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Despite the grim statistics, all has been without counter measures. The question that lingers in the minds is: How is Africa combating HIV/AIDS with high prevalence rates?
We are threatened with extinction. People are dying in chillingly high numbers. It is a crisis of the first magnitude, said Botswana President Festus Mogae while addressing the United Nations General Assembly in 2001. President Mogae was referring to the high prevalence rates of HIV/AIDS in his country that stood at 300,000 in a population of about 1.5 million.
The same year the then Kenyan President Daniel arap Moi said his Eastern Africa country would save many lives if people abstained from sex for at least two years. His message was in reference to 700 daily deaths from the AIDS pandemic in the country. He immediately declared HIV/AIDS a national disaster.
According to a World Health Organisation (WHO) report, the 21 countries in the world with the highest HIV infection rates are all in Africa. They are also among the world's poorest nations. Politically and economically, the devastation f the AIDS epidemic is clear according to the report.
United Nations Programme on HIV/AIDS (UNAIDS) states that African has about 26 million people infected with HIV/AIDS against a worldwide figure of 39.4 million. Of those infected, about 25.4 million come from Sub-Saharan African. WHO has labeled HIV/AIDS as the world's most deadly infectious disease, making it the fourth leading cause of death in the world today.
Yet, despite the grim statistics, all has not been without counter measures. The question that lingers in the minds of many is: How is Africa combating HIV/AIDS with high prevalence rates?
Several countries have come up with different strategies to combat the pandemic. In Uganda they adopted the famous ABC approach (Abstain, Be faithful to your partner and Condom Use). This strategy worked very well and managed to bring the prevalence rates down according to Uganda's National AIDS Documentation and Information Centre (NADIC). However this strategy did not work in isolation. Other countries have also tried the same. Many African countries employ the ABC approach to reduce sexually transmitted infections.
A US Agency for International Development (USAID) report on declining rates in Uganda notes that changes in age of sexual debut, casual and commercial sex trends, a reduction in multiple partners and condom use all appear to have played key roles in the continuing declines. In Uganda, prevalence rates peaked at 15 per cent in 1991 and fell to five per cent in 2001.
Communication has been very effective in reducing the infection rates in many states. Government machinery; international non-governmental organizations, United many other bodies as well as word of mouth have managed to sensitize many people about the scourge. Sensitization has been effective, however what remains is whether information provided will lead to observable changes in behaviour.
However, it has been noted that although there is so much information about AIDS and many people have accessed it, infection rates are still unbelievably high. A Cambridge University study in 1995 showed that 89 adult Ugandans out of every 100 knew of someone who was HIV positive.
According to AVERT, an international AIDS charity organization, campaigns for condom use in many countries have lowered infection rates. In Senegal for instance, condom use is virtually universal among sex workers who by law are registered. When AIDS hit in the 1980s, this group was easy to reach with information and condoms. In 2003 USAID-supported programmes sold four million condoms through 2,200 sale points. Total condom distributions were 10 million up from 800,000 in 1987, according to USAID.
Kenya diversified condom distribution by placing them in strategic points, such as in hospitals, next to bars, lodging and any other places where there is vibrant social activity.
To attain reduction in prevalence rates, Uganda employed Behaviour Change Communication (BCC) interventions which reached not only the general population but also key target groups including female sex workers and clients, soldiers, fishermen, long distance truck drivers, traders, bar girls, police and students without creating a highly stigmatized environment.
Male circumcision in most African countries appears to keep infection rates down. Studies show that removal of the foreskin makes the exposed to abrasion during sex and to STD infections. But this strategy can also be counterproductive as some societies still circumcise traditionally and use the tools on various people without disinfecting them. Discontinuation of many other cultural practices like wife inheritance, female circumcision, and polygamy has also been a factor in the decline of infection rates.
Campaigns by the religious sector in many countries have brought down the scourge. Churches like Catholics even have their own NGOs coordinating the fight against HIV/AIDS. In Senegal, quick realization that religion plays a key role in the fight against AIDS managed to keep infection rates low. Clerics would preach abstinence and fidelity but would not oppose condom use. In many countries, fear of offending religious constituencies has paralyzed efforts to distribute condoms or teach AIDS prevention.
