDS epidemic stabilizing, still work to do, U.N. says

LONDON » The AIDS epidemic is leveling off and the number of people newly infected with the virus that causes it has remained unchanged since 2007, the United Nations said in a report Monday.

Critics say that the body’s aim of wiping out the disease is overly optimistic, however, considering there is no vaccine, millions remain untreated and donations have slumped amid the economic crisis.

There were 2.7 million new HIV infections last year, approximately the same figure as in the three previous years, said the report from UNAIDS, the joint United Nations program on HIV and AIDS. The figures largely confirm earlier findings released by the group in June.

At the end of last year, there were about 34 million people with HIV, the virus that causes AIDS. While that is a slight rise from previous years, experts say that’s due to people surviving longer. Last year, there were 1.8 million AIDS-related deaths, down from 1.9 million in 2009.

The outbreak continues to hit hardest in southern Africa. But while the number of new infections there has fallen by more than 26 percent since the peak in 1997, the virus is surging elsewhere.

In eastern Europe and central Asia, there has been a 250 percent jump in the number of people infected with HIV in the past decade, due largely to the spread among injecting drug users. In North America and western Europe, the outbreak "remains stubbornly steady," according to the report.

"It’s looking promising, but the numbers are still at a scary level," said Sophie Harman, a global health expert at City University in London. She was not connected to the UNAIDS report.

In its strategy for the next few years, UNAIDS says it is working toward zero new HIV infections, zero discrimination and zero AIDS-related deaths. Harman said that was an admirable goal but wasn’t sure it was achievable. "They need to get real," she said. "Maybe they need to aim high but if their main goal is eradication, it’s highly unlikely that will ever happen."

Dr. Paul De Lay, deputy executive director of UNAIDS, acknowledged the idea of eliminating AIDS infections and deaths is "more of a vision for the future," and would likely not be accomplished without new tools like a vaccine, which could take several decades. Earlier this month, U.S. Secretary of State Hillary Clinton called for an AIDS-free generation and promised more money for programs in Africa.

De Lay said U.N. strategies will focus on more aggressive prevention and treatment policies, like treating people with HIV earlier. In Africa, people with HIV are not usually treated until their immune system reaches a certain threshold, and officials are now increasingly trying to start treatment before patients get too sick.

Future strategies might also include giving medicines to people at high risk even before they get infected. The World Health Organization is considering how to advise countries with major epidemics on giving drugs to healthy people vulnerable to catching the virus, such as prostitutes, gay men and injecting drug users, as a prevention method.

While studies have shown that could dramatically slow AIDS transmission, experts have voiced concerns about healthy people taking AIDS drugs, which have toxic side effects. It could also encourage drug resistance, and there are already millions of people in developing countries who qualify for treatment but are still waiting for it.

Sharonann Lynch, an HIV policy adviser at Doctors Without Borders, said many African countries are anxious to implement more aggressive strategies and that some are redrafting their guidelines even before official U.N. advice is available. But she said the financial crisis is affecting treatment and that enrollment in some clinics, like in Congo, have stalled or even been suspended. That could allow the epidemic to resurge.

"Just at the moment when we know how to manage HIV, we’re hitting the brakes," Lynch said. "Without more investment, we’ll be squandering the best chance we have of getting ahead of the new wave of infections."

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