Only a handful of countries have made serious efforts to combat the disease, the report said. Worldwide, less than one in five people at risk has access to basic prevention services, and only one in 10 with HIV has been tested and made aware of the infection, the report said.
For the first time, though, there was evidence that increased efforts over the last five years have resulted in fewer new infections, UNAIDS chief Peter Piot said.
Previous improvements - such as in Senegal, Uganda and Thailand - were considered exceptions, but falling infection rates among youths or pregnant women in several countries indicated a positive, overall trend.
"Now we have Kenya, several of the Caribbean countries and Zimbabwe with a decline," Piot said. "If you see a decrease in prevalence in young people, that reflects a decrease in recent infections." Infection rates among pregnant women are also considered a good indicator of what is going on in the population.
"People are starting later with their first sexual intercourse. They are having fewer partners. There's more condom use," Piot said. "It's a consistency now that's a really good sign."
For years, sub-Saharan Africa and the Caribbean have been the two regions with the highest rates of HIV infection, and the epidemic continues to intensify in much of southern Africa.
It is also expanding in Eastern Europe and Central and East Asia, where intravenous drug use and commercial sex are prevalent. Five years ago, one in 10 new infections were in Asia; today the rate is one in four or one in five.
China, Papua New Guinea and Vietnam registered significant increases. There were also alarming signs that Pakistan and Indonesia could be on the verge of serious epidemics, the report said.
Piot said he believed, however, that more countries were improving. "We see similar (positive) trends in countries in East Africa, but the evidence was not good enough to put in the report," he said.
The most dramatic drops in prevalence were among pregnant women in urban Kenya, where in some areas infection rates declined from about 28 percent in 1999 to 9 percent in 2003.
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