Coming up short on AIDS

THE UNITED NATIONS, IT HAS BEEN SAID, is the only organization that holds meetings to commemorate the failures of previous meetings. No further introduction is needed for the General Assembly special session on HIV and AIDS starting today, which will revisit commitments and goals the world made five years ago to fight the disease. Needless to say, those commitments have been a bust.

It isn’t that there hasn’t been any progress against AIDS; the spread of the disease is slowing, according to a U.N. report released Tuesday. It’s that the gains on prevention and treatment aren’t happening as fast as the virus is spreading. Last year, the report notes, there were 2.8 million deaths from AIDS.

The report, which will be Topic A at this week’s meeting, is an atlas of failure for world governments and relief organizations. Most of the goals set in 2001 not only haven’t been met, they aren’t even close to being met. The highest-profile goal was the so-called 3 by 5 initiative -- getting 3 million people on antiretroviral drugs by 2005. The actual number was fewer than 1.5 million.

Oddly, all these failures happened despite one striking success. Five years ago, donors promised to spend between $7 billion and $10 billion fighting AIDS by 2005. They have spent $8.3 billion. So why isn’t all that money having the effect it was supposed to? Mostly because the amount needed to reach the goals was grossly underestimated. A more recent estimate from the U.N. says that effectively fighting AIDS around the world will take $15 billion this year, $18 billion in 2007 and $22 billion in 2008.

It’s not just about the money. Donors and relief organizations are still very bad at coordinating their efforts, and they still tie aid to self-defeating policy prescriptions (such as U.S. requirements that grant recipients adopt policies that promote abstinence-only programs). Poor countries often lack the capacity to spend the money properly, and their governments often make things worse, squandering resources, failing to comply with grant requirements, denying the problem and passing discriminatory laws that discourage prevention and treatment.

AIDS, possibly the single greatest factor holding back human development, is among humanity’s most serious threats. The U.N. this week will decry last year’s failures while reconfirming next year’s goals, but what it won’t do is hold anyone accountable. Until it starts doing that, it’s doomed to more annual meetings assessing what went wrong.