The global battle against HIV will ultimately fail unless serious progress is made on women's rights in the developing world, the UN AIDS chief warns.

The pandemic is increasingly taking on a feminine face as it enters its globalization phase, but current prevention strategies are of little use to the millions of them who do not have the power to say no to sex or to insist on condom use.

The lack of women's equality - from poverty and stunted education to rape and denial of women's inheritance and property rights - is a major obstacle to victory over the virus, according to the latest global HIV status report published on Tuesday by UNAIDS.

Dr Kathleen Cravero, deputy chief of UNAIDS, said current HIV prevention strategies that urge women to abstain from sex until marriage, be faithful to their husbands and to use condoms, are inadequate.

"They are not female-centred strategies and they are not responding to the realities of women's lives," Cravero told a news conference in London.

Researchers have found that women need more than just information, she added.

"We are finding in most regions of the world, they simply do not have the economic and social power or choices, or control over their lives to put that information into practice," Cravero said.

AIDS prevention strategies need to address the factors that will give women control over their lives, the report said.

"Moving to a situation where every woman gets to keep her house, her land and her furniture when her partner dies is not beyond the realm of possibility," Cravero said. "It doesn't even require turning society on its head. It requires getting the right laws there and making them enforceable for women."

AIDS has to be the catalyst for women's rights in the developing world, UNAIDS chief Dr Peter Piot said.

"There was reason enough before AIDS, but now the link between the whole gender inequality and death has never been so direct as with AIDS," Piot said. "If AIDS is not enough to shift the agenda for women, then what is enough?"

"It's time now for the women's movement and the AIDS movement to find each other, and that hasn't happened yet," Piot said. "Ultimately, without putting women at the heart of the response to AIDS, I don't think we will be able to control this epidemic."

Violence against women is a worldwide scourge, but it is feeding the HIV epidemics in the developing world, where women and girls often do not have the power to say no to sex. For millions of other women, sex is their only currency.

"The fact that the balance of power in many relationships is tilted in favor of men can have life-or-death implications," concluded the report by UNAIDS. "These factors are not easily dislodged or altered, but until they are, efforts to contain and reverse the AIDS epidemic are unlikely to achieve sustained success."

Nearly 50 per cent of the 39.4 million people infected with HIV worldwide are women. In regions where the epidemic is mature, more women are infected than men, and in countries where epidemics are just beginning, new infections among women outnumber those among men and the gap continues to widen.

East Asia experienced the sharpest increase in the number of women infected with HIV in the past two years - 56 per cent. Eastern Europe and Central Asia come next, with infections among women rising 48 per cent in the past two years. In the Caribbean, which is the second worst hit area of the world after sub-Saharan Africa, young women are twice as likely as men their age to become infected.

Part of the reason for the rapid increase is that it is physically easier for women to get HIV through intercourse than it is for men to get it from women. However, in many parts of the world, especially in Asia, more women than men are now getting the disease because the virus has escaped the confines of brothels.

Twelve years ago, about 90 per cent of HIV transmission in Thailand was occurring between prostitutes and their clients. But now, about half of all infections are occurring in the wives of men who visit prostitutes.

In many parts of the world, stressing marriage and long-term monogamous relationships does not protect women from AIDS because they are unable to control whether they have sex. The approach - favoured by the American anti-AIDS package - also could backfire in areas where being married actually increases the risk of contracting HIV, research has found.

One study conducted in several areas of Kenya and Zambia found that among teenage girls, HIV infection levels were 10 per cent higher for married girls than for those who were sexually active but not married. Similar findings have been reported in Uganda.

Shortage of health workers

Efforts to combat diseases such as malaria, AIDS, tuberculosis and polio in the developing world are being thwarted by a critical shortage of 4 million health care workers, a new report has found.

Money is beginning to flow for health programmes in poor countries and drugs, vaccines and technologies are now more available than ever, but it is of little use without the health workers to deliver the care, concluded the report outlined this week in The Lancet medical journal.

"What we do, or what we fail to do, will shape the course of global health for the entire 21st Century," said lead investigator Dr Lincoln Chen of Harvard University.

The report is the result of two years of analysis by the Joint Learning Initiative - a consortium of more than 100 health leaders worldwide.

It documents for the first time the dangerous scarcity of doctors, nurses, midwives and community health workers in the developing world.

"On the front line of human survival, we see overburdened and overstressed health workers, too few in number, without the support they so badly need, losing the fight," said the report.

Many of the weakest health systems are the most besieged by HIV. In some countries, it is killing health workers faster than they can be replaced.

The ones that are left are often working in dire conditions, where supplies, drugs and facilities are depleted, the report found.

Scores of doctors and nurses are fleeing to richer countries for a better life and more rewarding work.

The report found, for instance, that there are more Malawian doctors in Manchester, England than in Malawi, and that only 50 of the 600 doctors trained in Zambia since that country's independence stayed.

Experts estimate that countries need at least one health worker for every 400 people. About 75 countries, with 2.5 billion people, fall below that minimum threshold, the report found.

In Uganda, for example, there is only one nurse or midwife for every 11,365 people, while Liberia and Haiti have one per 10,000.

Shortages are most severe in sub-Saharan Africa, where HIV medications sometimes exist, but hardly anyone is available to distribute them. About 1 million new health workers - triple the current number - are needed immediately there to boost collapsing health systems, the scientists found.

The Joint Learning Institute is funded by the Rockerfeller Foundation, the World Bank, the World Health Organization, the Bill & Melinda Gates Foundation, among others.

Antibiotics for babies

Babies of HIV-infected mothers should be given an inexpensive antibiotic to prevent infections and prolong their lives, United Nations aid agencies said on Tuesday.

The recommendation by the UN Children's Fund (UNICEF), UNAIDS and WHO follows a report in The Lancet medical journal on November 19 that a daily dose of the drug co-trimoxazole nearly halved the death rate in children.

Trials, involving children aged 1 to 14 years in Zambia, lasted 19 months and the drug deemed a big success.

The UN Agencies, in their joint advice to health ministries and aid workers, said that co-trimoxazole was a "crucial potentially life-saving intervention that should be given to all HIV exposed children born to HIV-infected mothers."

It should be offered as "part of a basic package of care to reduce morbidity and mortality," the agencies said.

Treatment should begin in children from 4-6 weeks of age and should continue until HIV infection has been definitively ruled out and the mother is no longer breastfeeding, they said.

It should be used before children require antiretroviral drugs "because it may even postpone the time at which antiretroviral therapy needs to be started," the joint statement said.

Jim Kim, director of WHO's HIV department, said: "This is an important piece of information which we hope to get out so that ministries of health change practices very quickly. We'd be happy if it is implemented in the next six months."

Everybody must fight AIDS

Former South African President Nelson Mandela, surrounded by rock stars, launched a book of photographs of a major anti-AIDS concert on Thursday with a call to ordinary people to take a lead in the fight against HIV/AIDS.

"We all have a responsibility to act. Each of us must do more. We are all leaders now and good leaders must lead," he told a news conference at the book launch in London.

The 46664 concert in Cape Town last year took its name from Mandela's prison number during his nearly 27 years in apartheid jails. Some 30 artists from Bob Geldof to Bono took part and the concert was beamed to an audience of up to two billion people.

The frail 86-year-old said it was not enough to rely on governments and the international drug companies - which were not doing enough - to stop the disease that infects 37.2 million people worldwide.

(China Daily 11/27/2004 page6)