NEW DELHI, India - With more than 4.5 million people carrying the virus that causes AIDS, India has become the world's second largest hub of the disease — but some of its states are "still in denial," a U.N. official said Friday.

According to India Health Ministry estimates made public Friday, about 4.58 million people — or about 0.8 percent of the country's adult population — have the HIV virus, compared with 3.97 million cases last year.That means that India has the second-largest population of HIV sufferers after South Africa, the Health Ministry said.

Despite the large number of infections, the percentage of the population affected in India, which has more than 1 billion people, is significantly lower than in many African countries.

Dr. Peter Piot, executive director of UNAIDS, said the Indian government's efforts to combat HIV/AIDS were patchy, with some states taking up the campaign vigorously, "while others were still in denial."

Piot was speaking to reporters ahead of an AIDS conference for legislators and village council members from throughout India.

A taboo in India on talking openly about sex has meant that sex education is not taught in schools, and people, especially women, are reluctant to seek treatment for sexually transmitted diseases.

"The political leadership will be key players to break the silence and the stigma attached to HIV/AIDS," Piot said.

He said there had been delays in several countries in recognizing the gravity of the AIDS spread.

"Asia is looking at the leaders of India, China and Indonesia to provide leadership in the fight against the disease," Piot said.

Indian Prime Minister Atal Bihari Vajpayee, top elected representatives from many of India's states, and hundreds of lawmakers are to attend the conference in New Delhi this weekend.

"HIV is spreading quite rapidly in Asia, but it has the opportunity not to make the mistakes made in other parts of the world," said Piot, referring to countries that did not quickly respond to the disease.

Meenakshi Dutta Ghosh, who heads India's National AIDS Control Organization, said politicians and nongovernment organizations should work with industry and religious groups to fight AIDS.

"The message that HIV/AIDS is preventable, that it can be treated, has to be taken to every village, every home," she said.

PARIS (AFP) - The United Nations' top official on AIDS has bluntly told India that if it wants to skirt catastrophe, it must pump money into distributing condoms, tackle stigma and smash a wall of silence about sex.

India, with its huge contrasts of wealth and poverty, "is a land of castes, of stigmatisations, and conservativism is not making it easy to promote condom use," UNAIDS Executive Director Peter Piot said ahead of India's biggest-ever forum on the AIDS crisis.

"If you cannot talk about sex, you cannot attack AIDS. Distributing condoms has to be part of the prevention strategy."

Piot mentioned no names in his interview with AFP, but his remarks seemed to be aimed at Indian Health Minister Sushma Swaraj, who is a critic of so-called "condom-centric" prevention policies.

Swaraj, under pressure from conservatives, recently told the press that her country's AIDS programme had to focus on sexual abstinence and faithfulness rather than just condoms, a stance that has caused dismay among HIV  campaigners.

"India has more than four million people with HIV. It probably has more infected inhabitants than South Africa," Piot said, referring to the country that at present has the largest number of people with the human immunodeficiency virus.

"It has to act now before the epidemic infects tens of millions of people, which will surely happen if things continue down this path."

Piot's grim predictions are backed by the US Centers for Disease Control and Prevention (CDC), whose director, Julie Gerberding, warned on July 3 that China and India were on the brink of following Africa down the path towards "catastrophe."

According to the US National Intelligence Council, the number of Indians with HIV/AIDS could reach 25 million by 2010.

"This is the most pessimistic estimate, but it is not impossible. This is why the time to act is now," Piot said.

Piot was interviewed on Wednesday ahead of a major two-day gathering to assess India's worsening AIDS problems.

The first-ever National Convention of the Parliamentary Forum on HIV/AIDS, meeting in New Delhi on Saturday and Sunday, will gather legislators, state ministers, mayors and local leaders.

One of the goals is that by speaking openly about HIV/AIDS, these figures will attack discrimination and stigma -- two of the conditions that drive the epidemic underground and let it flourish.

Piot warmly praised the meeting as "a breakthrough event... it is an unprecedented show of unity, and about time, too."

