The New York Times - August 18, 2006
Lawrence K. Altman

In a keynote address, the official, Stephen Lewis, the ambassador to Africa for AIDS for the United Nations, said South Africa "is the only country in Africa whose government continues to propound theories more worthy of a lunatic fringe than of a concerned and compassionate state."

South Africa has the largest number of H.I.V.-infected people in the world. Its president, Thabo Mbeki, has continually expressed skepticism that H.I.V. causes AIDS, and the country has questioned antiretroviral treatment and delayed providing it to pregnant women and AIDS patients.

In his remarks, Mr. Lewis said, "The government has a lot to atone for," and "I'm of the opinion that they can never achieve redemption."

He said he felt his job demanded that he advocate for the tens of millions of H.I.V.-infected people, including those in South Africa, even though many say a United Nations official has no right to criticize a member state.

Mr. Lewis has long been critical of countries for failing to help women who become infected.

"Gender inequality is driving the pandemic, and we will never subdue the gruesome force of AIDS until the rights of women become paramount in the struggle," he said.

The inequality of women makes them highly vulnerable to becoming infected through "marital rape to rape as a war crime," Mr. Lewis said, adding that, while sexual violence occurs everywhere, in Africa, "The violence and the virus go together."

Preventing the transmission of the AIDS virus from infected pregnant women to newborns, which can be done with simple regimens, is "very near the top in the hierarchy of preventive measures," he said. But the vast majority of pregnant women in the world, he said, go without such prevention, and even the women who receive it are not given full treatment to help keep them alive, so their children often become orphans.

Yet the world is doing very little for orphans whose number is expected to grow to 18 million by 2010. "I appeal to everyone to recognize that we are walking on the knife's edge of an unsolvable human catastrophe," Mr. Lewis said.

Mr. Lewis's term as envoy ends in December at which time, he said, he hopes his successor will be an African woman.

Other speakers urged training more nurses and health workers in poor countries to deliver the antiretroviral drugs and preventive measures needed to stop the AIDS epidemic. The many international programs that are scaling up efforts to deliver antiretroviral drugs to poor people cannot succeed without large numbers of health workers to monitor the care of AIDS patients.

"We need hundreds of thousands of new nurses" in poor countries, said Dr. James McIntyre, an AIDS expert in South Africa.

But low salaries and poor working conditions are driving health workers into other jobs and away from those countries, leaving "too few people with the right skills," said Anders Nordstrom, the acting director general of the World Health Organization. "It's not enough to provide money and drugs and to train people, as important as they are" in the scale-up programs, he said. "You need to pay people."

Disease is also taking its toll. Countries with 15 percent H.I.V. prevalence rates can be expected to lose 30 percent of their health workers over a 10-year period, Dr. Nordstrom said. At a news conference, he said antiretroviral drugs needed to be offered to more health workers.

Nurses and others involved in the care of AIDS patients often work in unsafe or dangerous conditions, said Dr. Pedro Cahn, the new president of the International AIDS Society, the main organizer of the AIDS conferences. This conference was the largest ever, drawing 26,057 participants.

Dr. McIntyre, the South African, cited the frustration of nurses who deal with high death rates among their patients because of the lack of antiretroviral drugs. He quoted an unidentified nurse who said, "If I wanted to be an undertaker, I wouldn't have trained as a nurse."

As the conference speakers delivered their remarks, hundreds of Africans, Asians and people from around the world began dismantling the global village created here to promote discussion of H.I.V. One exhibit, called "Dress Up Against AIDS," included 10 dresses by Adriana Bertini, a Brazilian artist, made from thousands of condoms. Nearby were women from the Masaka district of Uganda who displayed their crafts, including mats, straw bowls and drums. In another booth, Kenyan workers showed off sandals and beaded necklaces. In others, attendants handed out pamphlets on programs for H.I.V. and AIDS.

The next AIDS conference will be held in Mexico City in August 2008.

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