Only 10 percent of countries have HIV prevention programmes that are well matched to their national needs, leaving millions at risk of contracting the incurable virus, AIDS scientists said on Tuesday.

The Global HIV Prevention Working Group, an international panel of 50 leading AIDS experts, said many effective HIV prevention steps are not having anything like the impact they could because they are often not available to those at the greatest risk of infection.

In a “report card” published at an international AIDS conference in Vienna on national efforts to try to prevent new infections with the human immunodeficiency virus that causes AIDS, the group found most regions could do a lot better.

“On average the grades that were assigned by the working group ranged from average to poor, with some failing grades for some of the key indicators,” Helene Gayle, co-chair of the Working Group and chief executive of CARE USA, told reporters.

“Our overall finding is not that prevention is failing, but that we are failing prevention.”

The AIDS virus infects 33.4 million people around the world and has killed 25 million since the pandemic began in the 1980s. There is no cure and no vaccine but drugs can keep patients healthy. Without treatment, the virus destroys the immune system, leaving patients susceptible to infections and cancer.

Scientists and AIDS experts repeatedly say that the world cannot “treat its way out” of the AIDS epidemic.

High-profile speakers at the conference, including Bill Clinton and Bill Gates, have stressed the need to scale up prevention steps like male circumcision, male and female condom use, and clean needles or drug substitutes for drug users.

The working group graded the efforts of various sectors - including national government, international donors, and global health agencies - and said none had earned good grades.

It found that only half of countries have established national targets for HIV prevention, and that prevention programmes are rarely properly monitored.

In areas with highly concentrated epidemics, such as Eastern Europe and Central Asia where HIV is spreading faster than anywhere else in the world, less than 5 percent of prevention spending is targeted at drug users and less than 3 percent at gay men, it said.

Rates of HIV spread in Eastern Europe and Central Asia mean about 500 people a day there are newly infected with the virus, and the epidemic is being driven by risky behaviour among injecting drug users, sex workers, gay men and other marginalised groups. Drug users can spread HIV by sharing needles with an infected person.

In countries with more population wide epidemics, for example those in sub-Saharan Africa, only 45 percent of HIV infected pregnant women currently get the AIDS drugs they need to stop them passing the virus on to their babies.

Judith Auerbach, a member of the working group and of the the San Francisco AIDS Foundation, said national government and international donors should “take immediate steps to refocus HIV prevention programmes on populations at the highest risk”.

The experts also called for more funding. They estimate that no more than $2.9 billion was available for HIV prevention in 2009 - 21 percent of total spending on the epidemic, and less than a third of the amount UNAIDS says is needed to mount a “vigorous, effective prevention response”.

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By Kate Kelland

VIENNA (Reuters)