San Francisco Chronicle - The Voice of the West, 901 Mission Street, San Francisco, CA 94119 - Wednesday, July 10, 1996 - Page A1
David Perlman, Chronicle Science Editor

They also called for much greater protection of babies born to infected women.

At least 9 million women carry HIV, the virus that causes AIDS, according to Dr. Peter Piot, director of the United Nations AIDS program. Some 3 million children have been infected through mother-to-child transmission.

The disease is particularly devastating to women and their babies because many cultures give women little control over their sex lives, Piot told the 11th International Conference on AIDS. Women need devices as effective as men's condoms but that can be used without men's knowledge or approval, as well as vaginal creams to kill the virus, he and other experts said.

Many of the world's infections occur in brothels in developing nations, where men often demand sex without condoms. It is a condition, Piot said, that brothel owners frequently insist be honored. Little heed is given to dangers to brothel workers, who all too often are teenagers from rural areas, desperate for even the most degrading jobs.

And although perhaps more clandestine, similar problems of sexual subjugation exist in the industrialized world, among prostitutes, pickup dates or women in semi-permanent relationships.

At least 500,000 infants were born with HIV infections last year alone, Piot's group reported. Others have acquired the virus through breast-feeding by mothers who may not know they are infected. To Dr. Christopher Elias, a specialist in microbe-killing chemicals, the world's women urgently need preventive methods that they can use without the knowledge of their sexual partners -- such as vaginal or anal microbicides that might be used with condoms or applied as creams. ``Non-consensual sex, the fear of domestic violence or economic abandonment and difficulties concerning condom use greatly limit many women's prevention options,'' Elias said.

Female condoms exist, Elias noted, and surveys show they are chosen by 87 percent of women who are offered the option. They are constructed as pouches that fit inside the vagina. Researchers have developed and tested new chemicals that can make them highly effective in preventing infection by not only HIV, but also organisms that cause gonorrhea and syphilis.

Preliminary estimates indicate the risk of sexually transmitted diseases could be reduced by 97 percent during intercourse with new, internal female condoms that already have been developed and can be employed without the knowledge of the woman's partner, Elias said.

For many years a compound called nonoxynol-9 has been regularly used as a spermicide to coat male condoms -- particularly in the United States -- while other chemicals are common in condoms made in other countries. The substance kills HIV and can be used with female condoms.

One problem, however, is that many virus-killing creams can be highly irritating with frequent use, thus making prostitutes unable to use them. An advantage of one new product, called Col-1492, is that it appears to be nontoxic and nonirritating.

Another new form of female anti-viral contraceptive involves the use of once-a-day vaginal suppositories filled with specialized, detergent-like compounds that kill HIV, Elias noted.

The U.S. government pledged $100 million yesterday to help develop virus-killing creams that would protect women from HIV. Donna Shalala, secretary of health and human services, said the National Institutes of Health and the Centers for Disease Control and Prevention will spend the funds over the next four years to speed development of such products.

To find ways to protect babies born to infected women, Piot announced the start of a major new series of clinical trials involving 1,900 pregnant women at five sites in South Africa, Tanzania and Uganda. The trials will use AZT and another anti-viral drug called lamivudine, or 3TC. Both are among the first AIDS drugs and hinder the virus' ability to reproduce.

The cost of using these drugs is high -- about $1,500 per mother- child pair, Piot acknowledged. However, women in the trials will receive the drugs for free.
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