The number of new HIV infections in four south Indian states home to most of India's 5.1 million people with the virus, has fallen by more than a third, rare good news in the fight against AIDS, a study reported.

India has the world's second-highest number of people living with HIV/AIDS -- after South Africa -- but a study in the medical journal, The Lancet, said active surveillance and robust peer intervention among high risk groups such as female sex workers had had an impact in the south.

The Indo-Canadian study carried out by the University of Toronto and an Indian research institute reported HIV prevalence among women aged 15 to 24 years in the states of Tamil Nadu, Maharashtra, Karnataka and Andhra Pradesh had fallen from 1.7 percent to 1.1 percent in a four-year period.

New infections fell by 35 percent between 2000 and 2004. The four states account for 75 percent of people living with HIV in India.

"We are seeing a decline and it's real," Dr. Prabhat Jha of the Center for Global Health Research at the University of Toronto, said at a news conference.

The team said new infections among men visiting STI clinics in the four southern states -- which are home to 30 percent of India's billion-plus population -- fell 36 percent.

India has been pushing condom use as key to its anti-AIDS strategy, along with loyalty to one's spouse.

The study said the fall in new infections was seen across the rural-urban divide as well as among the literate and illiterate.

Dr. Rajesh Kumar, the main author of the study, said the study ruled out mortality as a reason for the fall in new infections as the number of deaths seen in the HIV prevalence data had decreased in the four-year period.

Last year, India's health ministry said new HIV infections had plunged to 28,000 in 2004 from 520,000 in 2003, sparking disbelief among health experts, including UNAIDS, the global body's AIDS agency, which said India's count could be unreliable.

But the study in the Lancet warned that gaps remained in HIV surveillance in north India, home to populous states like Uttar Pradesh and impoverished Bihar with a combined population of around 250 million.

"The northern states are much more of a challenge as there are fewer HIV surveillance sites," Jha said.

Former U.S. President Bill Clinton called on Tuesday for mandatory testing for HIV/AIDS in countries with high infection rates and the means to provide lifesaving drugs.

When the AIDS epidemic began two decades ago mandatory testing was frowned upon because of the stigma attached to the illness and the lack of treatment for people with the deadly virus.

But Clinton said countries where there is no discrimination against people with the illness and anti-AIDS drugs are available should consider universal testing.

"I think there needs to be a total rethinking of this testing position in the AIDS community and a real push for this," Clinton told journalists during a briefing in London.

More than 40 million people worldwide are estimated to be living with HIV/AIDS but a large number of them do not know they are infected.

"Now we can save people's lives and we can reduce the stigma. There is no way we are going to reduce the spread of this epidemic without more testing because 90 percent of the people who are HIV positive don't know it," he added.

LESOTHO TEST CASE

Clinton, whose foundation has been working to bring quality medical care and cheaper drugs to HIV/AIDS sufferers in poor countries, said this year Lesotho in southern Africa will become the first country to do universal HIV/AIDS testing.

He regards it as a test case to see if rapid tests which will cost between 49-65 cents each and drugs can reduce the 27 percent infection rate in the country. A budget of $100 million could cover the cost of 200 million tests.

"The whole idea is to treat this as a public health problem, not as some source of shame or disgrace and to keep as many people alive as possible," he explained.

The first aim is the stop infections and the second is to save the lives of those who are infected.

"I would be for whatever accomplishes those objectives."

He added the question was not whether a country was rich or poor but its infection rate. When the level of infection reaches a critical point, Clinton said, it imperils the entire public health structure of the country and its social stability.

It also makes if more difficult to bring rates down.

Since leaving the White House Clinton has devoted much of his attention to get anti-AIDS drugs to poor countries at the cheapest possible prices through the Clinton Foundation HIV/AIDS Initiative (CHAI).

It is working with 22 countries in Africa, the Caribbean and Asia to provide anti-AIDS drugs to more than a quarter of a million patients through special drug deals.

"I made up my mind that I would not spend the rest of my life wishing I was still president," he said when asked about his post-presidency projects.

"Once you let it go, you have got to let it go."

Nearly 2,000 babies are born with HIV each day because their virus-infected mothers do not get the treatment needed to stop transmission, the World Health Organization (WHO) said on Tuesday.

The WHO said fewer than 10 percent of HIV-positive women in developing countries got antiretroviral therapy during pregnancy and childbirth between 2003 and 2005, despite a tripling of overall access to the drugs in that period.

"Each year, over 570,000 children under the age of 15 die of AIDS, most having acquired HIV from their mothers," the U.N. health agency said in a report showing it missed its "3 by 5" goal of getting 3 million people on antiretrovirals by 2005.

By the end of last year, only 1.3 million poor people infected with the lethal virus were taking the life-saving drugs -- less than half the number targeted by the WHO two years ago and just one-fifth of the 6.5 million people needing treatment.

Some 660,000 children -- mostly in sub-Saharan Africa, the region most affected by HIV and AIDS -- were in immediate need of antiretroviral therapy in 2005, said the report, released jointly with sister U.N. agency UNAIDS.

Kevin de Cock, WHO director for HIV/AIDS, said children account for 15 percent of global AIDS deaths, but make up only about 5 percent of those receiving treatment.

Frail health systems in impoverished regions were partly to blame for the missed "3 by 5" target, he said.

