China is emerging from the shadows of the AIDS pandemic by improving its accounting of the number of cases within the country, the UN agency spearheading the fight against the disease said.

An estimated 650,000 people in China had the HIV virus at the end of 2005, while 31,000 deaths due to AIDS have been recorded since the disease was first discovered there, UNAIDS said in its biennial snapshot of the global pandemic.

Critics had feared the world's most populous nation could be a black hole in the global prevention and treatment effort, accusing authorities there of failing to acknowledge a spiralling epidemic driven by illicit drug use.

"Not only is more data available, but the analysis of that data has also improved and has allowed us to come to an estimate that we are quite comfortable with," said Peter Ghys, manager of epidemic and impact monitoring at UNAIDS.

The UNAIDS report said 45 percent of injecting drug users were being targeted by prevention programmes in China, and 25 percent of sex workers, highlighting the focus of official concern in the country.

Just eight percent of male heterosexuals were being reached by prevention programmes in 2005.

The official HIV prevalence rate of 0.1 percent in China compares with a rate of 0.9 percent in India -- the second-most populous nation -- where the epidemic is largely fuelled by unprotected heterosexual sex, according to the report.

UNAIDS has reduced its estimate of HIV patients in China down to a range of between 390,000 and 1.1 million people. In its previous report two years ago the equivalent range was 430,000 to as many as 1.5 million people.

But after refining its previous data as well, the report concluded that the prevalence rate was rising in China, as well as in neighbouring Vietnam.

A quarter of those ill in China were receiving life-saving antiretroviral drugs -- above the Asian average of 16 percent, the report found.

"The overlapping risks of injecting drug use and unprotected sex feature in several other epidemics in Asia", the report noted, citing Vietnam.

HIV has now spread into all 59 Vietnamese provinces and all cities. HIV infections have doubled there in five years to affect 260,000 Vietnamese, the report said. About 40,000 people are being infected every year.

But UNAIDS also gave signs of progress in southeast Asia.

Thailand, once a focus of concern as the epidemic spiralled there in the 1990s mainly due to prostitution, now has an HIV prevalence rate of 1.6 percent, one-third lower than in the previous decade.

Prevention efforts have borne fruit in Thailand as fewer men bought sex and condom use increased.

However, the 580,000 people with HIV in Thailand include some 16,000 children, according to UNAIDS.

And recent studies there have highlighted a growing number of HIV infections among women infected by their long-term partners -- one-third in 2005.

When HIV first escalated in Africa and the Caribbean, Asia remained virtually untouched and unaware. But the world's most populous continent is catching up.

Today, 25 years into an epidemic that has claimed 25 million lives worldwide, the Asia-Pacific region has the highest number of infections after sub-Saharan Africa.

The big question now is: How far will it go?

"I don't think it will go the African way," where in some areas up to a third of the population is infected, UNAIDS chief Dr. Peter Piot said in an interview with The Associated Press. But "there's slow but steady growth and with that kind of population denominator, the numbers are staggering,"

UNAIDS, the U.N. body leading the global war on AIDS, estimated 8.3 million people were living with the virus last year in the Asia-Pacific — and nearly 85 percent of those infected had no access to antiretroviral treatment.

The disease, first identified in the United States in an announcement by health officials on June 5, 1981, quickly went global. In Asia, a vast, diverse and mobile population has helped spread the virus, starting with unprotected sex and dirty needles. It first devastated Thailand's infamous sex industry, later reached millions in India and has pushed once-isolated communist Vietnam to the brink of an HIV explosion.

India is home to more HIV/AIDS-infected people than any other country, according to new UNAIDS numbers. Its estimated 5.7 million infections last year comprise more than two-thirds of all cases in the Asia-Pacific region.

In a country of more than 1 billion people, that number shrinks to a small fraction — 0.9 percent of adults compared to South Africa's almost 19 percent. But a small percentage can cause the problem to be neglected.

"Because of this low percentage, the issue doesn't seem to be a priority for political leaders and also for the man on the street," said Dr. Shigeru Omi, the Western Pacific regional director for the U.N.'s World Health Organization.