He called on lawmakers to approve laws that would discourage and punish the stigmatisation of people with HIV and push through budgets to expand prevention efforts.

Piot said he was struck by the diversity of the HIV/AIDS problems in India, highlighting incidence of the disease in the western city of Bombay and surrounding Maharashtra state.

"In Mumbai (Bombay), 50 percent of prostitutes have HIV and across Maharashtra state, between three and five percent of pregnant women are infected, which is enormous," he said.

But in the same state, he noted, big strides had been made to dampen prevention among risk groups.

Condoms were being used by 66 percent of known sex workers, 77 percent of their clients and among 52 percent of intravenous drug users, he said.

In southeastern Tamil Nadu state, more than one percent of the total population is infected, he said. As many as three out of every four intravenous drug users in the southeastern state of Manipur, near the border with Myanmar, had the virus.

Again and again, Piot said, experience in other countries had shown that the virus does not stay confined to small groups within the population -- it leaps out and infects the wider community.

GENEVA (AFP) - Negotiators at the WTO said a deal on providing poor countries with cheaper drugs to treat major diseases such as HIV/AIDS was taking shape, as top trading nations prepared to wind up a round of meetings on trade liberalisation talks.

The talks were still foundering on the central issue of agriculture and market access, and negotiators said they were looking for guidance from an informal meeting of ministers in Montreal, Canada due to begin on Monday.

European Union trade negotiator Carlo Trojan pointed out that the Montreal meeting would be the first gathering of trade and commerce ministers since the EU laid out key reforms to its farm subsidy system, and would also come as US pharmaceutical giants sought a swift deal on the medicines issue.

"The complication is that we don't only have governments, as is usual, but we have private industry at the table," he told journalists as a meeting of the World Trade Organisation's General Council got underway.

US and EU diplomats said they were trying to broker a deal which would preserve a tentative agreement on medicines reached last December at WTO.

But it would add a confidence-boosting pledge to stop generic versions of medicines from being sold on markets other than the poor countries they were intended for.

"Obviously part of that constellation has to be the December 16 declaration," US deputy trade representative Peter Allgeier said, adding that a deal should ensure that drugs producers in emerging markets did not reap a commercial adavantage from the arrangement.

Trojan said US pharmaceutical companies were looking for "belts and braces" and were no longer clinging to a restricted list of diseases that could be treated with cheaper medicines.

The 146 members of the Geneva-based global trade body are trying to ensure that developing nations without the capacity to manufacture drugs can import generic copies of patented medicines in a health crisis.

Negotiations became deadlocked in December when the US, under pressure from its pharmaceuticals industry, blocked an accord which had won backing from all the other WTO members.

The General Council meeting at WTO headquarters here was due to wind up on Friday after taking stock of the deadlocked talks on the Doha Development round, ahead of a key ministerial meeting in Cancun, Mexico, in September.

But negotiators this week indicated no progress on the key obstacle, setting out the terms of talks on freeing the global trade in farm products in Cancun and aiming for an overall agreement by the December 31, 2004 deadline for the Doha round.

Allgeier reiterated that the US was willing to cut levels of domestic support for farmers by 100 billion dollars.

But he followed negotiators from other countries in highlighting the "crucial" issue of market access or tariff cuts, allowing farm products to be imported freely.

"For our farmers, if we are going to reduce significantly the domestic support they get, they need to have the outlets in international markets to sell their products," Allgeier said.

GENEVA (AFP) - Jong Wook Lee was due to take over the top job at the UN's World Health Organization (WHO), and the South Korean specialist planned to hit the ground running with a major announcement on HIV /AIDS, the agency said in a statement.

"He will introduce his team and will announce important new measures to address the global HIV pandemic," said a WHO press release Monday, referring to Lee's inaugural speech.

The 58-year-old, who takes over from Gro Harlem Brundtland of Norway, is well versed in the workings of the World Health Organisation, having spent much of his career playing a key role in the WHO-led fight against infectious diseases.

Lee takes over the UN health agency at a time when the global body is squaring up to new viruses, such as the deadly SARS  epidemic that killed more than 800 people and infected more than 8,000 in some 30 countries.

