The AIDS epidemic has robbed 15 million children of one or both parents and reversed a trend toward fewer orphans driven by better health and nutrition, a U.N. report said on Tuesday.

With HIV infection rates rising and the incurable disease taking 10 years to kill without treatment, an estimated 18.4 million children will have lost at least one parent by 2010, according to the UNICEF report released at the 15th International AIDS Conference.

“It is a tidal wave of children who have lost one or more of their parents,” Carol Bellamy, executive director of UNICEF, the United Nations children’s agency, told Reuters.

“Fifteen million globally, close to 12 million in sub-Saharan Africa alone,” she said. “It has the possibility of destabilizing societies quite dramatically.”

Without the AIDS epidemic, which has already killed 20 million people worldwide and infected 38 million, the numbers of orphans would be falling because of better health care and nutrition. AIDS has reversed the trend.

Much of the AIDS meeting that began on Sunday has been focused on money, improving universal access to life-prolonging drugs and wrangling over whether abstinence or condoms is the best way to prevent new infections.

But children’s activists argue that the plight of orphans and vulnerable children is not getting the attention it deserves within the overall AIDS effort.

“In some ways orphans are one of the orphaned issues at this conference,” said Dr Joanne Carter, legislative director of RESULTS, an international anti-hunger and anti-poverty group.

“It’s clear that what is left in the wake of the AIDS pandemic is these kids. These kids are the futures of their society and they have been largely forgotten by the global community,” she added.

U.S. Congresswoman Barbara Lee, a Democrat from California and the only member of Congress at the week-long meeting, described the orphan crisis as “mindboggling.”

“The world cannot stand by and watch this occur,” said Lee, the author of legislation to help orphans and vulnerable children which has passed the U.S. House of Representatives and is attracting support in the Senate.

In Asia, where the AIDS epidemic began relatively recently and HIV prevalence is still low, the number of orphans has dropped since 1990. But if HIV expands, as many experts fear it will, so too will the number of orphans.

More than any other cause of death, AIDS is more likely to deprive children of both parents. They face discrimination because a parent has died of AIDS, abandonment if relatives cannot or will not care for them, and the responsibility of caring for younger siblings. They may be infected themselves.

They may also be deprived of guidance and education and will be more vulnerable to violence and exploitation.

The UNICEF report calls for more funding for programs to help families and the community cope with the crisis and to ensure there is education, health care and legislation to protect orphans.

“Much too little is being done,” said Bellamy.

“Simple things could make a big difference when it comes to AIDS orphans and could give these children an opportunity for the future.”

Medicins Sans Frontieres (MSF), a leading medical and humanitarian organization, said treating children with HIV/AIDS was an uphill battle because drugs and diagnostic tests have not been adapted for them.

“We need to pay more attention to them. They are not just small adults. There are specific issues in terms of diagnosis and specific issues in terms of treatment,” the MSF’s David Wilson told the conference being attended by more than 17,000 people.

Geneva-based MSF pharmacist Fernando Pascual said drug companies were ignoring the treatment of children, for whom there are none of the fixed-dose combinations available to adults.

“They will not produce formulations for children unless there is pressure from the international community,” he said.