By LAWRENCE K. ALTMAN
Published by NY Times: August 16, 2006

TORONTO, Aug. 16 - Efforts to expand treatment for AIDS are not reaching the vast majority of children who need it, a World Health Organization official said on Wednesday.

The official, Dr. Kevin M. De Cock, who directs the organization's AIDS program, said that an estimated 800,000 children worldwide under the age of 16 needed antiretroviral drugs to stay alive. Yet while they account for 14 percent of AIDS deaths, they make up only 6 percent of recipients of antiretroviral drug therapy.

"We must conclude that scale-up has so far left children behind," Dr. De Cock said in a featured talk here at the 16th International Conference on AIDS, which has drawn 24,000 participants. His comments drew on an extensive review of progress in efforts to step up antiretroviral treatment.

At the same time, less than 10 percent of pregnant women with H.I.V. in poor- and middle-income countries are receiving the simple regimen of pills that can prevent the transmission of the AIDS virus to their newborns. This contrasts to the rich countries that have virtually eliminated pediatric AIDS, Dr. De Cock said.

Dr. De Cock also described an inequity of antiretroviral treatment for drug users, particularly in Eastern Europe and Central Asia.

"An urgent priority is improving access to antiretroviral therapy for children, especially in sub-Saharan Africa, and for injecting drug users everywhere," Dr. De Cock said.

He did say women in poor countries were receiving therapy in proportion to the female infection rate, and exceeding expected rates in some places.

About 1.65 million of the estimated 6.8 million people with AIDS in poor and middle income countries who need antiretroviral therapy are now receiving it as a result of the programs, but for many it is coming too late to get the full benefit of the drugs.

The 1 million now receiving therapy in Africa is 10 times the number who were being treated in December 2003. Africans represent 63 percent of all recipients.