NYT19980628.0108 NEWS NEWSWIRE Pleas for national leaders to muster the political courage to carry out strong prevention programs to stop the global epidemic of AIDS were sounded at the opening of the 12th World AIDS Conference here Sunday. Saying that the world is facing a ``runaway epidemic,'' Dr. Peter Piot, the head of the U.N. AIDS program, told the conference that ``it is time to embrace a new realism and a new urgency in our efforts'' to overcome complacency about HIV, the virus causes AIDS. ``This epidemic is out of control at the very time when we know what to do, and what to do now,'' Piot said in pointing to areas in Africa where one in four adults is HIV infected. Other speakers said there was clear and increasing evidence that condoms for men and women, sex education, public information campaigns, short courses of drugs to reduce mother-to-child transmission of HIV, needle exchange programs for injecting drug users and other measures can prevent HIV. The female condom, speakers said, was giving women more choice in protecting themselves against HIV. More than 18 million female condoms have been sold since 1992. The United Nations has negotiated a program in which 4 million female condoms were sold in developing countries last year at a cost of from 50 cents to 90 cents, compared to $2 to $3 in the United States. Scores more millions of male condoms have been sold to combat HIV since the AIDS epidemic was discovered in 1981. Such preventive measures have slowed down HIV infection rates in developed countries and a few developing countries like Senegal, Thailand and Uganda, but Piot said more should be done. ``Why is it, despite our efforts, that 16,000 people a day are still getting HIV when the infection is preventable?'' he asked. ``It's a collective failure of the world.'' Dr. Ruth Cardoso, Brazil's first lady, said ``the AIDS epidemic is a global public health priority.'' ``Governments everywhere must be called upon, once and for all, to stop adopting the self-defeating attitude of downplaying the problem's urgency and to take on the fight against AIDS as a major priority for their national agendas,'' she said. Brazil ranks fourth on the United Nations's list of infected countries with 580,000 adult carriers of HIV, while AIDS is Brazil's second-leading cause of death among 20- to 49-year-olds, Dr. Cardoso said. In Brazil she heads a government-civilian program to combat poverty and social ostracism. Ruth Dreifuss, the Swiss minister of interior, health and social affairs, said the benefits of ``targeted prevention campaigns far exceed their supposed negative effects.'' ``Sex education and the promotion of condoms among young people works and does not lead to an increased number of sexual partners,'' Ms. Dreifuss said. She added that drug users have access to free needle exchange programs in Switzerland and that has drastically reduced the sharing of needles, a source of HIV transmission. She also said that 87 percent of the Swiss population supports such measures. Critics pointed to the U.S. government's lack of financial support for needle exchange programs that researchers have shown to be effective in reducing HIV infections. In April, Secretary of Health and Human Services Donna Shalala endorsed the use of needle exchanges but declined to help communities with federal money to run such programs. Asked about the discrepancy between the scientific findings and Clinton administration policy on needle exchange programs, Dr. Helene Gayle, who heads the AIDS program at the Centers for Disease Control and Prevention, said: ``We all know that science should be the basis of our policy. But it's not a perfect world. People in policy roles juggle a lot of things. Needle exchange is a complex issue in a complex world.'' Financing for prevention has not kept pace with the epidemic, and in some cases has actually declined as the number of people affected by HIV has increased, Dr. Peter Lamptey, who heads an AIDS program for Family Health International in Research Park Triangle, N.C., said at a separate meeting on AIDS prevention here Sunday. With more than 13,200 scientists, health workers, government officials and representatives of anti-AIDS groups registered on the first day, this is the biggest such conference since the first was held in Atlanta in 1985. More than 10 million people have become infected with HIV since the last AIDS conference in Vancouver in 1996. About half are under age 25.