Anyone who thought they understood the magnitude of the global HIV/AIDS crisis will be shocked by a new United Nations forecast that the epidemic will get worse (see www.unaids.org).

In the 45 most affected countries, 68 million people will die between 2000 and 2020 because of AIDS, predicts the study by the Joint United Nations Programme on HIV/AIDS (UNAIDS) unless prevention and treatment efforts are vastly expanded. That’s more than five times the 13 million deaths in the previous two decades of the epidemic in those countries.

Even if the U.N. figures err on the high side, the epidemic is expanding in countries that are already hard hit. It’s also spreading rapidly to new populations in Africa, Asia, the Caribbean and Eastern Europe.

In China, the disease, previously transmitted through drug use and unsafe blood transfusions, is now spreading through heterosexual contact. Ditto for Russia and Eastern Europe. The new freedoms in these countries mean people can move around more easily, and so can the virus.

In Indonesia, the world’s fourth most populous country, infection rates are rising rapidly. In Central and Western Africa, where rates had been high but stable, HIV is spreading more quickly. And in the most afflicted region of southern Africa, a country like Botswana has seen the percentage of infected adults climb from 36 percent to 39 percent over the last two years.

These daunting stats may make people living in Western countries want to pull up the covers and stop reading about HIV/AIDS.

But the very awfulness of the UNAIDS forecast means complacence isn’t an option. As Secretary of State Colin Powell said recently, “AIDS is not just a compelling moral issue, it is not just a humanitarian issue; it is far more than just a health issue. It is a security issue. It is a destroyer of nations. It is a destroyer of societies.” In South Africa, for example, an estimated 660,000 children already have been orphaned by AIDS.

What is to be done? The UNAIDS report points out two avenues that could lead toward control of the pandemic. Attention must be paid to nations that have achieved success in slowing the spread of HIV within their borders. Already, models are emerging.

A case in point is Uganda, where adult HIV prevalence has dropped to 5 percent from 8.3 percent in 1999. The essential ingredients were leadership at the top and involvement of grassroots organizations. Uganda’s President Yoweri Museveni broke taboos by promoting safe sex on television, and churches and mosques reinforced the message to their congregations.

There must be increased global cooperation between rich and poor nations to fight the pandemic, in tandem with nongovernmental organizations and the private sector. Which brings us to the issue of money. If the war on AIDS is a security threat and Secretary Colin Powell told me this week it is more dangerous than any regional conflict then the United States must appropriate the funds to fight this war.

The good news is that with Powell’s input the Bush administration has finally focused on the AIDS threat. Other Republicans in the Senate, including Sens. Arlen Specter, Pa., William Frist, Tenn., and conservative Jesse Helms, N.C., had already done so.

The bad news is the administration hasn’t yet backed up its new policy with real money. In mid-June, Bush proposed spending $500 million spread out over three years on overseas programs to prevent transmission of AIDS from mother to child.

But his proposal undercut a bill put forward by Frist and Helms, along with Sen. John Kerry, D-Mass., that would have provided more money to help these infants, immediately, without robbing other AIDS programs. This bill would have upped U.S. spending on HIV/AIDS from roughly $1 billion this year to more than $2 billion next year.

This is not a question of throwing money around. There are already programs on the ground in Africa some funded by the United States that are making headway in AIDS treatment and prevention. I have seen some of them in South Africa. They need to be replicated.

If the administration now takes the war on HIV/AIDS seriously, it must rearrange some priorities. In the Pentagon, an extra billion for fighting a war is a pittance. And in this war, it could save tens of thousands of lives.

Trudy Rubin is a columnist and editorial-board member for the Philadelphia Inquirer. Her e-mail address is trubin@phillynews.com.