The number of new HIV infections is declining, more people than ever are receiving treatment and deaths due to the disease and its complications are falling, but progress remains precarious, warns a new UN report.

Released today in Paris, the report — entitled Miles to go—closing gaps, breaking barriers, righting injustices — identifies some worrying trends, noting that the rate of infection is still rising in 50 countries, and that most of the treatment benefits affected adults, not children.

"We are sounding the alarm," Michel Sidibé, the executive director of UNAIDS, told reporters. "Entire regions are falling behind, the huge gains we made for children are not being sustained, women are still most affected, resources are still not matching political commitments and key populations continue to be ignored."

In 2014, UN members pledged to end the global AIDS epidemic by 2030. But the report says that the world risks missing many of the ambitious shared targets.

Among its key findings:

940,000 people died from HIV-related causes in 2017, the second straight year the number has fallen below one million, but far off the goal of 500,000 annual deaths by 2020.

1.8 million people were newly infected last year — almost half the number at the epidemic's peak in 1996, but 75 per cent more than the targeted 2017 number.

2.3 million more people accessed treatment, the biggest annual jump to date, meaning that 60 per cent of the world's 36.9 million HIV sufferers now receive care. But the target of 30 million in treatment by 2020 seems in doubt.

Overall, it is estimated that 80 million people have been infected, and 35.4 million have died since HIV was identified in the early 1980s.

The report finds that there has been significant progress in eastern and southern Africa — the region most affected by HIV — with a 30 per cent reduction in new infections since 2010. But those gains are being offset by a doubling of new cases in eastern Europe and central Asia, and a 25 per cent increase in North Africa and the Middle East.

West and central Africa continue to be a problem. Nigeria, for example, has seen 51 per cent of all new cases in the region, but only 33 per cent of its people living with HIV are receiving treatment.

The number of children still being infected is also a concern, with 180,000 kids acquiring HIV via breastfeeding in 2017, far off the 2018 goal of 40,000 such cases. And only 52 per cent of children with HIV are receiving treatment, while 110,000 died from the disease last year.

Key populations now account for 47 per cent of all new HIV infections worldwide.

Men with same-sex sexual partners are 28 times more likely to be infected than those in heterosexual relationships, the report notes.

Indigenous peoples in Brazil, Canada, Indonesia and Venezuela have a much higher rate of infection and mortality than the general population. In this country, for example, they accounted for 21 per cent of all new HIV cases in 2016, while being just over four per cent of the population.

Half of all sex workers in Eswatini, Lesotho, Malawi, South Africa and Zimbabwe are living with HIV, says the report.

Collectively, the world spent about $20 billion US to combat AIDS and HIV in 2017 — up eight per cent from 2016, but still just 80 per cent of the 2020 benchmark.

More money is needed, says the UN.

"We are short $7 billion per year to maintain our results and to achieve our objectives for 2020," Sidibé told Agence France Presse. "Without these resources, there is a big risk of the epidemic rebounding, of an increase in mortality due to AIDS."

And significant treatment gaps remain. In North America and Europe, 78 per cent of people with HIV received Antiretroviral drugs, compared to 40 per cent in west and central Africa and less than one-third in the Middle East and north Africa.

There are questions, however, about whether Sidibé is the right person to be leading the world's HIV fight.

The UNAIDS director has been reprimanded over his handling of a sexual assault allegation against his former deputy by another staffer at the Geneva-based organization. An internal UN probe found that the Malian diplomat erred by trying to settle the matter before an official investigation was completed, and in criticizing whistleblowers.

Today, Sidibé rejected calls for his resignation.

"I don't anticipate leaving my post," he told reporters in Paris. "I don't back away from difficult issues. I need to deliver on my job."

cbc