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25 years on, AIDS still spreading

A UN meeting this week takes stock of efforts to fight the disease, focusing on women.

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But beyond practicalities, Ms. Obaid says linking the two efforts has become imperative as AIDS has increasingly affected women, in particular those in developing countries. "ABC is a package that is having an impact in many places, but it is not enough when a growing number of infections are among women, and young married women," she says. "We need accessible reproductive-health policies that empower women, put more of the decisionmaking in their hands, and address the cultural issues affecting them, such as violence against women."

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Today half of all people with the AIDS virus are female - up from 41 percent in 1997 and 35 percent in 1985, according to the IWHC. And in many developing countries, well over half of newly infected people are female.

This trend is also appearing in countries like the US. Today, AIDS is the leading cause of death among African-American women ages 25 to 34, notes Yolonda Richardson, president of the Centre for Development and Population Activities.

In the US, AIDS infection rates are climbing again after a sustained decline. "So, to the extent that AIDS is increasingly affecting women," Ms. Richardson says, "we can say that our conventional strategies are not working because they are not working for women."

Mr. Ruse of C-Fam agrees that "conventional strategies" have not been effective, but adds that he means the focus on condom use has been no panacea. "The world is flooded with condoms, but it doesn't seem to have much impact on the HIV rate," he says.

One obstacle to resolving the "reproductive health" controversy is that even some success cases in lowering AIDS rates cannot be laid clearly at the feet of a particular strategy. A dramatic decrease in infection rates in Uganda, for example, is claimed by both "ABC" proponents and backers of abstinence-only programs.

One undeniable factor in Uganda's results is that both men and women have reduced their number of sexual partners, notes Ms. Germain of the IWHC. But after visiting sex-education classes in Uganda, she is convinced that Uganda would not be where it is today if condoms were not part of the curriculum.

One question some AIDS prevention and treatment organizations are asking is what tone the US delegation to the UN meeting will take in some of the controversial debates. That is especially true since the delegation is being led by Laura Bush, who is seen to be less socially conservative than some forces in the administration.

Critics of the administration say the so-called "gag rule" it imposed on even mentioning abortion in the context of US-funded reproductive-health programs has confused private groups on the limits for using US funding. They say a provision that at least one-third of American AIDS prevention funding be spent on abstinence-only programs has added to the confusion to a point where some successful AIDS prevention programs have decided to turn down US funds.

With all the opportunity for controversy at the UN meeting, some AIDS activists are hoping enough common ground can be found to deliver on what they say should be less contentious issues - such as higher funding of the Global Fund to Fight AIDS, Tuberculosis and Malaria; or a stronger focus on women in the battle against AIDS.

"I am alive today because I have overcome stigma, ignorance, and poverty," says Inviolata Mwali Mmbwavi, who heads Kenya's National Empowerment Network of People Living With HIV/AIDS. "If more women are able to determine their own economic status and take control of their lives without fear of violence, that will have an impact."