"We are working extremely hard to save five years of gains," said Adrienne Germain, president of the International Women's Health Coalition in New York, which assists groups in the developing world.

At Unifem, the United Nations development program for women, Stephanie Urdang, the adviser on sex and the virus that causes AIDS, said the voices of women in the third world are clear on this issue: women there cite property laws and cultural practices among the obstacles to protecting themselves against the disease, which is particularly ravaging sub-Saharan Africa.

"For example," Ms. Urdang said, "there is the belief in Africa and Asia that if a man sleeps with a virgin, he'll be cured."

She also noted the practice in which a widow is married off to her deceased husband's brother.

"Of course," she said, "in many cases the husband will have died of H.I.V.-AIDS, and she might be infected and will infect his brother."

Ms. Urdang continued: "Another practice that is very, very devastating is that women do not have land rights and property rights in most of sub-Saharan Africa, which means they are allocated a plot of land to work on in order to produce food for the family."

"But if the husband dies, they have no right to that land anymore, or even the house that the husband would have built for them. It's taken over by the husband's family, which is within customary law, and then they are left destitute."

"And if he's died of AIDS, what regularly happens is that the first person to be diagnosed in the family is the pregnant wife, because she'll go to a clinic and will be tested. Then she'll be looked at as the cause of the disease."

Noeleen Heyzer, executive director of Unifem, argues that to combat AIDS, governments and international agencies will have to focus on the particular needs of women, who are often denied medicines.

"We've talked for so long about the need to really look at gender in all aspects of development work," Ms. Urdang said. "With H.I.V.-AIDS, it is so much clearer because it is an issue of life and death."

"When you look at why this is happening," she added, "it's so much the cultural practices and values and beliefs that underlie our societies that discriminate against women."

Ms. Germain, who formerly directed programs in Bangladesh for the Ford Foundation, said women's groups there and in India and Nepal were raising similar warnings about the folly of ignoring social attitudes. She said that in South Asia, the disease was spread in somewhat different ways.

In India, for example, "there is quite a bit of unrecognized homosexuality, especially early among men, who then marry later, with their wives not having any idea that they had earlier relationships" that might have involved risky sex.

She added that women in India are often totally uninformed about sex when they are married, that the marriages are often to older men and arranged by their families. Women are then under great pressure to produce sons, and the use of contraceptives, specifically condoms, is out of the question.

And across Asia, Ms. Germain continued, "you have intravenous drug use, which in itself is a very important part of the picture, but can also lead into sexual prostitution and trafficking." Migrant labor, long-haul trucking, rail networks and the military all move infections around India, she said.

In most of South Asia, illiteracy among women is the highest anywhere, and there are few health centers attentive to the needs of women in rural areas.

The American Foundation for AIDS Research (Amfar) reported recently that as many as 30 million Indians could be infected by 2010.

Prostitutes in Asia, some of them now organized in self-help organizations, have long complained that their customers refuse to use condoms, which in any case are not always available. This month the government of Vietnam said it had found that 20 percent of prostitutes it had studied were H.I.V.-positive.

"In India," Ms. Germain said, "the low status of women, the economic dependence, the marriage patterns, all of these factors are going to mean that women are much less likely than even women in Africa to be able to negotiate condom use or to have any say at all about when sex occurs. Much more needs to be understood about the relationship between women's status and the epidemic."

Family-planning programs in India have played down the use of condoms, though a new government program for fighting AIDS is now trying to make them more accessible, Ms. Germain said. "We need to work with young people and get to both girls and boys early," she said, "and not in just the conventional sex education mode."

She recommended more education in sexual behavior that "emphasizes gender equality and power relations and sexuality more broadly, not just biologically."

"But there are a lot of taboos against doing that," she said. "The need to get information to young people is critical. But the political will doesn't yet exist."

Copyright 2001 The New York Times Company