The last decade has seen a nearly 25 percent decline in new HIV infections, a reduction in AIDS-related deaths, and "unprecedented advances" in access to treatment, prevention services and care, the United Nations AIDS agency said in a report released Thursday night.
But UNAIDS said these achievements are unevenly distributed, exceedingly fragile, and fall short of global targets.
The report said more than 34 million people were living with HIV at the end of 2010 _ including 2.6 million who became newly infected with the virus that causes AIDS in 2009.
An estimated 6.6 million people in low- and middle-income countries were receiving antiretroviral drug treatment at the end of last year, but about 9 million eligible people in those countries were not, the report said.
"We have made tremendous progress in stabilizing or reducing rates of new infections in nearly 60 countries," UNAIDS Executive Director Michel Sidibe said in the introduction. "But this success only highlights the rampant stigma and discrimination that contributes to rising infection rates among key populations at higher risk, and to the vulnerability of women and girls."
According to the report, between 2008 and 2010, HIV among sex workers increased from 44 percent to 50 percent, and among gay men it rose from 30 percent to 36 percent. An estimated 20 percent of the 15.9 million people who inject drugs worldwide are living with HIV, the report said.
UNAIDS released the 139 page document ahead of Sunday's 30th anniversary of the first official report of what would become the HIV epidemic by the U.S. Centers for Disease Control and Prevention.
The report says the epidemic was spinning out of control from neglect in the early years, with the number of people infected with HIV rising from less than one million in 1981 to an estimated 27.5 million in 2000. But since 2001, the report said the global response to HIV has made "important achievements."
"Between 2001 and 2009, global HIV incidence steadily declined, with the annual rate of new infections falling by nearly 25 percent," the report said.
It said "above-average declines" have occurred in sub-Saharan Africa and south and southeast Asia while "more modest reductions" of less than 25 percent have taken place in Latin America, the Caribbean and Pacific Ocean nations. The report said rates of new infections have remained relatively stable in east Asia, Western and Central Europe and North America. But the HIV incidence has steadily increased in the Middle East and north Africa while in Eastern Europe and central Asia a decline was reversed in mid-decade with new infections rising slightly from 2005 to 2009.
The report said the overall gains, "while unprecedented, are partial at best" and did not achieve global and national targets.
Former U.S. President Bill Clinton wrote in the report that "more than 7,000 people, including 1,000 children, are newly infected with the virus every day and someone dies an AIDS-related death every 20 seconds."
"People in rich countries don't die from AIDS any more, but those in poor countries still do _ and that's just not acceptable," he said.
According to the report, investment in the response to HIV in low-and middle-income countries rose from US$1.6 billion in 2001 to US$15.9 billion in 2009.
But UNAIDS warned that "as the epidemic enters its fourth decade, flattening support potentially jeopardizes the sustainability of financing at recent levels."
U.N. Secretary-General Ban Ki-moon wrote in the preface that "the world has reached a crossroads."
"The number of people becoming infected and dying is decreasing, but the international resources needed to sustain this progress have declined for the first time in 10 years, despite tremendous unmet needs," he said.
UNAIDS and the secretary-general urged international donors to increase support to sustain and step up the fight against AIDS.
Sidibe, the UNAIDS executive director, stressed that billions of dollars will be needed to meet the agency's vision for the future _ "zero new HIV infections, zero discrimination and zero AIDS-related deaths."
The report said "universal access" to drug treatment for those with HIV is achievable.
As of December 2009, seven countries had already reached at least 80 percent of treatment-eligible individuals with antiretroviral drugs _ Botswana, Cambodia, Cuba, Guyana, Oman, Romania and Rwanda, the report said.
Fifteen countries reported treatment coverage of at least 60 percent of those with HIV, but the report said 28 countries have 20 percent or less of those infected with HIV in treatment, including Russia, Egypt, Iran and Colombia.