India's epidemic is largely driven by heterosexual sex — mainly prostitutes and their clients who do not use condoms. In the country's south, a recent report found, prevention campaigns targeting sex workers have resulted in a 35 percent drop in new cases among 15 to 24 year olds.

But there has been little progress in India's highly populated north or drug-ridden northeast, said Prabhat Jha, of the University of Toronto, one of the study's authors.

"It's too early and one wouldn't want to be the fellow on the Titanic who said, 'All clear,' because the north is 70 percent of the population," said Jha, who's spent a decade researching AIDS in India. "If it explodes, you can imagine what would happen."

Chandi Sayeed, 39, of Bombay's gritty brothel district, said she was sold into prostitution at age 16 when she was already a mother of two.

"The problem is most women don't use condoms with their husbands or with customers they love," she said. "They only use it with men who aren't regulars. They say, how can we use it with our lovers? But women must think of their children and their family first."

Another trouble spot is Papua New Guinea, which shares an island north of Australia with Indonesia's easternmost Papua province.

The country of 5.7 million is plagued by political instability, poverty and rampant sexual violence against women. It has the Asia-Pacific's highest adult per capita infection rate of 1.8 percent, but the political will to tackle the problem is absent.

"Papua New Guinea is a very, very, very serious situation," Omi said. It "needs some special attention, otherwise there's a possibility that Papua New Guinea will become like Africa in the future."

In China, the AIDS picture is still a bit unclear. But its sheer size — some 1.3 billion people — is enough to worry experts.

In January, China and the United Nations lowered HIV/AIDS estimates there, saying roughly 650,000 people were infected in 2005 — nearly 200,000 fewer than an earlier projection.

Injecting drug users accounted for nearly half the infections in China, where the government was accused of being slow to address the problem. HIV took off in China in the early 1990s when farmers began selling blood plasma to earn extra money.

AIDS activists and people infected with the virus have been harassed, but top leaders have finally admitted publicly that a problem exists.

In late 2004, President Hu Jintao was photographed shaking hands with HIV-infected Zhang Hulin. It was a major step for the communist government, but Zhang says he and his family suffered even greater stigma and discrimination after the photos circulated.

Still, he remains hopeful a cure will be found.

"It's one of these diseases that the whole world is concerned with and doing research on," said Zhang, who tested HIV-positive in 1997. "So maybe it can be eradicated, but it's hard to say."

In Vietnam, the bulk of infections are among prostitutes and injecting drug users. But the virus has spread to all provinces and cities, and the country is at a very critical moment, Omi said.

With prevention campaigns, "they may be able to avert transmission into the community. But if they fail, they may end up having widespread transmission among the general public," he said.

Vietnam is the only Asian nation among 15 countries selected to receive emergency HIV/AIDS funding under a $15 billion Washington plan.

Thailand and Cambodia, in contrast, have been hailed as two bright spots in Asia. Both still have adult per capita infection rates over 1.4 percent, but the governments have largely reversed once-devastating epidemics by promoting 100 percent condom use among prostitutes working in brothels.

But both countries must refocus and refresh their prevention campaigns, said Jeanine Bardon, regional director of U.S.-based Family Health International.

Trends have shifted and HIV has latched on to new risk groups, including men who have sex with men; young people with multiple sex partners; injecting drug users; and monogamous women whose husbands have sex outside marriage.

"It's not just sex workers and their clients. It's much more complicated now," she said. "The new infections are now occurring between the men who got infected (by prostitutes) in the '90s and their wives."

Children are among the most tragic AIDS victims. There were an estimated 1.5 million children orphaned by AIDS in the Asia-Pacific, with more than 120,000 of them infected in 2004, UNAIDS estimated.

Often, they are unwanted, said Joseph Maier, a Catholic priest who runs Mercy Center orphanage, school and hospice in a Bangkok slum.

"Nobody's talking about, 'Come on, why don't we adopt some of these kids?" Nobody's talking about, 'Hey, these kids are bright, they're geniuses, there's poets among them,'" said Maier, known to everyone as Father Joe.

Thailand has made cheap antiretroviral drugs easily available, which has increased life spans but not reduced the stigma and discrimination.

"We walk around to all the schools in this area here and say we've got some kids with HIV/AIDS, we want you to take them in," Maier said. "They wouldn't let them in."

