Grim News From the 13th International AIDS Conference

DURBAN, South Africa-Leading experts on HIV/AIDS gathered at the 13th International AIDS Conference, held for the first time in Africa, the continent most severely affected by the pandemic. Experts estimate that 70% of the 34 million people infected with HIV worldwide live in sub-Saharan Africa.

The face of AIDS in Africa is “a young person and increasingly a girl,” said Carol Bellamy, UNICEF director, in releasing the agency’s annual Progress of Nations report. She said that the highest HIV-infection rates among 15- to 24-year-old girls are in southern Africa: 34% in Botswana, 26% in Lesotho, 25% in South Africa, and 25% in Zimbabwe.

Karen Stanecki, of the US Census Bureau, presented new figures on AIDS mortality in Africa. She said that life expectancy in the hardest-hit countries is expected to fall to around 30 years within the next 20 years.

For example, in Botswana, with more than one third of the adult population infected, life expectancy is currently 39, rather than 71 as would have been predicted without the AIDS pandemic. This level of life expectancy “has not been seen since the start of the 20^th century,” she said.

These levels of infection and death from AIDS are “having a devastating impact on families, communities, societies, and economics,” former South African president Nelson Mandela said at the closing session of the conference. “AIDS is clearly a disaster effectively wiping out the development gains of the past decades and sabotaging the future,” he said.

A Rebuke to Mbeki

Shortly before the conference convened, some 5,000 scientists issued a letter containing “The Durban Declaration.” It states that the link between HIV and AIDS is “clear-cut, exhaustive and unambiguous” and calls for public health professional worldwide to focus on stopping the spread of HIV.

The statement was seen as a rebuke to current South African president Thabo Mbeki. At the opening session, he defended his controversial decision to convene a panel of scientists last May to explore whether HIV causes AIDS. He claimed that he formed the panel to educate himself about the disease and to explore an “African solution.”

Effects of Spermicide

Among the scientific presentations at the conference was a report that the spermicide nonoxynol-9 (N-9) may increase the risk of HIV infection if used very frequently. The agent had been thought to protect against the disease.

“It is an understatement to say that we were extremely disappointed,” said the study’s director Dr. Lut Van Damme, of the Institute of Tropical Medicine, Antwerp.

Prostitutes in South Africa, Benin, Thailand, and the Ivory Coast were randomized to receive an N-9 gel (Advantage-S) or a vaginal moisturizer. They were also provided with condoms and urged to use them. These women used N-9 up to 20 times a day. The researchers said there is no evidence that women who use the spermicide only once or twice a day have an increased risk of HIV. Dr. Van Damme said that use of N-9 probably increases the risk of HIV by irritating the vaginal lining, which may cause tears that allow entry of the virus.

The Gates Foundation

One bright spot at the conference was the announcement by the Bill & Melinda Gates Foundation, created by Bill Gates, founder of Microsoft, that it would spend $50 million in Botswana to improve the nation’s health care system. The amount will be matched by Merck & Co., primarily by provision of AIDS medications. The Gates Foundation also plans to donate $25 million to develop and test products to prevent the spread of AIDS.