The first World AIDS Day was staged by WHO in 1988, at a time when the world was waking up to this disease and its multiple catastrophic impact. Since then, the face of the epidemic has changed in significant ways, and we are gaining better insight every day.

Some trends have been positive. Leaders in most countries are fully awake to the threat. Awareness has brought commitment, and resources continue to increase, including for the development of new tools.

This year’s report on the epidemic, jointly prepared by UNAIDS and WHO, indicates that HIV incidence peaked in the late 1990s and prevalence has been level since 2001. Data set out in this report further suggest that prevention efforts are leading to fewer new infections, especially in young people, and that greater access to treatment is contributing to fewer HIV-associated deaths.

These positive trends mask some alarming changes in the epidemic. My main message today is straightforward: do not forget Africa, and do not forget women.

Today, HIV/AIDS is overwhelmingly concentrated in sub-Saharan Africa, where it thrives on and traps people in poverty. This region accounts for over two thirds of people living with HIV and over three quarters of HIV-associated deaths.

In all regions, the proportion of women living with HIV is growing. In sub-Saharan Africa, it now approaches 61%, the highest in the world. The infection of women amplifies the tragedy. These are wives, mothers, caregivers, and often the backbone of family and community cohesion.

Access to treatment continues to increase, but we are far from the goal of universal access to comprehensive prevention programmes, treatment, care and support. In 2007, an estimated 1.7 million people were newly infected with HIV in sub-Saharan Africa. An estimated 1.6 million individuals died. That is 1.6 million personal and family tragedies.

When we consider Africa, we need to recall the significant progress achieved in a growing number of countries. This gives us both hope and a range of models for success. In countries like Cote d'Ivoire and Kenya, prevalence has peaked and declines are now being registered year after year. Leadership can change the tide. This can be leadership at the highest level of government, or leadership by a public figure who sets an example by speaking openly about AIDS and the need to fight stigma. Leadership has multiple other faces and forms, from foreign policy to corporate social responsibility and support from religious leaders and civil society.

We need to do several things. The 2007 report uses a more robust methodology, which allows a better assessment of the dynamics of this epidemic. Estimates are now more accurate, but we still need better data. What accounts for the positive trends? Which specific interventions work best in specific settings? Where do we need to concentrate our efforts?

We need to strengthen delivery systems. The weakness of health systems limits the ability to reach those in greatest need with sustainable prevention and treatment services. Under-resourced services cannot effectively prevent mother-to-child transmission of HIV, perpetuating an avoidable epidemic in infants and children.

We need to give more support to women. Improvements in the social status of women, in their control over household income, in education, also for girls, take time. But better access to sexual and reproductive health services is an achievable goal right now.

Weak systems may also not be able effectively to reach out to those at high risk of infection – including people in conflict and crisis situations, men who have sex with men, injecting drug users, sex workers and prisoners.

We need to press forward with care and antiretroviral treatment programmes to ensure the impressive achievements made continue and expand, and millions can return to health and productivity. We need to understand how to maximize the impact of treatment on HIV prevention, starting with pregnant women and uninfected partners.

For a mother to pass on infection to her child is a cause of unspeakable grief. Under-resourced services cannot effectively prevent mother-to-child transmission of HIV, perpetuating an avoidable epidemic in infants and children. We must seize every opportunity for women to learn their infection status.

Finally, another thing we can do right now is manage the co-epidemic of tuberculosis. Without access to antiretroviral therapy and proper TB treatment, most people living with HIV who develop tuberculosis will die quickly, sometimes in a matter of weeks. Effective joint interventions exist for TB and HIV, and these need to be scaled up in an integrated fashion to prevent these unnecessary deaths.

Progress since 1988 has been remarkable, but we have a long way yet to go, especially in Africa, and especially for women.