If more isn't done to combat HIV/AIDS now, Asia could surpass Africa — where 25.8 million are now infected — in the number of people living with the virus, said Bardon. The tragedy would be all the greater because today people know how to prevent it.

"We'll have lost an enormous opportunity to avert thousands of infections and eventually millions of lives saved," she said. "It's not that we don't know what we're doing."

A U.N. meeting on global AIDS strategy endorsed on Friday a goal of doubling funding to fight the epidemic, but fell short of concrete commitments and shied away from frank language on sex.

"More people need to know how AIDS is transmitted - and every country has an obligation to educate its citizens," first lady Laura Bush told the third and final day of the global AIDS conference that is setting guidelines for the next decade to help the 40 million people now infected.

Some 25 million people have died of the disease since 1981 and it is the leading cause of death among African between 15 to 29 years.

Friday's session of the conference brought together heads of state and other ministers in delegations from 151 countries.

Bush as well as U.N. Secretary-General Kofi Annan struck at a squeamishness about sex that dominates diplomatic gatherings and many governments and has caused dismay among the more than 1,000 activists participating in the gathering.

But British international development secretary, Hilary Benn, put the case more bluntly than any one else. "Abstinence is fine for those who are able to abstain, but human beings like to have sex and they should not die because they do have sex," he said.

The hotly fought-over final declaration, completed early on Friday after all-night talks, includes more-detailed language on prevention and the need for condoms.

It has stronger language on women and girls than a declaration in 2001. But its section on empowering girls under 18, many in forced marriages, to decide over their sexuality was weaker than U.N. officials had wanted.

"Commitment to women's rights have become a subject of controversy, rather than being recognized as a critical component of a pandemic that is increasingly becoming a women's issue," said Aditi Sharma of India from the South African-based ActionAid International.

While the declaration is nonbinding, it serves as a guideline for many governments and activists and spurs private groups and business into action.

The document says $23 billion will be needed annually by 2010 to fight AIDS, more than double the $8.3 billion currently spent. Nations pledged they would try to ensure additional resources would be available to ensure universal access to treatment by 2010.

But unlike the 2001 declaration, concrete commitments and timetables for funding and programs were not included. The United States and others have objected to international financial goals, although Washington is by far the largest single contributor to prevention and treatment.

The document contains strong language on the necessity of including "vulnerable groups" in all prevention and AIDS plans -- a reference to homosexuals, prostitutes and drugs addicts using dirty needles.

But as in 2001, diplomats, especially from conservative Latin American countries and Islamic ones, still refused to mention who is "vulnerable." In nearly every country in the world, AIDS untreated among these groups rapidly spreads to the general population.

"Leadership means finding ways to reach out to all groups -- whether young people, sex workers, injecting drug users or men who have sex with men," Annan said.

U.N. experts say the epidemic has peaked but the number of people living with HIV continues to rise, even if more slowly than before. Most Africans, some two-thirds of the 40 million infected with HIV, the virus that can lead to AIDS, die within 10 years due to lack of testing, treatment, and weak immune systems in communities where people lack food.

El Salvador's President Tony Saca told reporters Latin America nations seem to have been forgotten, despite rising rates of the disease in Central America. "We're not Africa in this respect, but we could be," he said.

The incidence of new HIV infections appears to have stabilized for the first time in the 25-year history of AIDS, although the global pandemic will still have a deep, long-term impact, a new UN report said.

While the world is at last making progress against the disease, thanks to a massive increase in spending, better access to drugs and growing awareness, huge problems remain, the UN agency coordinating the fight against HIV/AIDS warned.

"New data shows that the AIDS epidemic is slowing down globally," said executive director of UNAIDS Peter Piot at the launch of the Global AIDS report.

"We've seen important progress made by countries over the past five years that increased funding, with a decrease in the number of new infections, particularly among young people," Piot said at the UN headquarters in New York.

But he added that there was also bad news, highlighting the lack of progress in some countries, particularly South Africa, and the increase in the number of women getting infected.

"We are at the crossroads in this epidemic," he said.

In its report, issued on the eve of a UN General Assembly session on the disease, UNAIDS underlined the dangers caused by prevention programmes which it said in many countries were still far off-target and inaccessible to millions of people.

