By David Brown
http://www.washingtonpost.com/wp-dyn/content/article/2009/09/30/AR2009093004884.html

In a significant advancement, about 42 percent of people in the developing world who are infected with the AIDS virus and should be taking antiretroviral drugs are now receiving them, according to a new report.

The greatest increase has been in sub-Saharan Africa, where most of the world's HIV-positive people reside. At the end of 2008, 2.9 million Africans were on the lifesaving therapy, up by more than one-third from the previous year.

Similar gains have been made in testing pregnant women for HIV and persuading infected ones to take antiretroviral drugs to prevent transmission of the virus to their babies. Overall, however, nearly six in 10 infected pregnant women are not given that option, resulting in hundreds of thousands of HIV cases.

The report, prepared by the World Health Organization and its sister U.N. agencies UNICEF and UNAIDS, depicts a glass that is nearly half-full but was certifiably empty at the start of the decade.

"It is an incredible step forward compared to where we were in the early 2000s," Paul De Lay, deputy executive director of UNAIDS, said in a telephone news briefing.

At the end of 2008, 4.03 million people were taking antiretroviral therapy in 139 low- and middle-income countries surveyed by the agencies. About 9.5 million people in those countries had HIV infection advanced enough to warrant treatment, which generally consists of daily doses of at least three drugs that block the virus's replication.

In comparison, at least 700,000 people in high-income countries -- principally the United States, Canada, Western Europe, Australia, New Zealand and Japan -- were receiving treatment last year.

Although the number of people being treated is rising quickly -- it increased by more than one-third from 2007 to 2008 -- it is not keeping up with the growth of the epidemic. For every three people starting therapy, five become infected. In all, about 33 million people are living with the AIDS virus worldwide.

Women represent slightly more than half the people in need of treatment and make up 60 percent of those receiving it, the report said.

About 628,000 HIV-positive women in the developing world received antiretroviral drugs during pregnancy. That is 45 percent of the total number of infected pregnant women who should have received the therapy. An even higher percentage of infected women in eastern and southern Africa received the medicines during pregnancy. In those regions, preventing mother-to-child transmissions has been the focus of programs funded through the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President's Emergency Plan for AIDS Relief, created under George W. Bush.

About one-fifth of pregnant women were offered HIV testing last year, compared with one-seventh the year before. However, only one-third of those who tested positive were fully evaluated to determine whether they should stay on antiretrovirals after they delivered.

The number of children younger than 15 receiving therapy was 275,000 in 2008 -- up 40 percent from the year before. "An AIDS-free generation is within sight," said Jimmy Kolker, head of HIV/AIDS programs at UNICEF. "We know what to do, the science is clear, and the scale-up has been impressive."

A decade ago, AIDS experts debated whether it was feasible or even safe to offer people in poor countries the complicated and expensive treatment. Since then, the cost of AIDS drugs in the developing world has fallen steeply because of "tiered pricing" by pharmaceutical companies and the arrival of generic versions made principally in India.

A year's worth of drugs now costs $200 to $500 in the poorest countries, and $700 to $1,000 in middle-income ones, De Lay said. In the United States and Europe, the treatment still costs $8,000 to $12,000.