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August 28, 2004


Indeed, there is plenty of hope for avoidance of an AIDS catastrophe in Africa, as the following recent article attests:

Science, Vol 304, Issue 5671, 714-718 , 30 April 2004 [not viewable without password, alas]
Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda
Rand L. Stoneburner* and Daniel Low-Beer
Uganda provides the clearest example that human immunodeficiency virus (HIV) is preventable if populations are mobilized to avoid risk. Despite limited resources, Uganda has shown a 70% decline in HIV prevalence since the early 1990s, linked to a 60% reduction in casual sex. The response in Uganda appears to be distinctively associated with communication about acquired immunodeficiency syndrome (AIDS) through social networks. Despite substantial condom use and promotion of biomedical approaches, other African countries have shown neither similar behavioral responses nor HIV prevalence declines of the same scale. The Ugandan success is equivalent to a vaccine of 80% effectiveness. Its replication will require changes in global HIV/AIDS intervention policies and their evaluation.

Here in the US we need to remember that there are competent, well-managed countries in Africa that are struggling , often effectively, against terrible problems including instability in their neighbors. I would guess that here in the US we have few government programs as effective as Uganda's anti-AIDS campaign.

Yes, Uganda has been very effective at keeping HIV infection rates under control and avoiding the upward spiral that has taken place in southern Africa. If the Swaziland figures are confirmed, though, they may represent something even more significant because Swaziland will be the first country to _reverse_ the spiral. I've seen it argued as conventional wisdom that HIV infection spins out of control once it reaches the 10 percent level; if Swaziland can recover from 40 percent, then there's hope for the whole continent.

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