The San Francisco Examiner - Wednesday, Sept. 10, 1997
Lisa Krieger, Examiner Medical Writer

Experts gathered at an international conference in Washington said the AIDS epidemic was raging among newborns from HIV-infected mothers in Asia and Africa because poor nations could not afford drug therapy that had been successful in reducing HIV infection among American babies.

They urged policy makers to translate the U.S. success into a global effort to stop babies from being born with HIV.

"We can't assume that dramatic national control of HIV transmission from mothers to infants means we have the situation under control," Arthur Ammann, president of the American Foundation for AIDS Research (AmFAR), told the conference, called "Global Strategies for the Prevention of HIV Transmission from Mothers to Infants."

In Kenya, AIDS will be responsible for 41 percent of all infant deaths by the year 2010. In Zimbabwe, AIDS will claim 58 percent. But Botswana is projected to suffer the biggest casualty: 61 percent of all infants dying that year will succumb to AIDS, according to the U.S. Census Bureau's new report, "The Demographic Impacts of HIV/AIDS: Perspectives from the World Population Profile."

Worldwide, the percentage of infant deaths attributable to HIV-AIDS is still small. That is because, at this time, AIDS is not a significant cause of infant or child death in the countries with the biggest percentage of the world's children, especially China and India.

Here in the United States, anti-viral drug treatments are saving the lives of many newborns. Without treatment during pregnancy, more than 25 percent of HIV-positive mothers pass the disease to their newborn, but with treatment the rate drops to about 8 percent.

The prenatal HIV treatment, developed in the United States, calls for a pregnant woman to take the anti-viral drug AZT, or zidovudine, starting at the 14th week of pregnancy. During labor, the drug is given intravenously. After birth, the baby receives the drug for the first six weeks of life.

But according to Dr. Helen D. Gayle of the U.S. Centers for Disease Control and Prevention, this therapy costs about $1,000 per patient, far more than many developing nations can afford.

Moreover, there is fear that the problem may well get worse because the rate of HIV infection is increasing among women. In Africa, over half of new HIV infections occur among women, according to Gayle.

Women in the United States and other developed countries have an array of treatment choices - combination therapy, therapy with AZT alone or the taking of no drugs at all.

But in developing countries, it would be useless to offer expensive or complicated drug treatment regimens that could not be used, said Lynne Mofenson of the National Institute of Child Health and Human Development.

"We have to let them decide for themselves what will work in their countries," she said.

Ruth Nduati of the University of Kenya said it was a waste of time to tell infected African women not to breast-feed their babies, because children were at greater risk from dirty water used to make baby formula.

Studies are being run to see whether AZT could be taken for a shorter period and still reduce mother-to-child transmission. This could be a less expensive and more practical alternative to treatment throughout pregnancy.

Also being investigated is whether risks would be reduced by delivering babies as soon as possible after maternal membranes rupture, abbreviating the exposure of the fetus to the virus. Other studies are looking at whether better nutrition, such as supplementing with vitamin A, could reduce infection.

The best answer, Ammann said, would be a vaccine. "That is the ultimate answer to any infectious disease," he said.

Local news

AIDS Benefits Counselors, which provides services to 2,500 people with HIV-AIDS in San Francisco, says it will dramatically expand its services, thanks to grants from the mayor's office and the Levi Strauss Foundation.

The city's Office of Community Development has awarded AIDS Benefits Counselors a 1997 grant of $39,450 to match a $40,000 award from Levi Strauss. The funds will go to expand counseling, training and employment placement services to low- and moderate-income San Franciscans.

"Advocacy in a New Era," a comprehensive workshop for AIDS activists, will be held Saturday and Sunday. The workshop, sponsored by the S.F. AIDS Foundation, will present up-to-date information and suggestions on how to advocate for new HIV treatments, housing, and other public policy issues. To register, call (415) 487-3034.

Dr. Robert Gallo and Dr. Sandra Hernandez will be the keynote speakers at Project Inform's annual "Evening of Hope" benefit dinner and program on Nov. 7 at the Westin St. Francis Hotel. Gallo, co-discover of the AIDS virus, is director of the Institute of Human Virology at the University of Maryland. Hernandez, former head of The City's Health Department, directs the San Francisco Foundation.

Money raised at the event will help Project Inform continue to advocate for improved treatment of people with HIV-AIDS. Tickets are $125. Call (415) 558-8669.

The toll

Christopher J. Arcieri, 47, a systems analyst, fashion illustrator and graphic artist who worked for Air Touch Communications and who loved The City and its architecture . . . Perrin Jones, 33, a native of England who was a member of the Golden Gate Guards Motor Club and Tsunami Masters Swim Club . . . Gary Alan Brigham, 38, former branch vice president of Great Western Bank on Irving Street . . . Joseph Colton III, 44, a talented stained glass artist, cook, lover of the outdoors and environmental consultant for Fugro-West and ENSR Consulting and Engineering.

Date Cases Deaths reported

S.F.. . . 8/1 24,509 16,838

Calif.. . 8/1 101,898 65,257

U.S.. . . 8/1 581,429 362,004

WHO 8/1 8.4 mil 6.4 mil

Figures are cumulative since June 1981.

Note: AIDS statistics can no longer be updated weekly due to a decision by city, state and federal epidemiologists to release new data only four times a year.
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