UNICEF Decries Failure to Curb AIDS in Africa

Children are among the main victims of the rampaging AIDS epidemic in southern Africa, and the world’s response has been shortsighted and incompetent, according to a scorching report issued Wednesday by the United Nations Children’s Fund, commonly known as UNICEF.

Eleven million children have been orphaned by the disease. Hundreds of thousands have lost their teachers and, as a result, their access to education. And teenage girls are being infected at an alarming rate, 50% higher than that of boys, according to UNICEF.

“The HIV infection rates among young people are a searing indictment, documenting failures of vision, commitment and action of almost unbelievable proportions,” says the report, which was released at the 13th International AIDS Conference in Durban, South Africa.

“They tell a story of leadership unworthy of the name and the virtual abandonment of sub-Saharan Africa at a time of dire need.”

In other news from the conference Wednesday, researchers reported that the spermicide nonoxynol-9, which kills the AIDS virus in the test tube, actually increases the risk of viral transmission when used by women, that HIV infection may accelerate the spread of the epidemic by increasing sexual desire in men, and that bisexuals may be playing a growing role in passing the virus to the heterosexual population.

The UNICEF report on children is the latest in a series of gloomy forecasts released at the first AIDS conference ever held in a developing country. And it paints a bleak future for the African continent. The number of AIDS orphans on the continent, for example, will grow to 40 million in the next decade, and the number of children with the disease will also skyrocket.

Girls are particularly vulnerable. The report noted that in Botswana, for example, more than 30% of all females and 16% of all males under age 25 are now HIV-positive. In South Africa, the corresponding numbers are 25% and 11%.

Surveys show that, in many south African countries, most sexually active teenagers are unaware of ways to protect themselves from contracting the virus. Most sexually active girls do not believe they are personally at risk, and many do not know that they can be infected by a boy who appears healthy.

Even the uninfected are damaged by the epidemic. An estimated 860,000 grade school children in Africa lost their teachers to AIDS in 1999, with many not being replaced. In the first 10 months of 1998, 1,300 teachers died of AIDS in Zambia--almost as many as were trained during the same period.

AIDS “may be the greatest obstacle to child survival and to child health that we have seen in our time,” said Carol Bellamy, executive director of UNICEF. “What is required here is the largest mobilization of resources in history.”

In Washington on Wednesday, Richard Holbrooke, the U.S. ambassador to the United Nations, said that the U.N. Security Council will soon approve a resolution aimed at intensifying the battle against the epidemic. The resolution would require member countries to create effective, long-term strategies to halt the spread of HIV.

“If you ask what is the No. 1 problem in the world today, I would say it is AIDS,” Holbrooke said.

Efforts at reducing HIV transmission have focused primarily on behavioral changes and increased use of condoms, but those approaches are of limited value for many African women who remain at the sexual mercy of their husbands. “We need options that women can control,” said Nancy Padian of UC San Francisco, who runs a research center at the University of Zimbabwe in Harare.

One such option would be a microbicide that kills HIV in the vagina before a woman can become infected. But the effort to develop microbicides has suffered a major setback, according to a report on nonoxynol-9 released Wednesday.

Nonoxynol-9 is widely used in the United States and Europe as a spermicide for birth control. As many as a third of all condoms sold in those regions are coated with the agent. Because it kills HIV in the test tube, researchers had hoped nonoxynol-9 would be useful for blocking AIDS transmission as well as for birth control.

But Dr. Lut van Damme of the Institute of Tropical Medicine in Antwerp, Belgium, disclosed that results from the study of nearly 1,000 prostitutes showed that the drug may do more harm than good.

Half of the test subjects in Benin, Thailand, South Africa and Ivory Coast, who average 75 sexual contacts per month, used the spermicide regularly and half used a moisturizing cream. The study found that 15% of those using nonoxynol-9 became infected with HIV, compared with only 10% of those using the placebo.

“We were extremely disappointed,” Van Damme said. “I think this may be the end of nonoxynol-9 as a potential microbicide.”

Researchers speculated that the agent irritates the inner lining of the vagina to produce ulcers that make it easier for the virus to enter the woman’s body. Such ulcers have not been seen in women who use the chemical only as a contraceptive, suggesting that repeated use is the problem. At least 15 other chemicals are being investigated for use as microbicides, but none has had much human testing yet. Critics charge that pharmaceutical companies are not interested in microbicides because the profit margin is too low.

The search got a boost Wednesday when the Bill and Melinda Gates Foundation awarded $25 million to the Consortium for Industrial Collaboration in Contraceptive Research, headquartered at Eastern Virginia Medical School, for microbicide research targeting both AIDS and other sexually transmitted diseases. Some evidence suggests that syphilis, gonorrhea and other sex-linked diseases increase the likelihood that the victim will contract HIV.

“We’re hoping that we can demonstrate effectiveness against some [sexually transmitted diseases] in four or five years,” said Dr. Henry Gabelnick, head of the program. “For HIV, it might take longer.”

The Gates Foundation, which earlier this week awarded $50 million for AIDS programs in Botswana, also gave $15 million to the Los Angeles-based Elizabeth Glaser Pediatric AIDS Foundation to improve women’s access to programs that reduce mother-to-child transmission of HIV.

In an unusual report released Wednesday, Dr. Philip Starks of UC Berkeley said that HIV may have evolved a unique strategy to increase its spread through the human population--increasing men’s sexual drive.

Sparks said that the virus causes levels of the male hormone testosterone to rise in men after they are infected. No such effect was observed in women, however.

“Males at risk, or in the early stages of infection, should be counseled that HIV infection may increase sexual desire,” he said.

Studies presented earlier in the week showed that many men who have sex with men are reverting to risky sexual behavior that had abated during the last decade. Some of those men may be bringing the epidemic into the female population, according to a new study by the Centers for Disease Control and Prevention. Now that infection of women by intravenous drug users has been largely brought under control, bisexual men may be the biggest source of infection of U.S. women.

Epidemiologist Linda Valleroy and her colleagues studied 3,492 gay and bisexual men in seven U.S. cities and found that 1 in every 6 had sex with women. A quarter of those men, who were ages 15 to 22, said they had recently had unprotected sex with both men and women. Seven percent of the men in the study were HIV-positive.