Hundreds of grassroots groups organized around religion, ethnicity, business, dwellings/village, gender, and culture have rallied around the battle against AIDS as a national goal.
There are various partnerships with governments that have assisted the fight against HIV/AIDS. In Botswana, African Comprehensive HIV/AIDS Partnerships (ACHAP) supports the government in dealing with the problem while in Kenya there is a multi-sectoral approach in the fight against the scourge under the coordination of National AIDS Control Council. Ethiopia established its National AIDS Prevention and Control Council, under the leadership of the country's president and involving broad representation from government ministers, non-governmental organizations, and people living with HIV/AIDS, religious groups, and civil society.
Community action has also been used. In Uganda, the government recruited citizens to assist in fighting the pandemic. Among the earliest organizations was TASO (The AIDS Support Organization), which was founded in 1987 when there was great stigmatization of people with AIDS. TASO founder members were either infected or had lost a close relative through the disease. The organization now provides emotional and medical support to people who are HIV positive. It works with smaller groups to educate the public about the dangers of AIDS. In many countries there are many associations that have begun along the same lines like TASO and they have made significant contribution in the fight against the disease.
Various programmes taking place in many countries include public health education and awareness with messages on billboard most of them promoting safe sex. There is education for young people, condom distribution, and prevention of mother-to-child transmission.
Political commitment has also made gains in the fight against the virus. In 1986 after Yoweri Museveni became Uganda's President, he embarked on a campaign to urge people to avoid contracting AIDS as a patriotic duty to their country. In Kenya former President Moi and his successor President Mwai Kibaki have committed themselves in fighting the pandemic. In Senegal the first rallying call came from the head of state Abdoulaye Walde while in Botswana President Mogae has gone public including at international forums to plead for assistance in the fight against AIDS.
Elsewhere, in southern Africa, the fight has been spearheaded by former presidents Kenneth Kaunda of Zambia and Nelson Mandela and Fredrick de Klerk of south Africa. Indeed both Mandel and Kaunda lost their sons to AIDS and went public about the cause of their deaths.
Former US Vice-President Al Gore said in a UN Security Council meeting, Today, inside all the world, we are putting the AIDS crisis at the top of the world's security agenda. We must talk about AIDS, not in whispers, not in private meetings alone, nor in tones of secrecy and shame. This is what the two former African presidents have done in fighting the stigma associated with AIDS that has so far dogged the campaign against the pandemic. Mandela and Kaunda have never stopped fighting HIV at any given opportunity.
Though use of Anti-Retroviral Drugs (ARVs) is not widespread in Africa, with time it is expected to save many lives. As we scale up efforts to increase access to ARVs in Africa we must simultaneously help people living with HIV survive their bouts with tuberculosis. This is one of the most effective ways we can help save lives in Africa, said Jack Chow, Assistant Director-General of WHO at an AIDS Conference in Bangkok in August 2004.
At the end of 2005, WHO plans to spend $5.5m to treat three million people throughout the world. Kenya and South Africa who fought for cheaper ARVs, have managed to secure licenses to manufacture generics making them the only two countries to manufacture ARVs in sub-Saharan Africa. This would make the drugs cheaper and more accessible to many needy cases. The advantage of local production is use of local languages, which would help to improve compliance.
In 2002 the South African Cabinet voted to provide ARVs across the board. Soon after 122 centres were established and are now dispensing ARVs to more than 40,000 people are using the drugs. The government also provides multivitamin tablets to patients. Zimbabwe would soon be providing ARVs to many people, according to Owen Mugurungi, programme coordinator for Zimbabwean Ministry of Health and Child Welfare, Tuberculosis and AIDS Programme.
In many countries there has been support from international agencies such as USAID and UNAIDS. Employers too are starting to understand the benefit of a healthy staff and have started to fund ARVs for affected employees. At the moment, Botswana is the only country that aims to provide ARVs on a national scale. Its peace and high living standard can support this initiative. This would take the fight against AIDS to another level.
Voluntary counseling centers (VCTs) provide immediate quality services to sexually active groups have been started in various countries.
