Let me open with a simple statement of conviction: I have always believed and continue to believe that it is possible to turn the tide on AIDS in Africa. Clearly then, something is missing at the heart of the analysis to explain why remediation has not occurred. Knowledgeable activists and scientists have criticized individual African governments, lacerated the G8, raised questions about the Global Fund to Fight AIDS, Tuberculosis and Malaria and derided the US President's Emergency Plan for AIDS Relief.

But one dimension of the critique has been totally absent-the responsibility that rests with multilateralism. Had the United Nations done its job, the AIDS pandemic would by now be in retreat. There is nothing facile in that view: the United Nations has great numbers of staff, significant resources and tremendous influence in every high-prevalence country in Africa. A simple enumeration of opportunities lost gives a sense of what might have been. I shall draw upon four examples.

The first scenario involves President Thabo Mbeki of South Africa and his destructive Minister of Health, who have refused to take HIV/AIDS seriously, let alone to recognize that HIV leads to AIDS. Their staunch and irrational refusal to provide treatment has resulted in hundreds of thousands, perhaps millions, of unnecessary deaths. All the while, the United Nations has not said a word. The voices of the Secretary General, of the Executive Director of UNAIDS, and of the Directors General of WHO have remained silent, emboldening Mbeki to claim vindication for the course he had chosen.

Had the United Nations spoken out against President Mbeki's behavior, it could have shamed him into a change in policy. Failure to chastise Mbeki's ineptitude is a lasting scar on the integrity of the United Nations.

Second, there is the perplexing question of drug prices in AIDS treatment. Despite multiple meetings with brand-name pharmaceutical companies, the United Nations achieved little or nothing in terms of price reductions. Drug prices, however, did eventually decrease -so dramatically, in fact, that treatment became affordable to countless patients. And yet the orchestrator of change was not the United Nations; it was the Clinton Foundation, whose negotiations in India drastically reduced prices of generic drugs exactly equivalent in chemical composition to brand-name medications. Why did a private foundation succeed where the United Nations failed? Could it be that the United Nations was so mesmerized by the pharmaceutical industry that they could not see the pills for the dollar signs of corporate power?

Third, according to current data, only 10 percent of HIV positive pregnant women in Africa have access to drugs that would prevent transmission of the virus from mother to child during the birthing process. Highly effective preventive measures do exist; indeed, if a pregnant woman is put on full antiretroviral treatment for the bulk of her pregnancy, and for six months of exclusive breastfeeding thereafter, transmission can be reduced by up to 99 percent. Yet hundreds of thousands of infants are born HIV positive every year, doomed to an early and agonizing death that could have been prevented with access to appropriate treatment.

There is an esteemed and beloved agency of the United Nations called UNICEF, whose duty is to assist governments in providing children with the "highest attainable standard of health." We have a right to ask: where was UNICEF's obligation during this period of frightening child mortality?

Finally, the most vexing and heartbreaking dimension of the AIDS pandemic is the toll it has taken on women. In the five and a half years I served as UN Envoy on AIDS in Africa, I can confidently say that the one aspect of the pandemic that showed no improvement was the situation of women. At the state level, the absence of intervention on behalf of women by UN country teams was appalling. Moreover, these situations were ferociously compounded in conflict countries. In the Congo, for example, rape and sexual violence continue to aggravate HIV infection rates; yet these crimes have never been adequately addressed by the United Nations, either through its peacekeepers or through its agencies.

None of this takes individual governments off the hook, but at least they have been censured by many. The United Nations has a lot to account for, but it has been excoriated by none. UNAIDS-the coordinating body for UN intervention-has not done its job. If proof is needed, a visit to the teeming graveyards of the continent will suffice.