“[Brown’s] ability to make a complicated subject accessible to the general reader is remarkable...” –Katherine Salant, Washington Post
Chapter 10. Responding to the Social Challenge: Curbing the HIV Epidemic
The key to curbing the AIDS epidemic is education about prevention. We know how the disease is transmitted. It is not a medical mystery. In Africa, where once there was a stigma associated even with mentioning the disease, countries are beginning to design effective prevention education programs. The first goal is to quickly reduce the number of new infections below the number of deaths, thus shrinking the number of those who are capable of infecting others.
Concentrating on the groups in a society who are most likely to spread the disease is particularly effective. In Africa, infected truck drivers who travel far from home for extended periods often engage in commercial sex, spreading it from one country to another. They are thus a target group in reducing infections. Sex workers are also centrally involved in the spread of the disease. In India, for example, the country's 2 million female sex workers have an average of two encounters per day, making them a key group to educate about HIV risks and the life-saving value of using a condom.21
Another target group is the military. After soldiers become infected, usually from engaging in commercial sex, they return to their home communities and spread the virus further. In Nigeria, where the adult HIV infection rate is 6 percent, President Olusegun Obasanjo requires free distribution of condoms to all military personnel. A third important group, intravenous drug users who share needles, figures prominently in the spread of the virus in the former Soviet Republics.22
The Global Fund to Fight AIDS, Tuberculosis and Malaria, established in 2001, needs $10.5 billion for the next five years. Thus far, it has received pledges of just over $3 billion. The stakes in this game are high. These diseases affect national security, social progress, and the global economy. If failed economies default on their debts, it will affect the entire world.23
At the most fundamental level, dealing with the HIV threat requires roughly 8 billion condoms a year in the developing world and Eastern Europe. Including those needed for contraception adds another 2 billion. But of the 10 billion condoms needed, only a billion are being distributed, leaving a shortfall of 9 billion. Costing only 3¢ each, or $270 million, the cost/benefit ratio of supplying these condoms must go off the top of the chart. The condom gap is huge, but the costs of filling it are small. In the excellent study entitled Condoms Count: Meeting the Need in the Era of HIV/AIDS, Population Action International notes that "the costs of getting condoms into the hands of users—which involves improving access, logistics and distribution capacity, raising awareness, and promoting use—is many times that of the supplies themselves." If we assumed that these costs are six times the price of the condoms themselves, filling this gap would still cost only $1.9 billion.24
Sadly, even though condoms are the only technology available to prevent the spread of HIV, the U.S. government is de-emphasizing their use, insisting that abstinence be given top priority. An effective campaign to stop AIDS cannot function without condoms.25
One of the few African countries to successfully lower the HIV infection rate after the epidemic became well established is Uganda. Under the strong personal leadership of President Yoweri Museveni, over the last dozen years the share of adults infected has dropped from a peak of 14 percent down to 5 percent. More recently, Zambia appears to be making progress in reducing infection rates among its young people as a result of a concerted national campaign led by church groups. Senegal occupies a position at the front of the pack because it acted early to check the spread of the virus, holding it to less than 1 percent today.26
The financial resources and medical personnel currently available to treat those who are already HIV-positive are minuscule compared with the number of people who need treatment. For example, of the 29 million people who were HIV-positive in sub-Saharan Africa at the end of 2002, only 30,000 were receiving the anti-retroviral drug treatment that is widely available in industrial countries. Africa today is a window on the future of other countries, such as India and China, if they do not respond quickly to contain the virus that is already well established within their borders.27
21. Nita Bhalla, "Teaching Truck Drivers About AIDS," BBC, 25 June 2001; Hugh Ellis, "Truck Drivers Targeted in New AIDS Offensive," The Nambian, 17 March 2003; C. B. S. Venkataramana and P. V. Sarada, "Extent and Speed of Spread of HIV Infection in India Through the Commercial Sex Networks: A Perspective," Tropical Medicine and International Health, vol. 6, no. 12, pp. 1040-61, cited in "HIV Spread Via Female Sex Workers in India Set to Increase Significantly by 2005," Reuters Health, 26 December 2001.
22. Mark Covey, "Target Soldiers in Fight Against AIDS Says New Report," press release (London: Panos Institute, 8 July 2002); "Free Condoms for Soldiers," South Africa Press Association, 5 August 2001; HIV prevalence rate from Joint United Nations Programme on HIV/AIDS (UNAIDS), Report on the Global HIV/AIDS Epidemic 2002 (Geneva: July 2002), pp. 189-202; UNAIDS, AIDS Epidemic Update (Geneva: December 2002), pp. 12-15.
23. Pledges received listed at The Global Fund to Fight AIDS, Tuberculosis and Malaria, "Contributions," at www.globalfundatm.org/contribute.html, updated 16 April 2003; minimum needed by 2005 for effective prevention programs in low- and middle-income countries estimated by the United Nations, cited in Lawrence K. Altman, "Women With H.I.V. Reach Half of Global Cases," New York Times, 27 November 2002.
24. Nada Chaya and Kai-Ahset Amen, with Michael Fox, Condoms Count: Meeting the Need in the Era of HIV/AIDS (Washington, DC: Population Action International, 2002); 2 billion condoms needed for contraception also based on estimates from Robert Gardner et al., Closing the Condom Gap, Population Reports (Baltimore, MD: Johns Hopkins University School of Public Health, Population Information Program, April 1999).
25. "Who Pays for Condoms," in Chaya, Amen, and Fox, op. cit. note 24, pp. 29-36; Communications Consortium Media Center, "U.N. Special Session on Children Ends in Acrimony," PLANetWIRE.org, at www.planetwire.org/details/2704, 14 May 2002; Adam Clymer, "U.S. Revises Sex Information, and a Fight Goes On," New York Times, 27 December 2002.
26. UNAIDS, July 2002, op. cit. note 22, pp. 22-26, 189-202; UNAIDS, Report on the Global HIV/AIDS Epidemic (Geneva: June 2000), pp. 9-11.
27. UNAIDS, July 2002, op. cit. note 22, pp. 22-23.
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