On his election by the WHO's 192 member states in May, Lee vowed to strengthen the global outbreak alert and response network to identify and respond to outbreaks of disease.

"SARS is the first new disease threat of the 21st century, but it will not be the last," he said.

The plight of the world's poorest, especially in Africa, as well as improving the WHO's efficiency and transparency, will also top the South Korean's agenda.

Spanning 20 years, Lee's career at the WHO has seen him in numerous technical, managerial and policy posts.

After his medical doctor's degree, the new WHO head began his career in Samoa at a tropical medical centre and in 1983 joined the WHO as a leprosy consultant in Fiji. He went on to become team leader for leprosy control in the South Pacific.

He focussed on running polio eradication initiatives in the Western Pacific until 1994, when he took over as director of the WHO's global programme for vaccines and immunisation.

In December 2000, he also became director of the "Stop TB" (tuberculosis) campaign at the WHO and contributed to setting up a world system for providing anti-TB drugs.

Married to a Japanese woman, with one son who is currently studying electrical engineering in the United States, Lee speaks English and Japanese, and also reads French and Chinese.

He lists his hobbies as scuba diving, skiing and tennis, and asked about his personal secret to a healthy lifestyle, the South Korean mentioned eating vegetables, fish and fruit.

His father, a heavy smoker, died of throat cancer.

"Nobody in my family actually smokes," he said.

Before his election, Lee advocated the decentralisation of the WHO, vowing that by 2005 at least 75 percent of human and financial resources would be allocated to countries and regions.

"Clearly Africa should be the priority, and Africa is the priority, especially for HIV/AIDS," Lee told reporters in January.

Lee will be the sixth director-general of the WHO and the second to come from Asia. Previous incumbents since the body was set up in 1948 came from Canada, Brazil, Denmark, Japan and Norway.

He will be the first South Korean to head a UN agency.

By JONATHAN FOWLER, Associated Press Writer

GENEVA - A senior adviser to U.S. Secretary of State Colin Powell has been appointed as the new AIDS chief at the World Health Organization, the U.N. agency's chief said Monday.

WHO director-general Dr. Jong-wook Lee said he had picked Dr. Jack Chow to head a newly created department which is meant to fine-tune WHO's battle against AIDS, tuberculosis and malaria.

Chow, 42, currently serves as U.S. Deputy Assistant Secretary of State for Health and Science. In 2002 he also was appointed as Powell's special diplomatic representative on the AIDS issue, the first time U.S. authorities have created an ambassador-rank post covering health issues.

Chow, who told The Associated Press he expects formally to join WHO in the fall, took the agency's oath of office alongside 10 other new assistant directors-general appointed by Lee. Hailing from other countries including Canada, China, France, Sweden and Botswana, all pledged to set aside their national loyalties and work exclusively in the interests of all 192 WHO member countries.

"The United States considers (AIDS, tuberculosis and malaria) as global health priorities," Chow told reporters after the ceremony. "Once I'm an assistant director-general I will serve all nations afflicted by these diseases."

Last year alone, 3 million died worldwide from AIDS, and 5 million were newly infected with HIV, according to the United Nations Program on HIV/AIDS. About 42 million are living with the virus, including 19.2 million women and 3.2 million children.

TB infects 8 million people a year worldwide, killing 2 million. Malaria kills more than a million people a year, most of them in Africa.

Chow, who is originally from New Haven, Connecticut, is a medical doctor who studied for a Bachelor's degree at the University of Pennsylvania, trained at Stanford University Hospital and earned his MD from the University of California at San Francisco. He said his determination to battle AIDS was born during his studies in the 1980s, when researchers discovered the HIV virus that causes the disease.

In addition to his medical qualifications, Chow holds Masters degrees in public administration from Harvard University's Kennedy School of Government and business administration from the University of Chicago.

By Megan Rauscher

NEW YORK (Reuters Health) - Top HIV researchers and public health officials will present the latest research on preventing HIV infection -- including new information on rapid testing and mother-to-child transmission -- at the 2003 National HIV Prevention Conference next week in Atlanta.

