It doesn't solve any problems, but it does manage them. It's the kind of program that aid agencies and African governments -- even the normally dysfunctional Zimbabwean regime -- are now pushing aggressively , because it saves lives. This is how the world fights AIDS in Africa today: prevent one case at a time, treat one patient at a time.
Hand out condoms to sex workers. Simplify drug cocktails. Put posters in schools explaining safe sex and in pre-natal clinics explaining treatment options. Give out more preventative drugs antiretroviral coverage in Africa increased 20 percent last year alone. Over the past ten years, the prevalence of HIV has declined in 21 of the 24 worst afflicted countries; it's declined by more than 25 percent in five of Africa's worst affected states.
In Zimbabwe, the rate of new HIV infections has fallen to one fifth of what it was in Bringing together so many regional, national, and local projects has been something of a small revolution in governance for Sub-Saharan Africa, which not long ago was one of the least-governed places in the world.
States were frequently at war, both internally and with their neighbors, in a way that would have made today's cooperation on HIV impossible.
The United Nations, particularly the UNAIDS mission it launched in , often makes one of the most banal but important contributions: putting African government officials, African civil society leaders, aid agencies, and pharma reps together in a room to coordinate HIV programs big and small. Still, these small-scale advances do not add up to a cure. But excitement around their accomplishments is leading some AIDS experts to advocate for what they call " treatment as prevention " -- the idea that enough condoms, circumcisions, and education programs could win the war on AIDS.
While this one-by-one approach has saved tens of thousands of lives annually in Africa, it's hard to imagine that it could really push the number of HIV cases down to zero. And some critics warn that, by focusing on managing HIV's spread rather than stopping it outright, the world would be giving up on the bigger mission of stamping out AIDS altogether. The debate over "treatment as prevention" can get heated, but it's not the first controversy in the battle against AIDS in Africa, and it won't be the last.
Skip to content Site Navigation The Atlantic. Popular Latest. The Atlantic Crossword. Sign In Subscribe. These include Burkina Faso 6. With an estimated population of million, Nigeria is the demographic giant of sub-Saharan Africa. If the African epidemic has its roots in the Great Lakes region, the epicenter could well have moved westward into middle and western Africa.
Instead, it moved primarily southward. The question is an intriguing one and no consensus has emerged in response. Cultural and social norms may have played a role. Demographers John and Pat Caldwell suggest at least two additional factors.
They point out that the presence of other STIs is probably the single most important factor contributing to the rapid spread of HIV. However, it is not all STIs, but especially those that cause genital ulcers that serve as an effective conduit of HIV.
By contrast, syphilis and chancroid are the dominant STIs in eastern and southern Africa. Also, in most societies in West Africa, male circumcision is almost always practiced, while it is uncommon in a very large swathe of the AIDS-belt countries.
Is the epidemic still worsening or is the situation improving? Uganda is still the only country in the region that has achieved a sustained decline in HIV prevalence. In some places — parts of Zambia, for example — prevalence appears to be dropping among the younger age groups, a possible prelude to an overall prevalence decline.
National Center for Biotechnology Information , U. Published online Apr 8. Ayesha B. Quarraisha A. Author information Article notes Copyright and License information Disclaimer. This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.
This article has been cited by other articles in PMC. Abstract Global trends in HIV infection demonstrate an overall increase in HIV prevalence and substantial declines in AIDS related deaths largely attributable to the survival benefits of antiretroviral treatment. Open in a separate window. Table 2 Randomised clinical trial evidence for preventing sexual transmission of HIV adapted from [ 93 ].
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