San Francisco Chronicle - Wednesday, November 24, 1999
David Perlman, Chronicle Science Editor

In Africa -- where the epidemic is raging most strongly -- for the first time, more women than men are being infected with the AIDS virus, according to the report by the U.N. AIDS program, which was released yesterday.

And in several African countries, girls under the age of 19 are five to six times more likely than boys to become infected with HIV, a tragedy caused largely by sex with older men who are already infected, the report found. At a London teleconference with reporters from other nations yesterday, Dr. Peter Piot, director of the consortium of international agencies known as UNAIDS, offered a depressing story of the global epidemic's unceasing onslaught.

"Every new infection," he said, "adds to the ripple effect, impacting families, communities, households and -- increasingly -- businesses and economies."

The report, released yesterday in preparation for the 12th annual World AIDS Day on December 1, found that 33.6 million women, men and children are now living with the disease or are infected with HIV. More than two-thirds are in sub-Saharan Africa.

Among the many aspects of the epidemic that Piot underscored is the spread of the AIDS virus in the former Soviet Union -- particularly Russia and Ukraine -- where an explosion of intravenous drug use among addicts sharing needles has doubled the HIV infection rate in only two years.

In those nations, combined with former Soviet bloc countries in central and eastern Europe, infections with HIV climbed by more than a third this year, attacking an estimated 360,000 people, Piot said.

The UNAIDS report was studded with grim statistics indicating that the epidemic is far from slowing down.

In this year alone, he said, 5.6 million adults and children have been infected with HIV, two-thirds of them in sub-Saharan Africa, and another 25 percent in Southeast Asia, where many nations have been reluctant to approach the epidemic and develop prevention techniques.

AIDS continues to be a disease of the world's most impoverished developing nations. Piot said 95 percent of all the people now infected with HIV live in those countries, where inadequate health systems and limited resources open the floodgates to the spreading virus.

A FEW BRIGHT SPOTS

There are some bright spots in the grim picture, however limited they might seem, Piot said.

For example, he noted, many African heads of state and other government officials -- who for years virtually ignored the mounting threat of the epidemic -- now are committing resources and human health workers for aggressive prevention campaigns.

"Never before have so many heads of state spoken out," Piot said of the situation in Africa, "and more investments in fighting the disease are being made by the development agencies of the richer countries."

Similarly, in Asia, the governments of Thailand and the Philippines are succeeding in efforts to slow or even reverse the rate of new infections, he said.

Another positive development in the effort to curb the epidemic is the realization by many poor nations that the epidemic will inevitably block their development unless they lend more support for aggressive prevention efforts.

NEED TO EMPOWERING WOMEN

And those efforts, Piot said, don't stop at providing affordable or even free condoms to everyone. They require far stronger prevention campaigns to promote responsible sexual behavior among men and -- for the first time -- to "empower" women, as well.

That means giving women -- including teenagers, Piot said, the support they need to demand that men use condoms during intercourse, as well as lowering the cost of female condoms, which are now too expensive for most.

Research must also be speeded to develop and offer women low-cost vaginal microbocides that would kill the virus and prevent transmission during intercourse.

Among other depressing statistics in Piot's report: A total of 16.3 million adults and children -- 13.7 million in sub-Saharan Africa alone -- have died of AIDS since the worldwide epidemic began. And of the 33.6 million adults and children now living with HIV or AIDS, 23.3 million are in sub-Saharan Africa, another 6 million are in south and Southeast Asia, and 1.3 million are in Latin America.

"The threat of HIV has not diminished in any country," Piot said. "We have even seen evidence from North America and western Europe that the availability of life-prolonging therapies may be contributing to an erosion of sexual behaviors."
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