The San Francisco Examiner - June 27, 2000
Ulysses Torassa, Examiner Medical Writer

Despite glimmers of hope in a few countries, a third or more of today's 15-year-olds in some African nations will die of AIDS, a generation of teachers is being wiped out, and wealthy industrial nations have largely failed to step in with needed assistance, a new U.N. report says.

The statistics are grim, but the report released Tuesday also finds that in countries such as Thailand, Uganda and, more recently, Zambia, the infection rate has been cut significantly by vigorous prevention campaigns that have strong government and private-sector backing.

What's needed is more resources from Western nations, debt relief for poor nations and a systematic response to the epidemic, said Peter Piot, executive director of Joint United Nations Programme in HIV/AIDS or UNAIDS. Those are expected to be central issues at the International AIDS Conference next month in South Africa.

There are 34.3 million people infected with HIV worldwide, and 13.2 million children have been orphaned by AIDS. Nearly 19 million people have died since the epidemic began.

In Botswana, the hardest-hit country, more than a third of all adults are HIV-positive and two-thirds of the country's 15-year-old boys will die of AIDS, the report said.

In the developed world, expensive and complicated AIDS drugs are delivering on their promise of keeping people alive. But the report also finds some disturbing trends, such as the tripling in the percentage of men who tested HIV-positive at San Francisco's voluntary testing and counseling clinic from 1997 to 1999.

Uganda cuts infection rate

Thomas J. Coates, head of UCSF AIDS Research Institute, said the report shows that even in very poor countries concerted efforts can turn the tide, if Western nations step up their efforts and the leaders of affected countries make AIDS a top priority.

They did it in Uganda, where President Yoweri Museveni is given credit for corralling all sectors of society in an AIDS education and prevention campaign that cut the infection rate from 14 percent to 8 percent. Zambia is following a similar strategy, and the infection rate among young pregnant women in the capital, Lusaka, has been cut in half.

"When these strategies are put together correctly, we understand that they work," Coates said.

"When the history of this epidemic is rewritten and we're putting HIV away with small pox and polio, I think the U.S. is going to get a lot of credit. Clearly, our scientific response is the greatest in the world. But the amount of money we're willing to spend on the developing world is genocidal."

The impact of human suffering also is tearing at the social and economic structure in many countries. In Zambia, for instance, 1,300 teachers died of AIDS in the first 10 months of 1998. A survey of children in Zimbabwe found that not a single AIDS orphan was enrolled in secondary school, and half had dropped out of primary school.

In Thailand, the report said, a third of rural families affected by AIDS saw their agricultural output cut in half.

Those numbers also coincide with recent figures in another U.N. report that found the workforce in Namibia, Botswana, Zimbabwe and South Africa will decline 17 percent to 22 percent by 2020 over what it would have been without AIDS. Employers are hiring and training two or three workers for each job for fear they will be lost to the disease.

Although the eventual answer will likely come in the form of a vaccine, Coates said that is at least 10 years off. Meanwhile, he said, $2.5 billion to $3 billion a year would cut the infection rate worldwide in half.

'Spitting on a brushfire'

The United States spends billions treating and caring for the estimated 850,000 Americans with AIDS and earmarks more than $2 billion a year for research. But its contribution to fighting AIDS overseas this year was $195 million, up from $120 million in past years. It is expected to grow to about $250 million next year, but Coates said: "It's like spitting on a brushfire."

Rep. Barbara Lee, D-Oakland, has sponsored legislation to start an AIDS trust fund at the World Bank. Seeded with $100 million a year from the United States, its goal would be to attract up to $1 billion from other countries, foundations and private companies.

But Steve Morin, director of the Policy Center at the AIDS Research Institute, said mandated declines in foreign aid budgets leave little hope the endeavor will get the money it needs.

Still, Lee said she's noticed a shift over the past few years in her colleagues' attitudes about the disease overseas, in part because the economic and social impacts will have repercussions for the United States.

She said there will be an estimated 40 million AIDS orphans worldwide by 2010 - equivalent to the U.S. public school population.

"People need to see this as a national security issue," Lee said. "In some countries, half or more of the military is affected. You're going to have young people on the continent of Africa with nothing to do."

Meanwhile, she noted, Congress is approving $60 billion for a national missile defense system "that probably doesn't work.

"It's a matter of priorities," she said.

Apparently, many Americans are beginning to agree. A poll released Monday by the Kaiser Family Foundation finds that although 60 percent think the United States spends too much on foreign aid, 64 percent say they support using federal money to help solve the problem of AIDS in Africa.

At the same time, only half of those polled thought the money would make meaningful progress in fighting AIDS in Africa.

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