HIV/AIDS

The epidemic of HIV/AIDS is unprecedented, having expanded from a new disease to the leading cause of death in Sub-Saharan Africa in just over two decades. Despite some clear examples of success, such as Senegal for prevention, and Uganda for control, major new measures are needed to avoid further devastation. The epidemic in Africa is uneven, with the greatest burden in southern Africa, where populations are already experiencing major reductions in life expectancy and a reversal of progress in the management of national economies.

About two-thirds of the world's HIV infections are in Sub-Saharan Africa in just 10 percent of the world's population. Because HIV/AIDS in the Americas and Europe is uncommon in women and rare in children, Africa holds more than 90 percent of the world's burden on such issues as child mortality and the care of orphans.

At present, prevention strategies are largely limited to education for changes in sexual practices and the use of condoms. Vaccines and microbicides represent an extremely important area of research, but useful products are not likely to be available in less than 5 to 10 years. ARV drug treatment programs have begun in Africa but are as yet very modest in impact. Operational research to maximize the benefits of ARV use will be important to address treatment efficacy and drug resistance, the impact on health manpower resources, and cost-effectiveness. The full devastation of AIDS in Africa has yet to be fully appreciated. Still, an increase in awareness and willingness to act should give cause for optimism.