A relatively good healthcare infrastructure, the commitment of political leaders, and a high level of national financing that is enhanced by donations from global partners, including Merck & Co. and the Bill and Melinda Gates Foundation has helped Botswana in fighting HIV, according to Louisiana Lush of the London School of Hygiene and Tropical Medicine.
One of the problems Botswana initially faced in dealing with HIV was the lack of political will. It only opened in 1998 when President Festus Mogae took power and made fighting AIDS a priority.
Relative peace in many African countries has made it possible for various nations to concentrate on fighting the disease. In contrast conflict hit zones experience high prevalence rates. UN Secretary General Mr. Kofi Annan pointed out at meeting of the UN Security Council that: In already unstable societies, this cocktail of disasters is a sure recipe for more conflict. And conflict, in turn, provides fertile ground for further infection.
African women have also been active in this battle. The Society of Women Against AIDS (SWAA), an organization present in 28 African countries, is working to educate and involve African women in AIDS awareness and prevention. SWAA believes that women who are educated informed, free to decide what to do with their lives constitute an efficient weapon in the fight against health problems such as HIV/AIDS. At the grassroots level, the Women and AIDS Support Network in Zimbabwe is educating, counseling and organizing women to take control of their own health. They have been successful in persuading the Zimbabwean government to make female condoms available throughout the country. While these and other groups have attempted to provide information AIDS, there is still a lot to be done.
In East and Central Africa, wives of the region's presidents have taken the campaign against the disease through the formation of a lobby against HIV/AIDS.
In many African countries, official declarations have been made against the disease. What has been largely absent in this effort is practical work and approach to addressing HIV/AIDS at the local community level. As Nana Otuo Serebour II, the Omanhene of Dwaben Traditional Area in Ghana eloquently articulated to an audience in New York in September 2000, the era when chiefs led their people in imperial wars are over. Chiefs now have to fight new wars against ignorance, disease, and poverty. These new wars demand a different approach by the chiefs.
There have been concerted efforts to find the scourge since it was discovered. Kenya came up with a drug Kemron in 1990 that was undertaken by the Kenya Medical Research Institute (KEMRI) was found to improve the immune system of those infected with HIV. Currently research is going on the AIDS vaccine between Kenya and other scientists from abroad.
Stigma associated with the disease is one of the greatest barriers to the control of HIV/AIDS. This barrier often prevents the dissemination of accurate information and discourages education and the promotion of safe sex. In many communities, individuals with HIV or AIDS are ostracized. This leads to denial and obstructs efforts to manage and track the spread of the disease. Mr. Annan acknowledged, The first battle to be won in the war against AIDS is the battle to smash the wall of silence and stigma surrounding it.
The future for Africa looks optimistic if a pledge by the United States to spend $15 billion fighting AIDS in the developing world in the next few years is implemented.

THE FRANTIC SEARCH FOR VACCINE
The search for an HIV vaccine is being frustrated by failed trails and thinning resources. Though a failed trial is not entirely a loss, for it helps scientists eliminate what would not work, researchers feel a long series of failures would dampen the push for a vaccine.
The progress achieved in the past few years is undermined by critical scientific, operational and resource challenges. Many of these, though still not addressed, were raised five years ago by the International AIDS Vaccine Initiative (IAVI) the organization leading the world search for a vaccine.
According to the World Health Organisation, there are more than 30 candidate AIDS vaccines being tested in small-scale human clinical trails, the majority of which began in the past four years. These trails span 19 countries on six continents.
The number of the infected currently standing at 40 million countries to grow, and with it the need to get a vaccine, yet the effort remains starved of its most crucial fodder money. The world spends about US$600 million on AIDS vaccine research annually. IAVI feels this is just about half of what is needed.
Apparently, the issue of AIDS is not prominent enough to attract research and development dollars in the private sector, despite its disaster status. Instead, the pharmaceutical industry spends much more research money to feed the market needs of conditions such as erectile dysfunction, heartburn or insomnia. Private sector efforts in the search for an HIV vaccine amount to just $100 million annually.
Global spending on an AIDS vaccine is less than 1% of global spending on all health product research and development. Of course some not-for-profit organizations, such as the Bill & Melinda Gates Foundation have done a sterling job filling this void. But the world reaction has not yet marched the inherent threat. IAVI was to be represented in Scotland where the G8 converged in July, this year. Its mission: to convince the big eight countries to invest a further.