"Overall, the HIV incidence rate (the proportion of people who have become infected with HIV) is believed to have peaked in the late 1990s and to have stabilized subsequently, notwithstanding increasing incidence in several countries," UNAIDS said in the latest "Report on the Global AIDS Epidemic."

However, the agency warned that there was no room for complacency.

"We know what needs to be done to stop AIDS. What we need now is the will to get it done," the report said.

AIDS has killed more than 25 million people since it was first recognized in 1981, UNAIDS said, while the HIV virus which precedes the disease infected 65 million people over the same period.

Last year AIDS claimed the lives of 2.8 million people and over 4.1 million were newly infected with HIV, according to the report.

In 2003, the UN estimated that 4.8 million were newly infected with HIV.

An estimated 38.6 million people were living with HIV at the end of 2005, the vast majority of whom were unaware that they were infected, it added.

The UNAIDS report is based on detailed country-by-country estimates that the Geneva-based agency carries out only once every two years.

It pointed to "important progress" over the past five years, in the wake of a landmark 2001 UN summit which laid down targets for halting and starting to reverse the AIDS epidemic by 2015.

However, there is still "extraordinary diversity" in the epidemic, with a mixture of success and failure, it said. The disease is also predominantly spread by heterosexual sex.

Sub-Saharan Africa remains by far the worst-affected region, being home to two-thirds of all people living with HIV.

Two million people died of AIDS in the region last year and there were 2.7 million new infections.

While the epidemic in South Africa -- one of the worst in the world -- showed no evidence of a decline, other African countries nonetheless made major progress.

HIV prevalence fell in Kenya and Zimbabwe, as well as in urban areas of Burkina Faso.

"In the rest of sub-Saharan African, the majority of epidemics appear to be levelling off," said UNAIDS.

Elsewhere, there were declines in Cambodia and Thailand, but prevalence rose in China, Indonesia and Vietnam.

India overtook South Africa as the world's worst-affected country in terms of the absolute number of people with HIV, although not as a proportion of the population.

Epidemics in the former Soviet Union also spiralled.

Global resources for the fight against AIDS last year reached 8.3 billion dollars -- well within the range fixed by the UN summit in 2001. But annual needs are set to reach 22 billion dollars by 2008, UNAIDS said.

Access to antiretroviral drugs in developing nations has improved, it said. Some 1.3 million were receiving them in 2005 -- up from 240,000 people in 2001, although the figure was still less than half the goal of three million set by the UN.

In a grimmer assessment, UNAIDS said that less than one in five people in the world who risked HIV infection had access to basic prevention such as condoms and other safe sex measures, or programmes specifically aimed at helping drug users or prostitutes.

In addition, only one in eight people worldwide who want to be tested for HIV are currently able to be so.

Scaling up prevention and treatment could avert 29 million new infections by 2020, UNAIDS said.

It began quietly, when a statistical anomaly pointed to a mysterious syndrome that attacked the immune systems of gay men in California. No one imagined 25 years ago that AIDS would become the deadliest epidemic in history. Since June 5, 1981, HIV, the virus that causes AIDS, has killed more than 25 million people, infected 40 million others and left a legacy of unspeakable loss, hardship, fear and despair.

Its spread was hastened by ignorance, prejudice, denial and the freedoms of the sexual revolution. Along the way from oddity to pandemic, AIDS changed they way people live and love.

Slowed but unchecked, the epidemic's relentless march has established footholds in the world's most populous countries. Advances in medicine and prevention that have made the disease manageable in the developed world haven't reach the rest.

In the worst case, sub-Saharan Africa, it has been devastating. And the next 25 years of AIDS promise to be deadlier than the first.

AIDS could kill 31 million people in India and 18 million in China by 2025, according to projections by U.N. population researchers. By then in Africa, where AIDS likely began and where the virus has wrought the most devastation, researchers said the toll could reach 100 million.

"It is the worst and deadliest epidemic that humankind has ever experienced," Mark Stirling, the director of East and Southern Africa for UNAIDS, said in an interview.

More effective medicines, better access to treatment and improved prevention in the last few years have started to lower the grim projections. But even if new infections stopped immediately, additional African deaths alone would exceed 40 million, Stirling said.

