The explosion in the world's poorest countries of AIDS, or of infection with the virus that causes it, is turning back half a century of progress in making life healthier for children, the director of the United Nations children's fund says.
"The implications are quite extraordinary," said Carol Bellamy, executive director of the agency, Unicef. "In 23 countries, largely in sub-Saharan Africa, we already see H.I.V.-AIDS virtually reversing the gains that have been made in child survival.
"More children are dying and they're dying sooner, even though your immunization programs might be more successful," she said. "The fact is that improvements that were being made are being reversed. Not just stalled. Reversed."
What United Nations experts now call an AIDS pandemic, coupled with the increasing vulnerability of millions of families to the disruption and violence of civil wars, is forcing agencies dealing with children to rethink priorities and to introduce new programs, officials say.
"This pandemic is hitting most harshly, at this point, in southern Africa and eastern Africa," Ms. Bellamy said last week before leaving for a news conference in London, in advance of United Nations AIDS Day on Tuesday, where new AIDS figures were made public by the World Health Organization and the joint program called U.N. AIDS, in which Unicef takes part.
"Botswana, for example, is losing 20 years in life expectancy in just abut a five-year period," Ms. Bellamy said. "It's not a country in conflict, or a country at war. It's stable."
At the news conference, AIDS experts announced that the number of cases worldwide of people living with the human immunodeficiency virus, which causes AIDS, had grown by 10 percent in a year, to 33.4 million.
For Unicef, the AIDS crisis poses a range of problems. The number of orphans is soaring, Ms. Bellamy said. "It is expected to grow -- and these are guestimates -- to 40 million by the year 2020."
In eight sub-Saharan countries, more than 25 percent of children under 15 have already lost at least one parent, she said. These children are more likely than others to drop out of school and are less likely to be brought to clinics for vaccinations.
Because AIDS strikes hardest at the 10-to-24 age group, Unicef, which is identified mostly with programs for early childhood, will have to concentrate more on adolescent sex education, she said, something that is not always popular among donors. The fear of transmission of the AIDS virus is also forcing Unicef to modify, to some extent, its strong preference for breast-feeding.
"We are not reopening the discussion about breast-feeding being the best thing you can do for your child -- except, yes, you specifically open it around the subject of mother-to-child transmission," Ms. Bellamy said. "It's not something that can be ignored."
Ms. Bellamy said that because half of the 7,000 new cases daily are among young people, the best hope of stopping the rapid spread of the disease lies in creating intensive education programs and in encouraging peer-group projects.
"This is one ray of hope," she said. "The future does lie in adolescents' hands and if there could be more effort, really very concentrated advocacy, information and services programs focused on adolescents, there is some potential for getting control of this pandemic."