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    Three Things You Don't Know About Aids In Africa

    continued...

    According to my research, the major difference lies in transmission rates of the virus. For a given unprotected sexual relationship with an HIV-infected person, Africans are between four and five times more likely than Americans to become infected with HIV themselves. This stark fact accounts for virtually all of the difference in population-wide HIV rates in the two regions.

    There is more than one reason why HIV spreads more easily in Africa than America, but the most important one seems to be related to the prevalence of other sexually transmitted infections. Estimates suggest that around 11 percent of individuals in Africa have untreated bacterial sexually transmit¬ted infections at any given time and close to half have the herpes virus. Because many of these infections cause open sores on the genitals, transmission of the HIV virus is much more efficient.

    So what do we learn from this? First, the fact that Africa is so heavily affected by HIV has very little to do with differences in sexual behavior and very much to do with differences in circumstances. Second, and perhaps more important, there is potential for significant reductions in HIV transmission in Africa through the treatment of other sexually transmitted diseases.

    Such an approach would cost around $3.50 per year per life saved. Treating AIDS itself costs around $300 per year. There are reasons to provide AIDS treatment in Africa, but cost-effectiveness is not one of them.

    It won't disappear until poverty does.

    In the United States, the discovery of the HIV epidemic led to dramatic changes in sexual behavior. In Africa, it didn't. Yet in both places, encouraging safe sexual behavior has long been standard practice. Why haven't the lessons caught on in Africa?

    The key is to think about why we expect people to change their behavior in response to HIV-namely because, in a world with HIV, sex carries a larger risk of death than it does in a world without HIV. But how much people care about dying from AIDS ten years from now depends on how many years they expect to live today and how enjoyable they expect those future years to be.

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