"We will be grappling with AIDS for the next 10, 20, 30, 50 years," he said.

Efforts to find an effective vaccine have failed dismally, so far. The International AIDS Vaccine Initiative says 30 are being tested in small-scale trials. More money and more efforts are being poured into prevention campaigns but the efforts are uneven. Success varies widely from region to region, country to country.

Still, science offers some promise. In highly developed countries, cocktails of powerful antiretroviral drugs have largely altered the AIDS prognosis from certain death to a manageable chronic illness.

There is great hope that current AIDS drugs might prevent high-risk people from becoming infected. One of these, tenofovir, is being tested in several countries. Plans are to test it as well with a second drug, emtricitabine or FTC.

But nothing can be stated with certainty until clinical trials are complete, said Anthony Fauci, a leading AIDS researcher and infectious diseases chief at the U.S. National Institutes of Health.

And then there is the risk that treatment will create a resistant strain or, as some critics claim, cause people to lower their guard and have more unprotected sex.

Medicine offers less hope in the developing world where most victims are desperately poor with little or no access to the medical care needed to administer and monitor AIDS drugs. Globally, just 1 in 5 HIV patients get the drugs they need, according to a recent report by UNAIDS, the body leading the worldwide battle against the disease.

Stirling said that despite the advances, the toll over the next 25 years will go far beyond the 34 million thought to have died from the Black Death in 14th century Europe or the 20 to 40 million who perished in the 1918 Spanish flu epidemic.

Almost two-thirds of those infected with HIV live in sub-Saharan Africa where poverty, ignorance and negligent political leadership extended the epidemic's reach and hindered efforts to contain it. In South Africa, the president once questioned the link between HIV and AIDS and the health minister urged use of garlic and the African potato to fight AIDS, instead of effective treatments.

AIDS is the leading cause of death in Africa, which has accounted for nearly half of all global AIDS deaths. The epidemic is still growing and its peak could be a decade or more away.

In at least seven countries, the U.N. estimates that AIDS has reduced life expectancy to 40 years or less. In Botswana, which has the world's highest infection rate, a child born today can expect to live less than 30 years.

"Particularly in southern Africa, we may have to apply a new notion, and that is of `underdeveloping' nations. These are nations which, because of the AIDS epidemic, are going backwards," Peter Piot, the director of UNAIDS, said in a speech in Washington in March.

Later, at a meeting in Abuja, Nigeria, last month, Piot cited encouraging news including a sharp fall in new infections in some African countries. There also has been an eightfold increase in the number of Africans benefiting from antiretroviral treatment, he said.

But, he warned, "the crisis of AIDS continues and is getting worse and any slackening of our efforts would jeopardize the hard-won gains of each and every one of us."

Besides the personal suffering of the infected and their families, the epidemic already has had devastating consequences for African education systems, industry, agriculture and economies in general. The impact is magnified because AIDS weakens and kills many young adults, people in their most productive years.

So many farmers and farmworkers have died of AIDS that the U.N. has invented the term "new variant famine." It means that because of AIDS, the continent will experience persistent famine for generations instead of the usual cycles of hunger tied to variable weather.

Africa's misery hangs like a sword over Asia, Eastern Europe and the Caribbean.

Researchers don't expect the infection rates to rival those in Africa. But Asia's population is so big that even low infection rates could easily translate into tens of millions of deaths.

Although fewer than 1 percent of its people are infected, India has topped South Africa as the country with the most infections, 5.7 million to 5.5 million, according to UNAIDS.

The astonishing numbers have grown from a humble beginning.

Nobody knows for sure when or where, but the AIDS epidemic is thought to have begun in the primeval forests of West Africa when a virus lurking in the blood of a monkey or a chimpanzee made the leap from one species to another, infecting a hunter.

Researchers have found HIV in a blood sample collected in 1959 from a man in Kinshasa, Congo. Genetic analysis of his blood suggested the HIV infection stemmed from a single virus in the late 1940s or early 1950s.

For decades at least, the early human infections went unnoticed on a continent where life routinely is harsh, short and cheap.

