Indian schoolchildren march in front of an AIDS awareness poster as they take part in a rally for World AIDS Day in Bangalore, December 1. India, with a population of more than one million, living with HIV/AIDS after South Africa, which has an infected population of around five million out of a total population of some 42 million.

The death toll and shattering of communities across Africa—and increasingly other areas where the epidemic is skyrocketing—defies description. And yet world leaders, in rich and poor countries alike, are letting the problem worsen, as they let corporate greed, ideology, homophobia and incompetence get in the way of solutions.

The only good news is that activism has stopped the situation from being worse than it is, and holds out hope of making it a lot better.

Here are some quick reminders of how bad things are. For those who relate to numbers: Roughly 40 million people worldwide have HIV/AIDS, and the number is rising fast. More than three million people are dying from AIDS-related ailments each year, and that number is rising fast, too. The average life expectancy in many southern African countries, the region worst hit so far, has plummeted to less than 40. In St. Petersburg, Russia, infection levels rose 100 times between 1998 and 2002.

If the numbers don’t move you, check out the heart-rending report in the Sunday New York Times on how the HIV/AIDS epidemic is laying waste to Lavumisa, a village in Swaziland. Here’s a short excerpt:

“Sixteen-year-old Nkuthula Madlopha wanted to be a police officer. Instead, next year she will till her grandparents’ fields, filling in for her dead parents. Her brother will herd livestock.

“Their grandmother, Vayillina Madlopha, wanted a quiet old age. Instead, at 80, she is a new mother. ‘I thought my daughters-in-law would be serving me food, washing for me and cleaning the yard,’ she said. ‘Now I must start afresh.’

“Eleven-year-old Ntokozo wanted to be a third grader. Instead, he lies on the floor of his one-room hut, his knees swollen like baseballs and his mouth pitted with sores. His mother, who died in May, infected him with HIV, either during her pregnancy or later as he helped tend her oozing sores. His sister, Nkululeko Masimula, 26, wanted a job. ‘I wanted to have my own business; to be a hairdresser or a wholesaler,’ she said. Instead, she tends her brother and their 61-year-old grandmother. She sells the family’s chickens to raise money for food. Finding the $20 a month required to take her brother to the nearest antiretroviral drug site, 60 miles away, is a pipe dream.”

And here is a review of the miserable response of the world’s governments and institutions: A few developing countries have stepped up and instituted prevention and treatment programs that are, at least, remotely commensurate with the scale of the tragedy.

By and large, however, developing country governments have failed to devote serious resources or political capital to stopping the spread of the epidemic, reinvigorating public health systems, providing life-saving treatment to people living with HIV/AIDS, or stopping the violence against women and redressing the power imbalances that are responsible in considerable part, for the epidemic’s deadly surge among women and girls.

The performance of rich countries—who don’t have the same resource constraints to fall back on as an excuse—is equally appalling. In April 2001, UN Secretary General Kofi Annan called for the creation of a global fund of $7 billion to $10 billion annually to address HIV/AIDS. To put this number in perspective, the United States now spends $35 billion a year on pet supplies. The fund was, in fact, established as the Global Fund to Fight Against AIDS, Tuberculosis and Malaria.

The Global Fund is an imperfect institution. Among other problems, it has been slow to move the money it has received. But the Global Fund is among the best things going in international aid. It doesn’t waste money on a huge bureaucracy or overhead, and hasn’t let consulting firms capture money intended to assist people in the developing world, and it works to involve people living with HIV/AIDS and nongovernmental groups in the process of developing project proposals.

The Global Fund’s big problem is that it is criminally underfunded. It has committed $3 billion in its three years of existence. In November, because of funding shortfalls, the Fund decided to delay its next funding round for two months, until September 2005. This was a victory over those, led by the United States, who wanted to delay the next grant round indefinitely. The rich countries simply have not been willing to pony up the monies needed to address the epidemic, with more than enough blame to spread around among Europe, Japan and the United States.

The Bush administration has worked hard to subvert the Global Fund. Although the relevant Senate committees had agreed in 2004 to spend $550 million on the Global Fund, in the final appropriations process the administration maneuvered, pressured its Congressional allies, and succeeded in slashing the final Global Fund commitment to $350 million. To prevent a re-occurrence of this fiasco, activists are mobilizing to demand that Congress next year appropriate $1.5 billion to the Global Fund and provide $330 million to the Fund as part of an emergency spending bill expected this winter.

The administration dislikes the Global Fund in part because it is multilateral, in part because it supports the use of low-cost, quality generic drugs, and in part because of its readiness to fund condom programs. So instead of supporting the global initiative, the administration has invested billions in a bilateral program. The program will hopefully deliver results eventually, but it has been slow to get off the ground, duplicates work already accomplished by the Global Fund and other bodies, and is reluctant to support use of generics.

Indeed, the United States is actively working to undermine the prospect of generic production of AIDS and other drugs. In a host of free trade agreements, the United States is demanding, on behalf of Big Pharma (pharmaceutical companies), that countries agree to rules that will delay introduction of generic competition for years, or even a decade or more. Given that the generic price of first-line AIDS drugs is now less than two percent of the price of brand-name drugs just five years ago, this is a big deal.

Meanwhile, although they are reluctant to put new monies into developing countries, rich nations are quite happy to suck resources out. The sub-Saharan African countries hardest hit by HIV/AIDS happen to be the poorest and most indebted. Together, they owe $300 billion to the World Bank, the International Monetary Fund (IMF) and rich country creditors. There is no prospect of them ever paying off this debt. But they do send billions in interest payments to rich country financial institutions.

The bottom line of this collective global failure: The World Health Organization estimates that six million people in the developing world need AIDS drug therapy immediately—and face certain death if they do not get it. WHO set a target of three million to get treatment by 2005 (“3 by 5”). Less than eight percent of the six million are getting treatment, nearly a third of them in a single country, Brazil.

And the epidemic continues to spread and intensify. As bad as things are, they could be worse. Activism and generic competition has dropped the price of life-saving treatment drugs dramatically—from $10,000 a year per person to $140. The resulting lowered costs made it possible to talk about provision of treatment in developing countries, and created the conditions in which billions of dollars could be mobilized in aid.

The list of things that need to be done to improve the situation is very long. But the top priorities in rich countries are clear and achievable, if enough people demand they be met: Getting sufficient funding to the Global Fund;

Stopping trade agreement provisions that extend drug company monopolies and delay generic competition; and

Canceling the debt of the poorest countries—something that is now actually on the agenda of the G7 group of rich countries.

Concludes Brook Baker, of Health GAP,: “People with AIDS and their allies have moved from the outrage of nothing being done to the miasma of things being done far too slowly, and poorly to boot. Whatever specific campaigns that activists mount to expand and improve the global response, we must not do so without referencing the larger picture. The paucity and ineptitude of the global response is an indictment of a world order where businesses set global policy, where governments neglect social obligations, and where multilaterals and international NGOs curry favor from stingy, domestic-policy-crazed donors. The message on World AIDS Day 2005 is one of shame and of determination—shame at our collective inability to raise the world from its lethargy, and determination to show more pragmatic solidarity with the individuals, communities and nations wracked by this lethal plague.”