Study Cites Growing Ranks of AIDS Orphans

The number of children worldwide who have lost at least one parent to AIDS has skyrocketed from 1 million in 1991 to 13.4 million this year, and the total will double by 2010, according to an international report issued here Wednesday at the 14th International AIDS Conference.

“This is one of the most shocking reports released at this conference,” said Dr. Peter Piot of UNAIDS, an alliance of six United Nations agencies fighting HIV and AIDS. “The very fabric of society is disappearing with family structures that are crumbling.”

To put the numbers in perspective, officials said that the 13 million already “orphaned”--defined as having lost at least one parent to AIDS--is equivalent to the total number of children in the United States younger than 5.

The report noted that there are 34 million orphans in Africa, about one-third of them as a result of AIDS. By 2010, there will be 40 million orphans, half of them as a result of AIDS, said one of the report’s authors, Karen Stanecki of the U.S. Census Bureau. The AIDS orphans will account for 6% of the continent’s children.

The report also said there are now 65 million orphans in Asia, 2 million of them as a result of AIDS. That number is expected to grow to 5 million by 2010.

The report surveyed only those 15 or younger who had lost at least one parent to the disease. Poverty and other problems are so severe in the region that losing even one parent severely impacts a child’s ability to survive, become educated, and make a life. Such children are at very high risk of physical and sexual exploitation.

Officials also said that the numbers would continue to grow even in the highly unlikely event that HIV transmission suddenly ceased, because it will take many years for those now infected by the virus to develop AIDS and die.

“Even if today by some miracle the number of AIDS transmissions would stop, the number of orphans would continue to rise,” Piot said. “This is unprecedented except in times of war.”

In other news at the conference, researchers provided the first estimates of the cost of AIDS care in the United States.

The average cost for an HIV-positive patient is $14,000 a year, while care for those with AIDS averages $34,000 a year, Dr. Michael Saag of the University of Alabama at Birmingham told the conference.

“We knew it cost more to care for the sicker patients,” said Saag, who led the first comprehensive analysis of such costs. “This analysis shows how much more.”

Saag reached his conclusions by studying 700 patients at university clinics over a two-year period. But he used average wholesale prices for the drugs, so the figures may be conservative for many patients, he cautioned.

“Regardless of the stage of the disease, the majority of the cost is in the medications,” Saag said.

For people who are HIV-positive but showing no symptoms, those drugs cost about $11,000 a year. But as the illness progresses, the price of drugs to treat pneumonia, tuberculosis and certain cancers boosts the cost to about $24,000, Saag said.

The rest of the cost is primarily for hospitalizations. Clinic costs--the price of seeing a physician or nurse practitioner regularly--account for less than 2% of the average cost of care for all patients, averaging about $340 a year.

To deal with the high cost of AIDS care, a group of 15 Caribbean nations signed an agreement to get heavily discounted AIDS drugs from the manufacturers.

The new agreement will bring AIDS drugs to about 75,000 of the estimated 420,000 people in the region living with HIV or AIDS. That infection rate accounts for 2.3% of the region’s population, a prevalence second only to sub-Saharan Africa.

The agreement was announced Wednesday by Denzil Douglas, the prime minister of St. Kitts and Nevis. The six companies signing the agreement were GlaxoSmithKline, Roche Holding, Boehringer Ingelheim, Bristol-Myers Squibb Co., Merck & Co. and Abbott Laboratories.

The amount of the discounts will vary, depending on a country’s wealth. Some of the poorest countries will receive a 90% discount, equivalent to that given to some African countries.

Even so, “there are some countries that will still not be able to afford these prices--Haiti, Jamaica, Guyana, just to name a few,” Douglas said.

In other events, activists who had disrupted a Tuesday speech by U.S. Health and Human Services Secretary Tommy G. Thompson continued their controversial outbursts Wednesday afternoon, vandalizing two different booths at the exposition accompanying the conference.

Earlier in the day, they vandalized a booth operated by the European Commission, spray-painting “Shame” on the walls and plastering the booth with stickers asking, “Where is the $10 billion?”--a reference to the annual sum that UNAIDS says will be necessary to implement effective treatment and prevention efforts.

So far, wealthy nations have contributed less that $3 billion to this year’s proposed budget.

Speaking to reporters afterward, Octavi Quintana, director of health research at the European Commission, said, “I think the action was misguided.”

“The commission is responsible for a program of [nearly $900 million] a year as a response against AIDS,” he added. “You may say it’s a lot or not enough--probably it’s not enough--but I think it represents an important effort when you compare with what others are doing.”

Later, Spanish activists shut down a booth operated by the health ministry of the Spanish region of Catalonia, protesting the agency’s decision not to offer a needle-exchange program in the region’s prisons.

Security guards allowed the noisy but peaceful demonstrations to proceed, and both booths were reopened by the end of the day.