Then, on June 5, 1981, the Centers for Disease Control in Atlanta reported five young actively homosexual men in Los Angeles had a new, mysterious and as yet unnamed illness that attacked the immune system and caused a type of pneumonia. A month later, it reported an odd surge among homosexual men in the number of cases of Karposi Sarcoma, a rare cancer now linked to AIDS.

In the early days of the epidemic, just the mention of AIDS elicited snickers and jokes. Few saw it as a major threat. It was the "Gay Plague," and for some, divine retribution for a lifestyle Christian fundamentalists and other conservatives consider deviant and sinful.

When heterosexuals began to contract the disease through blood transfusions and other medical procedures, they were often portrayed as "innocent" victims of a disease spread by the immoral and licentious behavior of others.

The initial reactions and prejudices associated with AIDS slowed the early response to the epidemic and limited the funding. Too much time, money and effort was spent on the wrong priorities, Stirling aid.

"Over the last 25 years, the one real weakness was the search for the magic bullet. There is no quick and simple fix," he said. "But with the recent successes we are starting to see the end of epidemic."

"There is evidence to suggest we are at the tipping point," said Stirling.

The pace of change over the last couple of years suggests the number of new infections can be reduced by 50 to 60 percent by 2020 — if the momentum continues.

"It is surely possible, it is doable," Stirling said.

Twenty-five years after AIDS was first recognized, the world is in better shape than ever to put an end to the disease but is falling short on many fronts, the United Nations said on Tuesday.

"Despite some notable achievements, the response to the AIDS epidemic to date has been nowhere near adequate," reported UNAIDS, the U.N. agency that coordinates the global campaign against the devastating disease.

In the years since U.S. doctors first described it in June 1981, AIDS and the HIV virus that causes it have "spread relentlessly from a few widely scattered hot spots to virtually every country in the world, infecting 65 million people and killing 25 million," UNAIDS said in its 10th annual progress report.

Researchers have produced "mountains of evidence about how to prevent and treat this disease," said the report, based on data gathered by the U.N. system from 126 countries since December 2005.

But anti-AIDS initiatives and their results vary widely from country to country, and many are falling short of the benchmarks they set for themselves in a landmark special session of the U.N. General Assembly in 2001, UNAIDS said.

"Because this pandemic and its toll cannot be reversed in the short term, we need to sustain a full-scale response for the next decades," it said on the eve of a follow-up session opening on Wednesday in New York.

Among successes since the last special session, the report cited evidence of significant behavioral changes: More and more people are using condoms, having fewer sex partners and starting to engage in sexual activity later in life.

The global AIDS incidence rate is believed to have peaked in the late 1990s, and about 1.3 million people in the developing world are now on life-extending antiretroviral medicines, which saved about 300,000 lives last year alone.

Blood for use in transfusions is now routinely screened for HIV in most countries.

MORE TESTING AND COUNSELING

Four times as many people are seeking testing and counseling today than five years ago, according to surveys from more than 70 countries. In 58 countries reporting data, 74 percent of primary schools and 81 percent of secondary schools were providing AIDS education, UNAIDS said.

But some 4.1 million people were nonetheless newly infected and 2.8 million died in 2005. There were 4.9 million new infections and 3.1 million deaths in 2004.

Fewer than half of young people were actually knowledgeable about AIDS, and small numbers of individuals injecting illegal drugs or having homosexual sex benefited from any type of preventive services last year, surveys found.

The global supply of condoms was less than 50 percent of what was needed, and antiretroviral drugs, while more widely available, remained costly and hard to get.

Most important, because infected individuals still suffer from ostracism and discrimination, the vast majority of the about 40 million infected people in the world have never been tested for HIV and are unaware of their status, it said.

While $8.9 billion is expected to be available in 2006 to combat AIDS in developing countries, $14.9 billion will be needed, UNAIDS said. By 2008, it predicted, $22.1 billion would be needed, including $11.4 billion for prevention plans alone.

The report called on national and international leaders to transform the global response to AIDS from a crisis-management approach into "a strategic response that recognizes the need for long-term commitment and capacity-building."

It recommended more funding, new safeguards to ensure the money goes to those most in need, and ambitious efforts to end the stigma attached to infected individuals.