"This is the largest single gathering of HIV prevention experts in the U.S. that takes place every other year," conference co-chair Dr. Ron Valdiserri told Reuters Health.

In an interview ahead of the meeting, Valdiserri of the Centers for Disease Control and Prevention said "news from the meeting will focus on some of the progress that we've made but also on some of the big challenges still facing us in the U.S."

The CDC estimates that a quarter of a million people in the U.S. do not know that they are infected with HIV. "Many presentations will focus on new approaches to diagnosing HIV infection -- approaches that rely on the rapid HIV test for instance -- and how to work more closely with medical care providers," Valdiserri said.

He added that "important scientific information" would be coming out on the issue of preventing infection of babies born to HIV-positive mothers. Despite "tremendous progress" in reducing the number of infants born with HIV infection, the CDC estimates that as many as 300 infants are born each year with HIV infection. "We believe that we should able to get that number down to zero in a country like ours," the researcher said.

Information will also be released showing that as many as one in five pregnant women are still not tested for HIV and a sizable proportion of women of childbearing age are unaware that there are effective treatments to prevent transmission of HIV from mother to child.

"We'll also be sharing some success stories," Dr. Valdiserri said, such as a program in New York State that substantially increased the number of pregnant women tested for HIV.

Another program to be highlighted at the meeting concerns HIV testing during labor. Pregnant women who have not received any prenatal care are given the rapid HIV test at the time of delivery so that physicians can intervene with drugs to reduce the rate of transmission. "This is a big focus of the meeting," he said.

Other challenges on the horizon include the role of the Internet in this area. Some new research shows that the Internet provides an environment for gay and bisexual men to meet multiple, anonymous partners. On the flip side, the Internet provides some unique opportunities for HIV prevention.

"One non-government organization from the Midwest is actually doing outreach on the Internet, having a health educator go into chat rooms and do one-on-one counseling online," Valdiserri said.

The meeting begins Sunday, July 27.

By LISA LEFF, Associated Press Writer

SAN FRANCISCO - Workshops on safe sex in San Francisco's Mission District. HIV-prevention skits developed by teenagers in Chicago. A ministry that counsels black women in Baltimore, where syphilis rates are shockingly high. All are among the programs that could lose funding under the new HIV prevention strategy from the Centers for Disease Control and Prevention, which calls for increased attention to people who already carry the virus that causes AIDS.

CDC officials say they intend to pay for the new initiative by diverting $42 million that now goes to nonprofit groups like those in San Francisco, Chicago and Baltimore, whose work with uninfected people has been the norm for keeping the virus from spreading.

The plan, unveiled in April, faces mounting criticism from advocates and some federal lawmakers, who say it will shortchange proven prevention methods and represents a dangerous shift in the government's effort to combat HIV. They'll be pressing for more answers at the CDC's National AIDS Prevention Conference, which starts Sunday in Atlanta.

"You can't argue with an initiative that centers its AIDS-prevention efforts on people who carry and can actually spread the disease," said Debra Fraser-Houze, president of the National Black Leadership Council on AIDS. "But one that only focuses on people who are already HIV positive, and takes no responsibility for prevention among people who are not yet positive is insane and, I feel, genocidal."

The CDC's change threatens 211 community-based organizations nationwide, most of which serve minority communities and other populations that are at the highest risk of developing AIDS.

In announcing the new strategy, CDC director Julie Gerberding said it was clear that existing prevention efforts have "stalled." She cited rising rates of sexually transmitted disease rates in many U.S. cities, and that an estimated one-quarter of the more than 800,000 people living with HIV are unaware of their status.

About 40,000 more people in the United States are diagnosed with HIV every year; the CDC hopes to reduce that by half by 2005.

At the same time the CDC is changing its emphasis, President Bush has pledged $15 billion to fight AIDS in Africa and the Caribbean, providing medicine and caring for orphans of the disease. The House has approved more than $2 billion for HIV/AIDS as a first installment of the five-year plan.

