NEW YORK (Reuters Health) - Nearly one in every five young women in Kenya is now infected with the virus that causes AIDS, according to a new study. Researchers point to a basic lack of knowledge as the main culprit behind the explosive spread of HIV in the East African nation.

For example, when asked, just 7% of Kenyans knew that existing medications can help prevent the transmission of HIV from a pregnant woman to her fetus, according to researchers led by Dr. Mark Hawken of the Kenya Medical Research Institute in Nairobi.

"This study emphasizes the vulnerability of young (Kenyan) adults, particularly young women, to HIV infection," conclude the authors, who published their findings in the December 15th issue of the Journal of AIDS.

Experts estimate that a full 2 million of Kenya's population of 24 million are now living with HIV. In their study, Hawken and his colleagues conducted interviews and HIV tests among nearly 1,500 Kenyans ranging from 15 to 49 years of age living in the coastal city of Mombasa.

They found that 8% of men and nearly 14% of women carried the virus that causes AIDS. As is typical across Africa, women are at much higher risk of becoming infected with the virus due to a combination of physiological and social factors. The gender gap was most pronounced among young people in their late 20s, with close to 21% of women aged 25-29 testing HIV-positive, compared to just 8.4% of men.

Many young Kenyans may be contracting HIV because they have little or no idea how to prevent infection, the authors report. Four percent of women were unable to name even one method--condom use included--of reducing risks for sexual transmission of HIV, and 37% erroneously believe that not having sex during pregnancy can reduce mother-to-fetus transmission of the virus.

This lack of knowledge may be discouraging use of condoms and/or HIV therapy among young Kenyans. According to the researchers, just 22% of women and 45% of men said they had ever used condoms during sexual intercourse.

But other findings offered researchers a glimmer of hope. For example, while HIV rates were high in the 25-to-29-year-old group, they were markedly lower among Kenyan teenagers, with the infection "gender gap" shrinking considerably among teens, as well. To the researchers, these findings suggest that AIDS education may be having a "significant impact" on school-age Kenyans, reducing promiscuity and raising levels of condom use.

Further efforts are needed, however, and Hawken's team believes there is now "a large window of opportunity for appropriate, targeted sexually transmitted infection and HIV prevention interventions" to help slow the spread of HIV in Kenya.

SOURCE: Journal of Acquired Immune Deficiency Syndromes 2002;31:529-535.

By Alan Mozes

NEW YORK (Reuters Health) - Older men and women who provide much of the care and support for people with AIDS in sub-Saharan Africa are experiencing crushing physical and psychological hardships, World Health Organization (WHO) researchers say in a new report.

"Older caregivers are under serious financial, physical and emotional stress due to their care-giving responsibilities," WHO researchers state in the publication "Impact of AIDS on Older People in Africa."

The research team, led by Robert deGraft Agyarko of WHO's Geneva-based Aging and Life Course division, chose the sub-Saharan African nation of Zimbabwe as a case study to investigate the role of older community members in caring for adults and children with HIV/AIDS.

Agyarko and his colleagues point out that such care is tremendously important in a world where at least 40 million people are estimated to be living with HIV/AIDS. Sub-Saharan Africa, in particular, accounts for almost 85% of all AIDS deaths and is the locale for 70% of all new HIV infections.

The researchers interviewed 685 men and women 50 and older living in six rural and urban provinces in Zimbabwe. Women formed more than 70% of the sample.

Most study participants were either current or former main caregivers for a family member who was terminally ill with AIDS, or for one or more children orphaned by AIDS. Some participants were not main caregivers, but rather heads of households in which a terminally ill AIDS patient resided.

The researchers found that most of the terminally ill patients were the caregivers' sons or daughters--nearly three quarters of whom were between the ages of 15 and 49. The older people surveyed also cared for grandchildren, spouses, heads of households, in-laws, brothers, sisters, cousins, nieces and nephews, and most cared for at least one orphan--defined as a child who had lost at least one parent.

Most older caregivers lived in poverty. Over half were peasant farmers, and one quarter were unemployed. Almost nine out of every ten caregivers earned no regular monthly or yearly income. Subsistence farming, gardening, baby-sitting, ironing and begging were the principal means by which the caregivers made ends meet.

Limited resources notwithstanding, the older caregivers were called upon as the sole providers of a wide range of physical, emotional and financial assistance, such as washing patients and their clothes and providing food, care and companionship.

Older caregivers generally receive little recognition for their efforts from their community, local health caregivers or government leaders, WHO states. Nearly two thirds said they suffered from a range of community abuses--such as AIDS-related stigma or verbal and physical violence.

Additionally, less than one third described their own health as good. Nearly 60% who said they were in "poor health" attributed this problem to the fatigue, stress and burnout that accompanied their role as primary caregiver.

Nonetheless, many elder caregivers reported feelings of compassion and satisfaction from the task.

The researchers concluded that such older caregivers urgently need more support. Governments should, they suggested, provide older caregivers with better access to health care via improved transportation and subsidized medicines. As well, governments must enable the elderly to provide AIDS care by helping them find ways to earn income and offering them psychological counseling and material supplies--while promoting AIDS awareness throughout the population, the researchers say.

