Fewer people are being infected with the virus that causes AIDS than at the epidemic’s peak, but progress against the disease is still halting and fragile, the United Nations’ AIDS-fighting agency reported Tuesday.
In its new report on the epidemic, Unaids said 2.6 million people became newly infected with H.I.V., the virus that causes AIDS, in 2009 — almost 20 percent fewer than in the late 1990s.
But progress is spotty. About 25 countries are doing better at prevention, including several in southern Africa with sky-high AIDS rates.
South Africa, which has the world’s worst epidemic, has benefited from the changeover from the presidency of Thabo Mbeki, which was hostile to the distribution of AIDS drugs, to that of Jacob Zuma, who has publicly taken an AIDS test and urged citizens to do the same. Still, it faces an estimated 350,000 to 500,000 new infections annually.
In one area, progress has been heartening: giving mothers drugs to prevent the infection of their babies at birth or through breastfeeding.
“We’ve had a 50 percent reduction of infections among young people in South Africa, which is a huge reservoir,” Michel Sidibé, executive director of Unaids, said in an interview in Manhattan last week.
Mr. Sidibé gave several reasons for the change.
“Relations between parents and children over discussing sexuality are changing,” he said. “Previously, no one would talk about it. Now, more people are willing to talk to their children.”
Also, he said, people are sleeping around somewhat less. “In 59 countries we surveyed, only 25 percent said they had had more than one partner in the last year,” he said. “That is a big shift.”
And, he said, while posters urging everyone to use condoms are not particularly effective, government health agencies have gotten better at “concentrating on hot spots” like sex workers and long-haul truckers.
In countries like Senegal and Malawi, Mr. Sidibé said, “there has been a sea change in attitudes toward men who have sex with men.”
In countries that jailed homosexuals or simply denied that there were any, gay men have been released from prison. Instead of driving gay men underground, some governments are trying to reach them with safe-sex education and condoms.
At the same time, some countries are becoming worse, especially those in Eastern Europe and Central Asia, where the epidemic is concentrated among heroin-injectors and their sexual partners. As Afghan and southeast Asian heroin spreads along new distribution routes, more addicts are created, increasing AIDS infections in countries with little history of dealing with them.
There are exceptions. In Iran, Mr. Sidibé said, he accompanied a woman in a chador who was handing out condoms in prison.
“I was shocked,” he said. “In Iran, the prisons had one of the most progressive programs. There was methadone maintenance; there was condom distribution. They even had conjugal visits for prisoners — five hours in a private room every three months with your wife. With condoms.”
There is also both good and bad news on the treatment front. About 5.2 million people are getting antiretroviral drugs — more than ever before, thanks to the multinational Global Fund to Fight AIDS, Tuberculosis and Malaria and its strictly American counterpart, thePresident’s Emergency Plan for AIDS Relief. But 10 million more still need the treatment immediately, and it seems unlikely that donors will give enough money to keep them all alive.
Also, some people have developed resistance to first-line drugs, but the money for more expensive second- and third-line drugs is not there.
It is now nearly 30 years since the epidemic began, and an estimated 33.3 million people are living with H.I.V. That number has never been higher, and its growth is due to a combination of new infections and the receipt of life-prolonging treatment by more of the sick.
But a comparison illustrates how much progress still needs to be made before it can be said that the world is winning the war on AIDS: in its previous report, Unaids estimated that for every 100 people put on treatment each year, 250 became newly infected. Now, it estimates that for every 100 on treatment, 200 become infected.