Three Things You Don't Know About Aids In Africa
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.