By 9:35 on a typical morning at a downtown Baltimore AIDS clinic, nearly a dozen HIV-positive children already wait impatiently to see the doctor. Some read or color with crayons; others stare straight ahead -- they are too sick to play.
The children are brought to this University of Maryland clinic by their HIV-positive mothers or by whatever adult remains in their lives in the wake of the AIDS epidemic: grandmothers, aunts, the occasional father, a foster parent.
Families like these are the focus today of the seventh annual World AIDS Day, an observance begun by the United Nations to call attention to the estimated 14 million people worldwide who are living with the virus that causes AIDS or who already have the disease.
Although recent advances have brought improved treatments and a new way of slowing the spread of the fatal virus among infants, the toll of the epidemic on families is a growing global tragedy, medical professionals say.
"There are so many losses for these children, my heart cries out," said Sue Hines, who has spent seven years as a nurse practitioner at the clinic. "Every day you can see the ripple effect."
About 25 percent of all babies born to untreated HIV-positive women are infected with the virus. And by 2000, as many as 126,000 children and adolescents nationwide may be motherless because of the disease, according to the Orphan Project, a New York research group.
In the same time span, more than 5 million children worldwide will have lost their mothers or both parents to AIDS, according to the World Health Organization. Last year, about 700,000 children were born to HIV-positive women in Africa alone.
To mark World AIDS Day in Maryland, where 5,637 people have died of acquired immune deficiency syndrome, Gov. William Donald Schaefer is urging those who know someone affected by the disease to drive with their headlights on during daylight hours.
"AIDS is a problem for all of us. We all have families and as the epidemic continues, those people who don't know anyone with AIDS or HIV will be rarer and rarer," said Dr. Joseph Horman, acting director of the state AIDS Administration.
L "We need to work together to defeat this epidemic," he said.
In addition, speeches will be given, proclamations made and candles lighted from Paris to Baltimore. Governments and institutions in about 180 countries are backing events that acknowledge the terrible toll and personal tragedies inflicted by the modern-day plague. They include:
* Distribution of more than $50,000 to local AIDS service providers by Baltimore's Health Education Resource Organization (HERO).
* Competitions about preventing AIDS and other sexually transmitted diseases held by government-run newspapers in China.
* An international AIDS conference being held in Saudi Arabia, where cases of AIDS are rarely reported.
* And, at a "summit" in Paris, public health leaders from 42 nations, including U.S. Secretary of Health Donna E. Shalala, are meeting to forge greater cooperation in the battle against AIDS. Leaders of participating nations hope to balance how AIDS funding is spent globally: About 92 percent of AIDS money now goes to wealthy nations where a fraction of AIDS cases occur.
The Paris group will consider a pledge that expresses the idea that "violations of human rights are co-factors in the spread of HIV," said the head of the U.S. national office of AIDS policy, Patricia Fleming, who is attending the summit. "Homophobia, racism and sexism are vehicles for HIV if each person is not empowered to defend him or herself from the virus."
Maryland records show that in the 12 months ending in September, the state's AIDS caseload increased by 2,720.
Nationwide, the total number of people with AIDS grew by 85,260 in the year ending in June, the latest 12-month period tracked by the Centers for Disease Control and Prevention in Atlanta.
Despite such increases, many doctors, researchers and activists express cautious hope as they contemplate medical advances since the last World AIDS Day.
"This is a year with promise. If you had asked me last year, I would have been negative. This year there has been remarkable change in treatments and in hope," said Dr. Peter Vink, director of the pediatric AIDS program for the University of Maryland Medical Center.
A key advance came when a study showed that the drug AZT, when administered to HIV-positive pregnant women, can dramatically reduce the transmission of HIV to newborns.
"This is the first 'clean needle' or 'condom' for infants -- the first chance to intervene in the transmission of HIV to babies," Dr. Vink said.
That pathway of HIV infection poses an enormous public health problem in developing countries in Africa, Asia and South America, where millions of people have AIDS or HIV and where infection rates among childbearing women can reach 30 percent in some areas.
Figures on how many Maryland children are infected with HIV -- or have been orphaned by the virus -- are not available. But 140 HIV-positive children are being treated at Dr. Vink's clinic alone. And another 80 to 100 children who were exposed to HIV at birth, but are too young to be tested conclusively, also receive care.
"The story of the year is the study showing that we can prevent perinatal transmission from mother to baby," said Dr. John Bartlett, chief of the infectious disease division at the Johns Hopkins Medical Institutions. "There is also an evolving enthusiasm for a much more aggressive use of the drugs we have now and some that are on the horizon."
As better treatments are developed, children and adults with AIDS are living longer than before and with an improved quality of life.
"Last year there was a general defeatist feeling in the community," said Greg Satorie, president of Baltimore's People With AIDS Coalition.
But this year, "there is some renewed hope on the scientific front," he said. "Right now there is no cure, but treatments -- combinations of AZT and other drugs -- show signs of hope of delaying the onset of AIDS. Maybe if you add a few years to your life, the next development will come along."
Here are some of today's public observances of World AIDS Day:
* City Hall ceremony: noon, 100 N. Holliday St. The city Health Department and the Black Mental Health Alliance will present music, proclamations and testimony from families affected by AIDS.
* University of Maryland College Park: 12:30 p.m., Art-Sociology building. Reading, music and exhibits, including "Significant Losses, Artists Who Have Died of AIDS."
* Vigil in Towson: 6 p.m., Goucher College chapel. In a candlelight ceremony, a father and his 10-year-old daughter will describe their family's struggle with AIDS.
* Annual Baltimore vigil: 6:30 p.m., Mount Vernon Methodist Church, North Charles Street at Mount Vernon Place. Music and speakers. Candles provided.
* Ecumenical ceremony in Columbia: 7 p.m., Oakland Mills Meeting House, 5885 Robert Oliver Place. Candlelight vigil.
9- * Cumulative total AIDS cases since 1981:
Maryland .. .. .. .. . ..10,140
U.S. .. .. .. .. .. .. .401,749
* Children diagnosed with AIDS since 1981:
Maryland .. .. .. .. .. .. .201
U.S. .. .. .. .. .. .. .. 5,734
* AIDS cases per 100,000 residents:
Maryland .. .. .. .. .. ...45.1
Highest in U.S. (D.C.) ...273.1
Lowest (South Dakota) .. ...2.4
* Elsewhere: adults with HIV or AIDS since 1981:
Africa .. .. .. .. ...10,000,000
Southern Asia .. ... ..2,500,000
and Caribbean .. .. ...2,000,000
Western Europe .. .. .. .500,000
and Middle East .. .. ...100,000
and Central Asia .. .. ...50,000
East Asia/Pacific .. .. ..50,000
Australasia .. .. .. .. ..25,000