AIDS in Africa: A Reality Check

It is hard for us in the United States to understand the enormity of the AIDS epidemic in Africa. there are countries in which close to one third of all adults are infected with HIV/AIDS, and few receive the effective antiviral treatments that allow Americans with AIDS to live with the disease.

One of the few bright spots has been a flood of money to Africa to pay for antiviral drugs. Sadly, it appears that this flood of money is not enough--inflections are growing faster than the numbers treated. Put bluntly, the failure of prevention programs is greater than the success of treatment.

The Washington Post has a very sobering article about the reality in Africa.

Amid the morning bustle of Johannesburg Hospital's AIDS clinic, Francois Venter darts from room to room, poking his head inside and asking both doctor and patient, "Are you okay?"

More and more, they are. The clinic he helps oversee is one of the continent's best at distributing antiretroviral drugs. The waiting room fills each day with more than 100 patients whose full faces contradict the stereotype of hollow-cheeked Africans with AIDS.

But beyond the walls of this hospital, Venter says, doctors are not winning -- and probably cannot win -- the war against the epidemic, because it is spreading far more quickly than doctors are treating its victims. Even as billions of dollars are spent expanding access to antiretroviral drugs, the goal of controlling AIDS in Africa remains remote.

"At the moment, I just see a never-ending sea of disaster," said Venter, 37, the dark-haired, long-limbed president of the Southern African HIV Clinicians Society.
Underlying his frustration are grim statistics: For every South African who started taking antiretroviral drugs last year, five others contracted HIV, the same ratio as on the continent as a whole, U.N. reports say. A South African turning 15 today has a nearly 50 percent chance of contracting the virus in his or her lifetime, research shows.

The problem is not the medicine, which is among the most powerful in the world. In places such as the United States and Europe, where prevention programs were already succeeding against much smaller epidemics, the arrival of antiretroviral drugs was a turning point in the battle against AIDS.

But in sub-Saharan Africa, prevention programs have mostly failed to curb the behavior -- especially the habit of maintaining several sexual partners at a time -- that drives the epidemic, research indicates.

So while antiretroviral drugs have prolonged and improved the lives of hundreds of thousands of Africans, millions more are being newly infected with a disease that is still incurable and, for most, terminal.

In South Africa, AIDS deaths are projected to increase at least through 2025 despite steadily improving access to antiretrovirals, according to the Actuarial Society of South Africa. The prognosis on the rest of the continent is at least as bleak.

Global health officials and AIDS activists once predicted that expanding treatment would bolster prevention efforts by encouraging more openness about the disease and making it easier to educate people on how to protect themselves from HIV.

But among African countries with the most serious AIDS epidemics, the only one to report a recent drop in HIV rates is Zimbabwe, which has one of the region's smallest treatment programs.

In neighboring South Africa, attention has shifted from attempting to prevent new infections to treating existing ones, said Suzanne Leclerc-Madlala, an anthropologist at the University of KwaZulu-Natal and a director of one of South Africa's largest AIDS organizations. In meetings, she said, maybe 10 minutes is spent discussing prevention for every hour focused on treatment.

Read it all.