In an interview with Reuters Health, Agyarko said that the quality of life of both AIDS orphans and those living with AIDS across Africa would be greatly improved by empowering their caregivers emotionally and financially.

"Support for these older guardians (will) improve their efficiency and widen the support network needed, in response to an increasing demand for patient care," he said.

MBABANE (Reuters) - The tiny African kingdom of Swaziland has acknowledged for the first time that it has one of the highest AIDS rates in the world, with almost 40 percent of Swazi adults now infected with the HIV virus.

Prime Minister Sibusiso Dlamini, in a New Year's address printed in newspapers Thursday, said the country's official AIDS prevalence rate had risen to 38.6 percent from 34.2 percent in January 2002.

"It is enormously disappointing that the education and prevention initiatives of the past year have had so little effect," Dlamini said.

The new figure puts Swaziland just behind Botswana for the highest AIDS prevalence rate in the world.

The latest United Nations estimates in early 2002 said that Botswana had a 38.8 percent rate, Zimbabwe had a 33.7 percent rate and the tiny kingdom of Lesotho 31 percent.

Swazi officials have traditionally been circumspect in discussing the AIDS crisis in the country, which is also struggling with severe food shortages that have left almost a quarter of its one million people hungry.

Dlamini's speech cited AIDS statistics from an unreleased health ministry report based on a 2001 survey of pregnant women and women giving birth at government hospitals.

The data was used as a basis for determining the HIV prevalence rate for the general adult population. Last January, a similar study found a national infection rate of 34.2 percent.

Health officials have conceded that the actual prevalence rate is probably higher. "The report is months old, and the figures are probably out of date," one official told Reuters.

Dlamini promised that anti-retroviral drugs, the only treatment available to slow the disease, would be available next month at government hospitals to help prevent transmission of HIV from infected mothers to their unborn children.

He acknowledged that AIDS deaths have cut the agricultural workforce, worsening a food crisis brought on by crop failures last year. Dlamini said starvation was occurring in parts of the country, something the government has not said before.

Activists said they would await signs of concrete action from the government, particularly on providing AIDS-fighting drugs, before declaring that the country had turned a corner in its fight against the disease.

Swaziland's population prior to the onset of AIDS was projected to be 1.2 million in 2000. The population today is about 970,000, with 20,000 HIV-positive Swazis developing full-blown AIDS annually.

A UNICEF report projects that by 2010 about 15 percent of the population will be comprised of underage orphans who lost their parents to AIDS.

There are concerns about HIV-positive nurses

By BARRY SCHWEID, AP Diplomatic Writer

WASHINGTON (AP) - The State Department is seeking substantial budget increases to fight the global AIDS epidemic and to counter terrorism, including more than $1 billion in new funds to tighten security at embassies, officials say.

High on the department's wish list is $100 million to hire an additional 399 officers for Secretary of State Colin Powell's initiative to promote U.S. foreign policy, said the officials, speaking only on condition of anonymity.

The battles against terrorism and AIDS, a more quiet foe that claimed 3.1 million lives around the world in 2002, have helped shape the department's request to the White House budget office for the fiscal year that begins Oct. 1.

President Bush is to submit his budget for fiscal 2004 to Congress early next month. In the meantime, Congress has not completed action on the department's spending requests for the current fiscal year, which include more than $16 billion to combat terrorism.

The 2004 budget will aim to sustain a broad effort against terrorism that involves economic assistance, foreign military training and economic development.

A wave of anti-American and anti-Western sentiment has translated into attacks and spurred increased security at U.S. embassies.

Powell's initiative is designed to fill vacancies in the foreign service and to place new emphasis on teaching foreign audiences what the United States is trying to accomplish.

A senior department official declined to provide the precise amount that department would seek in counterterrorism spending.

Powell, meanwhile, has given high priority to the struggle against the HIV/AIDS epidemic.

"The positions we hold in our governments give our voices resonance at home and abroad," he told a group of foreign ambassadors last month. "We can and must use our voices to convince others of the urgency and gravity of this global problem."

Powell said every nation — regardless of its size, economic status or political strength — is vulnerable to the disease.

As the department prepared its requests, six former national security advisers who have served both Democrats and Republicans asked Condoleezza Rice, who now holds the job, to support a substantial increase in foreign spending.

In real terms, foreign spending was 30 percent higher during the Reagan administration, they wrote Rice.

"Our diplomats will play a critical role in assembling coalitions that will defeat global terrorist organizations, and they need the tools to do the job," they said in a letter obtained by The Associated Press.

The six former officials — Frank C. Carlucci, Zbigniew Brzezinski, Anthony Lake, Richard V. Allen, William P. Clark and Brent Scowcroft — said they were confident Congress and the public would support a substantial increase in spending.

The boost, they said, "will serve as a vital complement to military and intelligence upgrades in this country's long battle against global terror."

Powell's push for more security is reflected in a multiyear plan that Congress financed with more than $1 billion for fiscal year 2002, with a request for like amounts in fiscal 2003 and 2004, the official said.

At the same time, Powell has made a point of hiring more officers for the foreign and civil services. That effort began with 300 new positions in 2002, and funds for the same number in the next two years. That will cost about $100 million each year, the official said.