NEW YORK - If black America were a country, it would rank 16th in the world in the number of people living with the Aids virus, the Black Aids Institute, an advocacy group, reported on Tuesday.
The report, financed in part by the Ford Foundation and the Elton John Aids Foundation, provides a startling new perspective on an epidemic that was first recognised in 1981.
Nearly 600000 blacks are living with HIV, and up to 30000 are becoming infected each year. When adjusted for age, their death rate is two-and-a-half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.
Those and other disparities are "staggering", said Kevin Fenton, who directs HIV prevention efforts at the Centre for Disease Control and Prevention, the federal agency responsible for tracking the epidemic in the US.
"It is a crisis that needs a new look at prevention," Fenton said.
In a separate report, the UN painted a somewhat more optimistic picture of the worldwide Aids epidemic, noting that fewer people are dying of the disease since its peak in the late 1990s and that more people are receiving antiretroviral drugs.
Nevertheless, the report found that progress remained uneven and that the future of the epidemic was uncertain. The report was issued in advance of the 17th International Aids Conference, which begins this weekend in Mexico City.
The gains are partly from the Bush administration's programme to deliver drugs and preventive measures to people in countries highly affected by HIV.
The Black Aids Institute took note of that programme in criticising the administration's efforts at home. The group said that more black Americans were living with the Aids virus than the infected populations in Botswana, Ethiopia, Guyana, Haiti, Namibia, Rwanda or Vietnam - seven of the 15 countries that receive support from the administration's anti-Aids programme.
The international effort is guided by a strategic plan, clear benchmarks like the prevention of 7million HIV infections by 2010 and annual progress reports to Congress, the group said. By contrast, it went on, "America itself has no strategic plan to combat its own epidemic".
In a telephone interview, Fenton said: "We recognise this is a crisis, and clearly more can be done." The institute, based in Los Angeles, describes itself as the only national HIV-Aids study group focused exclusively on black people.
Phill Wilson, the group's chief executive and an author of the report, said his group supported the government's international anti-Aids programme.
But Wilson's report also said that "American policy makers behave as if Aids exists 'elsewhere' - as if the Aids problem has been effectively solved" in this country.
The group also chided the government for not reporting HIV statistics to the UN for inclusion in its biannual report.
Others speaking for the agency said the answer would have to come from the State Department.
Helene Gayle, president of Care and a former director of HIV prevention efforts at the disease control centres, told reporters on Tuesday that the US needed to devote more resources to care for people with sexually transmitted diseases. Such infections can increase the risk of HIV infection.
The federal government and communities needed to promote more testing among all people, particularly blacks, to detect HIV infection in its earliest stages when treatment is more effective.
The UN report said that in Rwanda and Zimbabwe, changes in sexual behaviour had led to declines in the number of new HIV infections.
Condom use is increasing among young people with multiple partners in many countries and more young people are postponing their initial sexual intercourse. - New York Times