Dr. Robert Janssen, director of the Division of HIV/AIDS prevention at CDC, said in an interview this past week that the agency doesn't plan to stop funding traditional prevention activities in the U.S., but they will represent "a smaller share" of federally supported efforts.

"What we don't want to do is just hand out condoms and brochures," he said.

Janssen said community-based non-profits may reapply for grants and have a good chance of receiving them if they redesign their programs to focus on HIV-positive populations.

If they don't, their CDC funding will likely run out in May.

They can still apply for money from $140 million in prevention funding the CDC provides to state and local health departments, although those agencies also are being directed to make targeting people already infected with AIDS their top priority.

Many advocates suspect the new initiative is motivated as much by politics as by science. Gerberding's April announcement came without any input from long-established AIDS advocates and on the heels of the CDC's audit of Stop AIDS, a San Francisco prevention program that has run workshops congressional conservatives deemed obscene.

"The conservatives, for a very long time, have worried that this kind of money for education and prevention efforts was just community development money for homosexuals and drug users," said Steven Tierney, director of HIV Prevention for the San Francisco Health Department.

Janssen rejected the idea that the shift was political.

"All of the recommendations in the initiative we have been talking about for a number of years," he said. "This all started in the Clinton administration."

Still, David Holtgrave, a predecessor of Janssen's at the CDC and now a professor of public health at Emory University in Atlanta, said "it's fair" for advocates to be concerned about cuts in HIV-prevention programs that have been shown to be effective.

The Congressional Black Caucus, House Minority Leader Nancy Pelosi and other lawmakers are urging the Bush administration to reconsider the changes.

"This is like we just threw public health out the window," said Donna Christensen, the Virgin Islands' nonvoting delegate to the House, and the first female doctor to serve in Congress.

By DANIEL YEE, Associated Press Writer

ATLANTA - The government is unveiling a new surveillance system to better track HIV infections, scrapping an existing method that doesn't indicate how recently patients were infected.

The new system no longer relies on AIDS cases data submitted by state health departments — half of which don't report those cases because of privacy laws — but on anonymous data from 35 sites around the country to create a nationally representative snapshot of new infections by the virus, researchers at the Centers for Disease Control and Prevention said.

Federal health officials also will now use two antibody tests that indicate whether a patient had been infected in the last six months. With some HIV-infected people living for more than a decade without developing AIDS, the old method did not reflect recent HIV infection trends.

"The new system applies this technology and allows us to distinguish a new infection from an old infection," said Dr. Ronald Valdiserri, deputy director of the CDC's National Center for HIV, STD and TB Prevention. "It gets at the question everyone wants answered, which is how many new cases of HIV are occurring."

The new reporting system will provide statistics from areas that represent 93 percent of the country's HIV population, according to Dr. Robert Janssen, director of the CDC's HIV and AIDS Prevention division. To help collect the data, the CDC will send a total of $13 million to states participating in the program.

The CDC planned to announce the system Sunday during the first day of the agency's National HIV Prevention Conference in Atlanta.

CDC officials say the new set of antibody tests is about 95 percent accurate.

"It relies on the fact human beings go through a fairly predictable process of antibody development" after infection by the HIV virus, Valdiserri said. "Early on in the infection, you don't have too many antibodies to HIV. Over time, the longer you're infected, the more antibodies you're able to produce."

By knowing where recent HIV infections are, health officials can shift resources to tackle the new cases. The government has been trying to cut new HIV cases — currently about 40,000 a year — in half.

Advocacy groups have expressed concern over how the data will be recorded and whether infected people will retain their anonymity.

"No doubt it will provide a more accurate picture of the epidemic but it's coming full-scale against the debate over how to best do it and protect" the privacy of patients, said David Harvey of the AIDS Alliance for Children, Youth and Families in Washington.

The new system also comes amid debate between the CDC and advocacy groups over how money is spent for HIV prevention efforts.

The CDC has announced new guidelines that shift HIV prevention efforts from community projects aimed at educating the general public to focusing on people who can spread the disease.

Harvey said some advocates are concerned that the CDC policy could stigmatize people who are already infected and overlook some people who are at risk.