Back in 2001, the first United Nations General Assembly Special Session on HIV and AIDS (UNGASS) ended with 191 countries endorsing a declaration full of ambitious HIV goals in dollars and deadlines. It produced the Global Fund to Fight AIDS, Malaria and Tuberculosis, and countries worldwide intensified efforts to prevent and affordably treat HIV. However, as the second UNGASS meeting—held May 31 to June 2 in New York City—ended, hundreds of activists attending the confab marched out of the UN in protest, chanting “Silence Equals Death.”

Many said they felt betrayed and that the new declaration was actually a step back. “The UN was supposed to deliver a road map,” says attendee Asia Russell of Health Global Access Project. “Instead, member states shirked their responsibility, and we got what is at best a laundry list of intentions.”

The 2006 statement calls for universal treatment access by 2010, but activists say it lacks any clear plan to meet the goal. “We wanted powerful countries, like the U.S., to define universal access and set targets, but they refused,” Russell adds. The declaration acknowledges a UNAIDS estimate that at least $20 billion is needed annually to fight AIDS, yet it offers no commitment to actually foot the tab.

“We don’t need more unachievable international goals,” counters Mark Dybul, MD, President Bush’s acting global AIDS coordinator. “Countries need to set their own realistic targets. President Bush has provided more money for AIDS than the rest of the world combined. First, other countries need to respond like the American people.” Indeed, many conference attendees reported that the U.S. delegation pushed to eliminate language tying countries to goals. Michael Sidibe, head of UNAIDS’ Country and Regional Support Department remains hopeful—and diplomatic: “I would like to have seen an even stronger declaration. But some governments want and will do more. The key now is to mobilize communities and get them the tools and services they need.” The shell-shocked global AIDS community won’t be discouraged. “We will redouble efforts to hold leaders accountable to not write off the lives of millions of people,” says Russell. And perhaps finally tie commitment-phobic governments down.