Nearly three million lives have been saved by HIV/Aids treatment, but scarce resources are being misspent and stigma is still keeping the most vulnerable from seeking help, according to a new book by researchers commissioned by the UN.
The failings are particularly worrying at a time when worldwide recession and donor fatigue are hurting spending on Aids, the researchers say.
Among the two dozen people involved in the research was Nelson Mandela Foundation chief executive Achmat Dangor, who hosted a discussion of the research.
The book was aimed at ensuring that "the response to Aids is systematic and effective in the long term," Dangor said. "We believe it is crucial also to our founder's legacy."
Since finishing his term as South Africa's first black president, Mandela has campaigned to raise awareness about Aids in the country with the world's largest Aids burden.
Now 92 and ailing, the anti-apartheid icon galvanised the Aids community in 2005 when he publicly acknowledged the disease killed his son.
The researchers were asked by the UN Aids agency three years ago to review how the world has tackled the disease. The experts also were asked to determine what changes need to be made to radically reduce the number of infections and deaths by 2031, which will mark 50 years since the Aids virus was first reported.
The researchers, collectively known as the aids2031 Consortium, said it was "fair to ask whether the Aids effort has always achieved good value for its money."
"Despite a more than 53-fold increase in Aids funding in barely over a decade, the epidemic continues to outpace the rate at which programs are delivering," they said in the book entitled "Aids: Taking a Long-Term View."
The researchers said developing treatments and getting the drugs to the infected saved nearly 3 million lives between 1996 and 2008. Efforts to prevent infected mothers from transmitting HIV to their babies averted at least 200,000 new infections around the world between 1996 and 2008.
Rate of infection to fast
But every day, more than 7,000 people become infected, more than twice as many as are able to start Aids treatment.
The researchers called for a new focus on prevention, and criticised governments for ignoring research that could help guide efforts. For example, programs in Uganda focused on young people while research has shown high rates of HIV among older adults in steady relationships in the East African country.
Laws making homosexual sex a crime and harassment of intravenous drug users also keep those who need it most from seeking help, the researchers said.
Changing society's attitudes is a long-term project, without the quick, measurable results of increasing the spread of Aids treatment drugs, the researchers acknowledged. They said the costs of a lifetime of treatment for millions of HIV-infected people in poor countries are unsustainable.
After Dr Aaron Motsoaledi took over as South Africa's health minister in 2009, he said he was baffled by how much the government was spending to buy Aids drugs from private companies. South Africa, the country with the most people living with HIV in the world, provides free Aids treatment to its citizens.
Late last year, Motsoaledi announced that by taking such steps as asking more companies to bid and demanding they provide costs breakdowns, he had cut costs by more than half.
The Global Fund to Fight Aids, Tuberculosis and Malaria, which endorsed aids2031's work, also has found that up to two-thirds of some grants it provides are lost to corruption. The independent agency, backed by celebrity campaigners, is a major international funder of Aids programs.
(Sapa, February 2011)