Amidst lots of noise in the U.S. about the so-called "End of the AIDS Crisis"--especially amongst gay and bi men chafing after 15 years of fear, funerals, and safer, duller sex--a little-noticed United Nations report this month tells the bigger, far scarier story.

In 1997, nearly 2.5 million people, most in the underdeveloped countries of Africa and Asia, will be infected with the HIV virus. That's up nearly 50 percent from last year. The majority are heterosexuals, almost half are women, a large number are under age 15, and nine out of 10 don't know they have the virus. In the bars of Capitol Hill, talk about AIDS is boring and passe. In much of the rest of the world, it's a Holocaust gathering steam.

As with many other emerging and re-emerging diseases in the third world, there are a number of reasons for the HIV carnage, most of them human-made. Abject poverty, cultural displacement, and urbanization--fueled by cash crops, deforestation, and economies in free fall--encourage prostitution and multiple sex partners. The U.S. has withheld funding for numerous international efforts to fund sex education and birth control. In both the countryside and the slums of the major cities, there simply is no functional public health system, nor much in the way of infrastructure (including sanitation) at all. Health clinics are few, poorly staffed and trained, and chronically short of basic supplies. Global austerity programs, imposed by the west in the name of capitalism, eliminate public health recordkeeping, clinics, and prevention programs (as well as making poverty itself far worse). Transnational drug companies have treated AIDS like a bonanza; in their rush to develop ever more expensive drugs, simple and cheap ones--the kind that could have an impact in poor countries--are discontinued as not profitable enough. A combination of callousness and racism allows wealthy governments to ignore the accelerating crisis.

In the U.S., of course, there's no room for complacency. The protease inhibitor drugs that have brought relief to many HIV patients don't always work, have often debilitating side effects, require patient regimens that rarely get 100% compliance, and are extremely expensive. Poor folks without insurance--and that's a large number of the folks who contract HIV through IV drug use--face prospects as grim as ever. Many people with health insurance, in an age where breathing is considered a pre-existing condition, can't afford treatment, either.

At home as abroad, whether it's AIDS, breast cancer, TB, malaria, or bad drinking water, the problem isn't whether we have the will or the knowledge to save lives, but whether a fraction of the world's wealth can be diverted to that purpose. So far, greed has proven more important. Given the limits of hi-tech medicine, and the speed with which ailments can be spread across continents by global disease vectors (aka "businessmen"), that greed may come back to haunt us all.

--Geov Parrish