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"So far from God, and so close to the United States," goes the old saw about Mexico. Central America is a little further from the US, but judging by the thousands of people with AIDS who died needlessly last year for lack of medicine, no closer to God.

Recall the UN's special assembly on AIDS last June? Fine words were spoken about increasing access to life-saving anti-retroviral drugs for people in poor regions, where 92 percent of all adults with HIV live. Sub-Saharan Africa, the most devastated, gets the most attention. But Central America and the Caribbean, with 1.8 million infected and firmly in the American sphere of influence, is a proving ground of the rich world's resolve to provide access to meds.

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The short-term progress report? Spotty. The UN AIDS bash "was not a bad thing as such," says Richard Stern, director of the Costa Rica-based Buena Agua Human Rights Foundation, "but its impact in Latin America seems to have been minimal."

El Salvador's health minister spoke at the UN meeting of his government's commitment to human rights. But three months later, the Salvadoran Congress passed a law permitting employers to screen job applicants for HIV. In a sop to Catholics, the law decrees that condoms should not be relied upon to prevent AIDS.

There's some good news, too. Costa Rica provides universal access to anti-retrovirals-- the only Central American country to do so. And prices for the drugs in Honduras dropped 85 percent in 2001, down to about $1,300 yearly-- a sum still well beyond the reach of most HIV-infected Hondurans.

In bordering Nicaragua, a country even more impoverished, the price for anti-retroviral treatment remains above $5000 yearly for most cocktails.

Why the difference? In Honduras UNAIDS implemented its "Accelerated Access to Care and Treatment," and multi-national drug firms reduced their local prices. However UNAIDS has not acted in neighboring countries-- including El Salvador, Guatemala, and Belize, or throughout much of South America.

Perhaps two or three thousand Latin Americans survive with AIDS thanks to "recycled" meds from the US and Europe, Stern says. But mostly people with HIV get by without the drugs-- and suffer correspondingly high death rates.

In the Caribbean, Cuban PWAs enjoy an excellent health system and decent access to anti-retrovirals, some of which Cuba produces. Though the poorest country in the Western Hemisphere, Haiti has some model programs for distributing the "cocktail" to the very poor. Next-door, in the Dominican Republic, some 9000 people with HIV go without.

Moving south, Argentina, Chile, Venezuela, and Columbia have been providing anti-retrovirals to a significant percentage of those with HIV. But in Bolivia, Peru, Ecuador, and Paraguay, more than 90 percent of those needing them receive no anti-retrovirals. With Argentina's recent economic collapse, don't count on subsidized drugs this year.

Brazil has become a global leader in treating AIDS with anti-retrovirals, producing its own medications, and providing subsidized treatment to some 105,000 people. But Brazil has not taken the extra step of offering its meds for sale to its neighbors in Latin America. "To do so would be a courageous action that would save thousands of lives in the region," Stern says-- but it would also set off a row with the US, for whom the defense of corporate "intellectual property"-- much of it created with public funding-- is a cause second only to the war on terrorism. Efforts to import to the Americas to inexpensive Indian-made generic anti-retrovirals have also so far faltered.

For now, people with AIDS in neighboring countries such Paraguay, Ecuador, Guyana, and Peru try to cross the border into Brazil, hoping to be assimilated into Brazil's health care system.

2001 was the year that activists around the world succeeded in putting the issue of drugs access on the official agenda. The much-heralded Global Fund For AIDS, Malaria, and Tuberculosis became a reality in January, and has about $700 million available this year. Will that mean more drugs for those who need them? Stay tuned.

Editor's Note: –Richard Stern contributed to this report