The threat was first identified some two decades ago. Since then, more 20 million people have been killed, and unless immediate offensive strikes are made, intelligence sources predict the slaughter of another 68 million within 20 years. That's around 9,000 victims per day, all claimed by HIV. No continent will be spared: the war against AIDS — the hackneyed metaphor is in this case an understatement — is truly a world war.

Virologists have been mobilized, but with hopes of an effective vaccine still years down the road, the immediate imperative has less to do with science and more to do with politics and hard cash. We already have the weapons — prevention schemes and anti-retroviral drugs — to prevent some 29 million new infections by 2010 (J. Stover et al. Lancet 360, 73–77; 2002). What's missing is the political will and the money to deploy them quickly where they are most needed: in the developing countries where 95% of cases occur.

The international community is at least talking a good fight, having pledged in June 2001 to “reduce by 2005 HIV prevalence among young men and women aged 15 to 24 in the most affected countries by 25%”. To achieve this, it promised an annual spend of US$7–10 billion. But so far just $2 billion has actually materialized for the Global Fund to Fight AIDS, Tuberculosis and Malaria. And while a handful of developing countries have made AIDS their top priority, many continue to deny and stigmatize the disease, failing to prioritize the investments in health infrastructure that will be needed if any injection of new donor funds is to be effective.

Some economists and politicians still argue for putting all available cash into preventing new cases, arguing that supplying anti-retroviral drugs to much of the developing world is not cost-effective. But this flies in the face of the evidence and thankfully is becoming a minority view. In reality, the human, social and economic benefits of widening access to drugs are obvious. People live longer, so they can work to support their families, and fewer children are orphaned — not to mention the fact that anti-retrovirals could prevent the transmission of HIV to some three million babies each year.

Moreover, the availability of drug treatment seems to create a virtuous circle, reducing the spread of HIV. People are more motivated to take diagnostic tests, and the vastly reduced viral load in most treated individuals reduces the risk of them infecting others.

If we can get cheap Coca-Cola to every corner of Africa, there is no reason why we can't deliver anti-retroviral drugs there too. Three years ago this proposal would have seemed outrageous. Annual drug treatment for one person cost between $10,000 and $15,000, and the logistics were a nightmare. But the cost of treatment has fallen to as low as $300, and the aid agency Médecins sans Frontières reckons it can be brought down to $50. In part, this is due to the Joint United Nations Programme on HIV/AIDS and the World Health Organization brokering price deals with drugs companies. A more successful strategy comes from countries such as Brazil, Thailand and Cameroon, which have used the threat of compulsory licences to produce generic alternatives as a tactic to negotiate tough deals with the big drugs firms.

Brazil alone has treated 115,000 patients. Its genuine and sustained commitment to prevention and to purchasing and delivering drugs means that a national epidemic that was predicted to reach 1.2 million cases this year instead stands at 600,000, and AIDS-related deaths have been slashed by half. What's more, the policy has saved government money by cutting the costs of caring for AIDS patients with opportunistic infections.

This evidence speaks for itself. The time for lukewarm promises and glacial progress is over. The world's rich nations must start filling the Global Fund's coffers, so it can fight the war on AIDS in earnest.