As leaders of nations corroded by Aids gather at the United Nations in New York today to discuss the disease, another group will be noticeably absent: leaders of the world's richest nations who pledged them significant help five years ago.
The continued ambivalence - even as public health experts are heralding the first tentative signs of a slowdown in the growth of Aids since it was identified in 1981 - reflects both the enormity of the task ahead and the political and ethical sensitivities that underpin it.
