The ‘2nd Wave’ of the AIDS Epidemic Begins to Stalk a New Generation : Health: The sweep of infection catches whole families in a sea of terrifying social, legal and medical issues.

The face of the second wave of AIDS infection is young and female, the face of a mother, like Maria Ferrer. She hugs the child at her side, a tiny mirror image with the same long dark hair, deep-set eyes and flawless skin.

Another victim of this incurable disease, even though she is not infected.

“What’s going to happen to my girls when I’m gone?” Ferrer asks, her voice husky from a sore throat. A drug addict since she was 14, the 36-year-old tested positive five years ago for HIV, the virus that causes AIDS. Her husband is infected too. They have not told their three young daughters.

“They haven’t asked me: ‘Do you have AIDS?’ But in some way, I think they do know,” she said. “The thing that concerns me most is my children.”

In the next 10 years, New York officials estimate that 100,000 children will lose one or both parents to AIDS. In New York and Newark, N. J., it is the No. 1 killer of women ages 25 to 44.

This year, AIDS is expected to become the fifth-leading cause of death for all U.S. women of childbearing age, just behind cancer, accidents, heart disease, murder and suicide and ahead of strokes, liver disease and diabetes.

Over the course of the disease, more than 16,800 women have been diagnosed with AIDS nationwide--almost one-third of those in the last year.

While most women still are infected through intravenous drug use, the tide has taken an ominous turn. Now, 35% of infected women have contracted AIDS through sex, sometimes with a man they have no reason to suspect is a carrier.

This is what AIDS specialists call the epidemic’s second wave, a deadly stream of infection that sweeps whole families into a sea of complex and terrifying social, legal and medical issues.

The stigma of AIDS often crushes the spirit from families even before they actually become sick, making it impossible for them to ask relatives and friends for support. It is a disease of gays, of junkies, of people who brought it on themselves: That is what mothers and their children hear others say, and that is why AIDS becomes their terrible, overwhelming secret.

“When I first heard my diagnosis, the first thing that came to my mind was: ‘Oh, my God, what kind of cancer can I tell people I got?’ ” said Ernestine Adderley, a Bronx AIDS educator who was diagnosed in 1989.

In addition to the stigma, the activists’ chant, “AIDS is a disaster, women die faster,” appears to have some truth to it, although the exact reasons are unclear.

Little research has been conducted to determine if the disease progresses more quickly in women. But doctors and AIDS advocates know that health care providers tend not to suspect HIV in women unless they shoot drugs, so a diagnosis often comes in the last stages of the disease, too late for life-extending treatments.

“We’ve seen again and again, women come into the hospital, get their HIV testing, two weeks later get their HIV positive results and their AIDS diagnosis at the same time, and never leave the hospital,” said Jill Dunsmore, Family Outreach Coordinator at Bronx-Lebanon Hospital Center.

“I had a woman call me after she had been hospitalized, not diagnosed with HIV, but suspecting that she might have been infected,” said Marie-Lucie Brutus of the Women and AIDS Resource Network in Brooklyn. “She was fearful of not being able to kiss her children, to hug them.”

She died two weeks later, without ever knowing she was HIV positive.

A survival study at Montefiore Medical Center in the Bronx showed that men who contracted the disease through intravenous drug use lived the longest after diagnosis, an average of a year. The shortest survival, an average of about 10 months, was among women infected through heterosexual intercourse.

Social worker Eula Johnson counseled a Bronx woman infected by her husband, a man with no apparent risk factors. They learned he had AIDS when the woman was eight months pregnant with their daughter.

The baby was born with full-blown AIDS in 1988. The husband died in 1989. The mother died in January.

Men still account for the bulk of AIDS cases, but the disease is spreading faster among women. Last year, there was a 29% jump in female cases, compared to an 18% increase for men.

Black and Latino women bear the brunt of the epidemic, with infection rates wildly disproportionate to their numbers: Although they represent only 20% of U.S. women, they are 72% of all adult female AIDS cases.

Despite protests by groups such as ACT UP, women still are under-represented in government drug trials, the only access most people have to the latest treatments. Women make up 6.8% of trial participants, even though they make up 10% of all case nationwide and 20% of all cases in New York City.

“The figures have not gotten much better over the last three years,” said David Barr, assistant policy director at Gay Men’s Health Crisis. “The most important reason is that the drug trials aren’t held where people of color and women get their primary care. People don’t have access.”

Children’s treatment options lag even further behind, he said. About 3,000 cases of pediatric AIDS have been reported in the United States, and 84% of those were born infected. The disease progresses rapidly in babies, far faster than in adults; most babies develop full-blown AIDS in their first year, said Dr. Margaret Oxtoby, epidemiologist at the Centers for Disease Control in Atlanta.

Researchers have yet to determine how likely it is that an infected woman will pass HIV to her unborn child, she said. Most studies place the risk at 25% to 35%, but a recent European survey, which followed the children of 400 HIV-infected mothers for 15 months after birth, pegged the risk at about 13%. Research also indicates that the more advanced the woman’s disease, the more likely she will transmit the virus to her infant.

Many times, a woman first learns she is infected when she gives birth to an infected child.

Donna Bersch, a Bronx social worker, took in a 5-year-old girl whose brief existence with an HIV-infected mother and aunt had been more about dying than living.

Her grandmother, who had raised her as the family bounced in and out of residence hotels, died of heart disease in 1987. A year later, the girl’s father, whom she had seen just three times in her life, died on the street of a drug overdose. A year after that, her drug-addicted mother died of AIDS, and her aunt was diagnosed with the disease.

Three months after the girl came to live with Bersch, she asked a natural question with no ready answer: “Who’s going to take care of me when you die?” That question haunts women who know they may die soon and want to make legal arrangements to have their children cared for by someone they choose.

Some never make it through the legal maze; others have had their children snatched away by long-absent fathers who learn of their condition, said Dianne LaGamma, a lawyer who handles such cases at Montefiore Medical Center.

In the worst-case scenario, their mothers die before making arrangements, and the children end up in foster care.

For Maria Ferrer, there is time. She is still healthy. She will find a way to tell her girls that she is infected. Then she will find a way to prepare them for life after her death.

“Whatever time I have left on this Earth,” she said, “I want to do something for my children.”