The global AIDS epidemic infected and killed more people than ever this year, spreading rapidly in Eastern Europe and gaining a stronger foothold in the huge populations of India and China.
At the same time, infection rates fell in a few hard-hit areas of Africa, and large numbers of people on that continent can realistically hope to get state-of-the-art treatment soon.
Those were the twin messages delivered Tuesday by UNAIDS -- the program run by the United Nations, the World Health Organization and the World Bank -- in its annual report on the epidemic.
"So the glass is either half-full or half-empty, however you want to look at it," said Peter Piot, the Belgian physician and epidemiologist who heads UNAIDS.
Worldwide, about 40 million people are living with human immunodeficiency virus (HIV) infection. Of that total, 5 million became infected this year, including about 700,000 children. About 3 million people have died of the disease this year, about 500,000 of them children under age 15.
Africa remains the world's most severely affected region, with two-thirds of all infections and more than two-thirds of the deaths.
Worldwide, about $4.7 billion has been spent on AIDS treatment and prevention in the most affected countries this year, about a 50 percent increase over last year, Piot said in a telephone news conference.
Much of the money came from the affected countries. Brazil provides antiretroviral treatment to all citizens who need it, and South Africa announced a similar commitment last week. The Global Fund to Fight AIDS, Tuberculosis and Malaria, in operation since January 2002, has approved three rounds of grants to programs in 121 countries, for a total of $2 billion.
Nevertheless, the sum being spent to fight AIDS is less than half the $10 billion a year that an economic commission appointed by the WHO said was needed.
That is likely to change soon. The new director-general of WHO, Jong Wook Lee, announced in July his intention to help countries and nongovernmental organizations put 3 million AIDS patients on antiretroviral therapy by the end of 2005. WHO will unveil details of its "3 x 5" plan next week.
The Bush administration is drawing the road map for a five-year, $15 billion plan for AIDS, tuberculosis and malaria.