The San Francisco Chronicle - Wednesday, June 28, 2000
David Perlman, Chronicle Science Editor

In some southern African nations, crops are going unharvested because the epidemic has afflicted large numbers of agricultural workers. Business and industrial output is also being disrupted because AIDS is killing off major segments of the workforce.

And many of the younger generation are being left without education because the epidemic has taken a severe toll on teachers, according to the U.N. report.

"The AIDS toll in hard-hit countries is altering the economic and social fabric of society," said Dr. Peter Piot, the Belgian-born UNAIDS chief, in a telephone press conference from Geneva.

"HIV will kill more than one- third of the young adults in countries where it has its firmest hold, yet the global response is still just a fraction of what it could be. We need -- we must -- respond to this crisis on a massively different scale from what has been done so far.

"There is a whole generation that is being taken out," he said. The 130-page UNAIDS report released yesterday is a grim analysis of an epidemic that took the world by surprise when it was discovered in 1981. It spread swiftly across every nation in the world, but it has hit hardest by far in the developing nations of sub-Saharan Africa.

The report was released in advance of the International AIDS Conference in Durban, South Africa, next month.

In the past year alone, HIV, the virus that causes AIDS, has infected nearly 3 million people worldwide. More than 34 million are living either with the infection or the disease itself, and 13 million children have been orphaned, according to the U.N. report.

Workers in the international consortium known as UNAIDS are hard-pressed to mobilize desperately poor and undermanned health- care systems in developing nations.

Despite intensive research into AIDS vaccines and major efforts to distribute condoms widely in nations where unprotected sex is common, it is impossible to predict when the plague's pace will slow, the UNAIDS report said.

And Piot warned that the toll "is only going to get worse over the coming years, even if today, by some miracle, all HIV transmission would stop."

The center of the crisis is southern Africa, where in 17 nations more than 10 percent of the population has been infected with HIV and even the simplest of AIDS drugs are far too expensive for even limited distribution.

In seven of those nations, including South Africa, at least one-fifth of the population is infected, the UNAIDS report said. And the infection rate is at least three times greater among young women than men.

"If you are 15 years old in those countries today, the probability that you will die of AIDS is over 50 percent," Piot said.

One of the report's bleaker findings is the AIDS epidemic's expected impact on education. Many of the younger generation are being deprived of education because the epidemic has taken a severe toll on teachers, the report said.

KILLING OFF TEACHERS

"The epidemic is undermining basic education in many parts of Africa," Piot added. "It's killing off teachers well before their retirement age, and many households are forced to spend too much money on health care, and have less money for school fees. We are only at the beginning of the severe impact on society."

Seeking to allay the seemingly endless details of disaster, the report did note a few bright spots:

Countries whose governments recognized the epidemic's full force early and began intensive prevention strategies, for example, have begun to see stable -- or even falling -- infection rates. In some countries where prevention efforts are strongest, evidence suggests that young people are delaying their first sexual experiences, having fewer sexual partners or using condoms regularly if they're available.

In Thailand, the report said, an anti-AIDS campaign has persuaded most prostitutes to insist that their customers use condoms, and Cambodia has begun a similar program. Up to three-quarters of brothel patrons reported that they always use condoms, the report noted.

Similarly, in Brazil, where four years ago fewer than 5 percent of young men reported using a condom the first time they had sex, the figure last year rose to 50 to 75 percent.

`KEEP HOPE ALIVE'

"Achievements like these keep hope alive by proving that the world is not powerless against the epidemic," Piot said, "but up to now the gains have been scattered, not systematic."

Because of AIDS, Piot said, "poverty is getting worse just as the need for more resources to curb the spread of HIV and alleviate the epidemic's impact on development is growing. It's time to make the connection between debt relief and epidemic relief."

E-mail David Perlman at perlmand@sfgate.com.

WORLDWIDE TOLL OF AIDS CONTINUES TO RISE

Global estimates of HIV/AIDS

Children and adult estimates as of end of 1999

People living with HIV/AIDS: 34.3 million

New HIV infections in 1999: 5.4 million

Deaths due to HIV/AIDS in 1999: 2.8 million

Cumulative number of deaths due to HIV/AIDS: 18.8 million

Children under 15 orphaned by AIDS(x) 13.2 million

(x) HIV-negative children who have lost their mother or both parents to AIDS before the age of 15.

Regional estimates of people living with AIDS

Western Europe: 520,000

North Africa and Middle East: 220,000

Sub-Saharan Africa: 24.5 mil.

Eastern Europe and Central Asia: 420,000

South and Southeast Asia: 5.6 mil.

East Asia and Pacific: 530,000

Australia and New Zealand: 15,000

Caribbean: 360,000

Latin America: 1.3 mil.

North America: 900,000

Source: United Nations AIDS Program
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