Perils of Ignoring AIDS
Following the 20th anniversary this summer of the HIV/AIDS epidemic,
we spoke with Kenrad Nelson, MD, about the current global situation
of the disease and what needs to be done. Nelson is professor and
director of Infectious Disease Epidemiology in the Department of
Q. It was recently announced that the U.S. is putting an additional
$200 million into the international fight against AIDS. Will this
A. No. The World Health Organization [WHO] has said that an additional
$7-8 billion per year will be needed. Other European governments
and private foundations will help, but the U.S. needs to do more.
The control of HIV in Africa certainly is in the vested interests
of the U.S. and Europe. If the countries in Africa and Asia become
politically unstable, that certainly will affect us. If new HIV
viruses recombine, and emerge, it may complicate the development
of a preventive vaccine even further.
Q. Is more money the answer?
A. I suspect no matter how much money is spent, it will not be
possible to fully equalize the situation between poor African communities
and the U.S. In many African countries, there are very few doctors,
clinics, and nurses, outside the large cities. Nonetheless, I think
at least in the cities it would be possible to establish some specialized
clinics and train clinicians to identify, treat, and monitor HIV-positive
Q. Despite all we've learned about HIV and its transmission in the
past 20 years, 36 million people are estimated to be HIV-infected,
almost 90 percent of them in developing countries. Why haven't prevention
efforts been more successful?
A. When there isn't agreement among the political and religious
leaders that this is a serious problem and how it should be addressed,
it becomes more difficult to deal with.
I understand that several religious
leaders in Africa have recently opposed the promotion of condoms
to prevent HIV. This type of confused leadership contributes to
the problem. So politicians may believe it politically easiest to
just ignore the epidemic. AIDS is different from malaria and tuberculosis
and many other infectious diseases in that it involves marginalized
populations and issues of sexual behavior, drug use, commercial
sex, and rape.
Q. What makes some programs successful?
A. Only when countries have decided that HIV/AIDS is a preeminent
health problem that they must deal with have they been successful.
Thailand is one example. The prevalence of HIV among 21-year-old
military conscripts has decreased from 12 percent in 1991-92 to
about 2 percent in 2000. And, less than 5 people per 1,000 per year
now are becoming infected. Uganda, Senegal, and Zambia also have
effective prevention programs. But these countries are exceptions.
The HIV/AIDS epidemic has exploded
in the last five years in southern Africa. In Botswana over 35 percent
of the entire adult population is infected. Similar rates of infection
are seen in populations in South Africa, Namibia, Zimbabwe, and
Malawi. The WHO has estimated that, if the epidemic continues, the
likelihood of a young man in Zimbabwe dying from AIDS before he
reaches the age of 50 is 60 percent.
Q. Given those statistics and the fact that one in 10 sub-Saharan
Africans between the ages of 15 and 49 is infected with HIV, what's
going to happen in the next few decades?
A. Without effective intervention, it probably will have the same
devastating effect it now has. Or worse.
I think the choice is really clear. We need to move on this. There
are really effective prevention techniques that have been shown
to work in developing countries, and there are therapeutic advances
that would really make a difference. I think as health professionals
we need to be in the forefront in educating politicians and the
public about the severity of the current problem and what the outlook
is if we don't act now.