FORMIDABLE OBSTACLES

"Sub-Saharan Africa is short at least 1 million health care workers, and this is probably one of the most formidable obstacles for the future," he told reporters, adding hospitals, labs and other infrastructure were also lacking.

Other factors in the way of the 3 million-person treatment goal included weak partnerships among aid providers, inadequate drug supplies and a funding shortfall, the report said.

Worldwide AIDS expenditures nearly doubled to $8.3 billion between 2003 and 2005, with most funds coming from the U.S. President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Bank.

Still, UNAIDS estimates there remains a $18 billion gap between available and needed funds for the 2005 to 2007 period.

By 2008, it said at least $22 billion per year -- nearly three times the current funding level -- will be required to pay for national HIV prevention, treatment and care programs.

If financing levels aren't increased dramatically, UNAIDS said antiretroviral treatment would likely remained limited for vulnerable groups like pregnant women and children.

About 50,000 new people began antiretroviral therapy each month in the past year, the report said, estimating that 250,000 to 350,000 premature deaths have been averted in developing countries as a result of expanded treatment access.

The price of first-line treatment meanwhile fell by between 37 percent and 53 percent depending on the drug regimen used, making an extension of services more feasible, the report said.

UN health agencies admitted that they had widely missed their goal of getting AIDS drugs to three million poor people by the end of this year but insisted the initiative had succeeded in many other ways.

By December 31, more than 1.3 million people in low- and middle-income countries had access to antiretroviral therapy, the World Health Organisation (WHO) and UNAIDS said in their final scorecard on the "Three by Five" scheme.

The two agencies had aimed to reach three million out of the 6.5 million infected poor people who need the drugs.

Despite this setback and the many problems that persist, the initiative had transformed the war against AIDS, WHO and UNAIDS said.

It had tripled the number of poor people on antiretrovirals, saved hundreds of thousands of lives and laid down the foundations for saving many more in years to come.

It had catapulted AIDS to the top of the political agenda and shown that poor countries could, like rich countries, change HIV from a death sentence into a manageable disease.

The next step is universal access to HIV treatment by 2010, WHO and UNAIDS said.

"Two years ago, political support and resources for the rapid scale-up of HIV treatment were very limited," said WHO Director General Lee Jong-Wook.

"Today, Three by Five has helped to mobilise political and financial commitment to achieving much broader access to treatment. This fundamental change in expectations is transforming our hopes of tackling not just HIV/AIDS, but other diseases as well."

Lee unveiled Three by Five on World AIDS Day on December 1 2003, when only 400,000 people in the developing world had access to the drugs which hold the human immunodeficiency virus (HIV) in check.

AIDS campaigns in these countries had focussed almost exclusively on preventing infection because treatment of those already infected costs thousands of dollars a year per person, and was way out of reach.

Three by Five called on governments to draw up national plans backed by targets to monitor performance. This was coupled to technical support from the WHO and arm-twisting of politicians, donors and the pharmaceutical industry.

"When we launched this, most people thought this was suicidal or lunacy, so we've gone from lunacy to global policy in two years," said Charles Gilks, director and coordinator of treatment and prevention scale-up at the WHO, in an interview with AFP.

"We've slipped on the (target) numbers, that was always a bit ambitious. But in so many other ways, we've set the scene for success. Care and treatment are now an integral part of the national response to HIV -- anywhere, not just in the rich north."

With Big Pharma facing a clamour to slash its prices -- and generic manufacturers also pushing at the door -- the cost of firstline drugs sold to poor countries has fallen by a third or a half over the past two years.

Funding rose from 4.7 billion dollars to 8.3 billion and universal access to treatment was endorsed by the G8 and the UN General Assembly.

Kevin De Cock, the director of the WHO's HIV/AIDS Department, recalled those who, "six or seven years ago," derided notions of distributing AIDS drugs in Africa.

The daily pill-taking regimen is complex and demanding and the drugs can have toxic side effects or meet viral resistance.

In rich countries, the patient's doctor is backed by a laboratory to monitor HIV and immune cell counts, thus enabling him to alter the drug mix as needed.

To help overcome this cost, experts have devised simplified treatment for poor countries, enrolling health workers to monitor the patient.

Despite this achievement, Three by Five failed to make the hoped-for breakthrough in Africa, home to two-thirds of the 40.3 million people living with HIV or AIDS.

More than 800,000 Africans today have access to the drugs, up from 100,000 in 2003. But 200,000 of these live in South Africa, the continent's wealthiest country. Overall coverage is only 17 percent, meaning that five out of every six Africans who need antiretrovirals still do not get them.

De Cock underlined the lack of adequate hospitals and laboratories.

"A major barrier of huge importance for the future is the weakness of health systems in poor countries," he told journalists.

Sub-Saharan Africa is also short of some one million health workers, according to the WHO.

"This is probably one of the most fundamental obstacles for the future," De Cock added.

The report also pointed the finger at developing countries' bureaucracy, delays in disbursing funds and lack of capable administrators.

It pointed to a looming controversy over the pricing for second-line drugs and sternly warned that funding for AIDS should remain at high levels for a long time to come.

By 2008, at least 22 billion dollars per year, from all sources, will be needed to fund comprehensive national HIV prevention and treatment programmes, it said.