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"We should not be at funerals every Saturday afternoon," Kenya's top health official, Charity Ngilu, recently told the Nairobi media. In 2001 an estimated 190,000 adults and children in her East African nation died of HIV/AIDS complications. As the world's eyes are fixed on combat in Iraq, we are losing ground in the war against HIV/AIDS. The rapid increase in new infections poses a lethal threat to many nations in the developing world. According to a December U.N. report, 5 million people worldwide were newly infected with HIV last year and 3.1 million died of AIDS-related causes. More than 42 million people across the world have HIV/AIDS.

The U.S. Congress, the United Nations, and the World Bank are preparing to spend millions of dollars in the fight against HIV/AIDS through faith-based organizations. But new spending does not itself vanquish HIV/AIDS. There must be a much better balance of spending priorities. Prevention programs, which stress abstinence and fidelity, should have equal standing with efforts to care for the sick and their families.

Yesterday saw a huge step forward as the U.S. House passed a bill to provide $15 billion for fighting HIV/AIDS, tuberculosis, and malaria in the next five years. An amendment requiring that a third of the program's prevention funds be used to promote abstinence received much attention and lobbying. The amendment passed, but few noted that prevention efforts receive only 20 percent of the $15 billion (55 percent goes to treatment programs, 15 percent to palliative care, and 10 percent to AIDS orphans). We rejoice that both the bill and the amendment passed, but think it's a tragedy that prevention received only a fifth of the funds.

People with HIV/AIDS should have access to a high level of care, including anti-retroviral drugs at minimal cost. But unless prevention becomes a clear priority, things are only going to get worse. Standard practice in fighting epidemic disease is to stop new infection by dramatically curbing transmission. The Hyde- Lantos bill won't do that very well. HIV is spreading explosively in developing countries. In Uzbekistan, health officials recorded nearly as many new HIV infections in the first half of 2002 as they did in the previous 10 years. In addition, social ills from illicit drug abuse and prostitution to regional warfare accelerate the spread of HIV, especially among young people. In highincome nations, including America and Britain, prevention programs are declining and complacency has set in.

According to the U.N., unless nations mount "drastically expanded" prevention efforts, there will be 45 million new HIV infections in the developing world within the next eight years. Rolf Zinkernagel, a Nobel Prize-winning immunologist, has voiced strong doubts that scientists will ever perfect a cure or vaccine against HIV/AIDS. "It's easy to say you want a vaccine, but it's much, much easier not to run the risk of getting it in the first place," he said. But some government-endorsed programs embrace indiscriminate condom distribution for the sexually promiscuous and using bleach to disinfect needles for street-drug addicts. That's not a prevention strategy. Avoiding risky sexual behavior is the most effective way to prevent HIV.

Daniel Fountain, in a 1998 article in Evangelical Missions Quarterly, said Christian leaders must intensify their efforts against HIV/AIDS on what he calls the 15/45 Window, which marks the age boundaries for individuals at highest risk of new infection. "AIDS is a disease of relationships," he said. "The fundamental problems leading to HIV infection are spiritual and social."

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April (Web-only) 2003, Vol. 47