Washington, DC — This week, world leaders will gather at the United Nations (UN) in New York to review commitments made five years ago in the fight against HIV/AIDS. In recent weeks, African governments and civil society groups have conducted similar reviews of international pledges and targets on HIV/AIDS. The results are grim. Promises of an urgent and coordinated response to this pandemic have been disregarded, and Africa continues to bear the brunt of the global failure to defeat HIV/AIDS.

It's not just that African efforts to combat HIV/AIDS are hindered by the continent's poverty. Nor is it only that the U.S. and other rich countries have failed to contribute sufficient resources to fight HIV/AIDS in Africa and other impoverished regions, though this is still a large part of the problem: a much greater investment in Africa's health care infrastructure and HIV/AIDS initiatives is possible, and indeed it is a prerequisite to turning the tide of this global pandemic.

But beyond the question of funding, it is increasingly clear that the orientation of U.S. policies on HIV/AIDS, in particular, is at odds with African priorities in combating this pandemic. The priorities articulated by international health experts, and by many African governments and civil society groups in the fight against HIV/AIDS, are actually being undermined by current U.S. policies, which hinder an effective response on the front lines of this devastating crisis.

Africa is home to more than 25 million of the 40 million people living with HIV/AIDS worldwide, and most of those living with HIV/AIDS on the continent are women, but U.S. policies fail to address the needs and vulnerabilities of African women and girls. The "gag rule" denies U.S. funding for many essential reproductive health programs across the continent if they also conduct or provide information on safe abortions as part of their work.

When it comes to HIV prevention, the heavy U.S. focus on abstinence-only programs undermines a more comprehensive strategy and fails to support the needs of women who remain vulnerable even when they stay faithful to one partner. Promoting women's sexual and reproductive rights, and empowering women to make their own decisions, are central elements to defeating HIV/AIDS, but U.S. policies fail to support these priorities for African women and girls.

While there has been a small improvement in expanding access to HIV treatment in Africa in recent years, only a fraction of those living with HIV/AIDS on the continent now have access to life-saving anti-retroviral therapies. Treatment is key in the fight against HIV/AIDS, but U.S. policies are hindering efforts to expand the delivery of low cost, effective generic equivalents of HIV/AIDS drugs. U.S. programs still rely heavily on expensive brand-name treatments, which often cost two to three times as much, and therefore reach only a portion of potential beneficiaries.

Five years ago, when the UN last held a special session on HIV/AIDS, one of the concrete outcomes of that meeting was the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. This multilateral vehicle has mounted a successful and comprehensive response to HIV/AIDS in more than 130 countries, funding effective prevention, treatment and care programs. But the failure of the U.S. and other rich countries to provide adequate support to the Global Fund has left it facing chronic funding shortfalls and unable to scale up its programs to meet the needs on the ground.

Rather than supporting the Global Fund, the U.S. channels most of its HIV/AIDS funding through its own unilateral program, announced by the President three years ago. This directs funding primarily to a dozen African countries, or less than a quarter of the continent. Such a selective U.S. policy approach not only ignores the rest of the African continent, which is also being devastated by the HIV/AIDS pandemic; it precludes the more coherent and comprehensive response required to defeat this public health crisis.

African efforts to confront HIV/AIDS are also still handicapped by the continent's massive debt burden, and by the policies of the World Bank and International Monetary Fund (IMF), which constrain spending on health care in many African countries. The U.S. is the single largest shareholder and the most powerful voice in these financial institutions.

Twenty-five years into this unprecedented pandemic, HIV/AIDS continues to kill millions of people each year - especially in Africa - not because this is an invincible disease, but because the international community has not done what's needed to stop it. Until there is a new sense of urgency, and a shift in U.S. policies that seek to respond to this crisis, HIV/AIDS will remain a permanent and deadly feature on the international landscape, and Africa will remain at 'ground zero' of this global pandemic.

Ann-Louise Colgan is Acting Co-Executive Director of Africa Action, the oldest Africa advocacy organization in the United States.