The report called for more and better-targeted education and prevention strategies, more treatment opportunities, and more drug research, particularly on drugs for children, whose needs "have been largely left out of the research agenda."

It also advised governments, "where necessary," to consider using emergency mechanisms in international trade law to bring down the cost of patented AIDS medications.

"We know what needs to be done to stop AIDS. What we need now is the will to get it done," the report said.

More than 100,000 New York City residents have HIV, and 20 percent don't know it. Many sicken and die without learning their status.

New York City health officials want to reverse the trend by making it easier for doctors to administer HIV tests and to monitor the care of people who have the virus. But the issue has drawn outrage from AIDS service providers.

The dispute coincides with the 25th anniversary of the AIDS epidemic. On June 5, 1981, federal health authorities found that five gay men in California had contracted a rare kind of pneumonia, the first recognized cases of what later became known as AIDS.

At issue in 2006 in New York is whether it is time to start treating AIDS more like other communicable diseases or whether AIDS still carries so much stigma that issues of privacy and confidentiality must remain paramount.

The changes would abolish a requirement in New York for separate written consent for an HIV test and permit public health authorities to share information about matters such as viral load and drug resistance with an HIV patient's doctor — information which can help doctors treat their patients effectively.

New York City Health Commissioner Dr. Thomas Frieden made his case for the changes at a series of public meetings this spring.

"As long as HIV testing is different from all other testing in the medical care system it's not going to be part of routine medical care," he said at a Harlem Hospital forum.

His audience largely disagreed; it included representatives of civil liberties groups and organizations that serve people with AIDS.

"To imagine that it's just like every other disease — like cancer or diabetes — is false," said Tracy Welsh, executive director of the HIV Law Project. "Getting a positive test result is something that turns somebody's life upside down."

"How will we ensure that those individuals who test positive will not be criminalized in an effort to contain the epidemic?" asked Ofelia Barrios, a staff member with the Harlem Directors Group, a consortium of AIDS services organizations.

Frieden said he was not proposing mandatory HIV testing or breaching confidentiality. But following his plan, he said, could halve the number of people "who find out that they're HIV positive when they're already sick with AIDS."

HIV testing policies differ around the nation. California does not require separate written consent for an HIV test, and the San Francisco Department of Public Health on May 16 amended city policy to eliminate the need for written consent there.

New York's HIV laws were written at a time when there was no effective treatment for AIDS and the disease was associated with a group, gay men, already facing discrimination. People with AIDS feared that if they disclosed their diagnosis they would lose jobs, homes, families.

There is still no cure for AIDS, but antiretroviral medications can make it a manageable condition for many patients — if they learn their HIV status and take the drugs.

State Sen. Tom Duane, the New York State Legislature's only openly HIV-positive member, said Frieden underestimates the persistence of AIDS stigma.

"People do not lose their jobs if their employer finds out that they have high cholesterol," he said. "Dr. Frieden may live in a world where the stigma's less. ... He needs to come visit a trailer park with me, where people with HIV are living, to find out what their lives are like."

Frieden's proposed changes will face an uphill fight in the Legislature, where he expects them to be formally introduced in the next few weeks. Assemblyman Richard Gottfried, chairman of the Health Committee, said he would be surprised if there is action taken on the bill this session.

Assemblywoman Nettie Mayersohn, a veteran of past HIV battles, said, "My point was always, let's treat it as we treat any other disease. When the patient goes into the office for a routine checkup, let HIV be included in the test without any extra forms to fill out, without going through the hassle."

In 1996, Mayersohn authored the Baby AIDS bill, which required that either a pregnant woman get tested or that her baby be tested at birth. Prior to its enactment, newborns in New York were tested for HIV exposure but only for statistical purposes. Their parents were not given the results. Now, HIV-exposed infants are offered medical care.

Many groups opposing Frieden's plan fought the newborn bill, arguing it amounted to an involuntary HIV test on the mother, since a positive result meant that the mother had the virus, too.

Dennis deLeon, the president of the Latino Commission on AIDS, said he regrets his earlier opposition.

"We have to rethink how we approach testing," he said. "There is stigma around TB. There is stigma around gonorrhea. ... The way you address stigma is to make the testing routine and integrate it across the board. I just don't want to make the same mistake again."