US$400-500 million per year in research for AIDS vaccine so that the overall spend increases to over $1.1 billion a year. The organization says most of this money should be targeted at key applied research challenges and product development and to building more capacity in Africa, Asia, and Latin America.
Unfortunately, US funding for an AIDS vaccine is expected to fall in 2006, forcing scientists to collaborate more. As we now approach 2006, 2007, 2008 and 2009, it has become clear that not only will there be a less than two percent increase in the (National Institutes of Health) NIH budget, that the previous largess that was associated with all research, particularly HIV, is now not going to be a reality for the future, Anthony Fauci, Director at the US National Institute of Health of Alergy and Infectious Diseases was quoted saying,
That will mean working even more with private industry and groups such as the non-profit IAVI to get the most bang for the buck, he said. The US institute makes up the largest public research group in the world. Of the $600 million spent worldwide on developing an anti-HIV vaccine, over $500 million is spent by NIH. The rest comes from the public-private international initiative. The new US budgetary constraints spell stricter criteria for measuring the success of 30 clinical trails being run internationally.
The current vaccine efforts seek to boost the human immune system, which works by producing neutralizing antibodies known as killer T-cells that work to repel infections. IAVI is involved in more than 30 clinical trials in dozens of countries.
In their recent Summits, the G8 leaders have recognized AIDS vaccines as a global priority. Last year the leaders affirmed the need for accelerated and more collaborative research efforts. A selection of top priorities have been developed for action by G8 governments.

Unlike the 1990s, the political will to fight the disease has fairly grown. This is a fact also recognized by UN Secretary-General Kofi Annan who singles out India and China for praise. But this has not abated the expansion of the pandemic.
In report in UN General Assembly, which tracks implementation of pledges made in the Assembly's June 2001 Declaration of Commitment on HIV/AIDS, Annan says, Despite encouraging signs that the epidemic is beginning to be contained in some countries, the overall epidemic continues to expand, with much of the world at risk of falling short of the targets set forth in the Declaration.
The report has been sourced from a broad range of data, especially AIDS indicators from 17 countries in Africa, Asia, the Caribbean and Eastern Europe.
The 2001 Declaration says everyone should be informed about prevention, mother-to-child transmission must be stopped treatment should be given to all those infected, the search for a vaccine must be redouble and the millions of AIDS orphans must be cared for.
The number of agencies working toward a vaccine has increased as well. Four pharmaceutical companies have vaccine candidates in trials, up from two in 2000. The long-standing programmes of the US National Institutes of Health and the French government have grown, and they have been joined by the European Vaccine Effort Against HIV/AIDS (EuroVac), the South African AIDS Vaccine Initiative and the Australian-Thai HIV Vaccine Consortium, among others. IAVIs partnerships with biotechnology companies, academic centres and government research agencies have advanced five candidates to clinical trials since 2000.
Poor countries, which in 2000 participated in vaccine research and development only marginally, are now helping lead the field. In 2000, one.
African country, Uganda, was conducting on AIDS vaccine trial. Today, four African countries have small-scale trials underway, and five others are preparing for trials. The first-ever AIDS vaccine trials in India were expected to begin later this year.
Efforts to salvage Kenya's AIDS vaccine candidate, built around the Majengo slums prostitutes, have also failed and the whole initiative has been discontinued. Although preliminary results publicized last year had indicated no gains.
According to results released in Canada by Prof Andrew Mc Michael, immune responses elicited by volunteers were not sustained long enough. In Kenya, collaborating scientists at the Kenya AIDS Vaccine Initiative (KAVI) have also finalized the higher dosage trials and are in the process of analyzing the data.
Throughout Africa, Asia and Latin America, state-of. clinics and laboratories, staffed by local physicians and technicians, exist where four years ago there were none.
It is critical that developing countries conduct AIDS vaccine trials because the incidence of new HIV infections is among the highest in these areas. In addition, the subtypes of HIV circulating in developing countries are different from the subtype common in industrialized countries.
Scientists do not yet know if or how subtype will impact a vaccine's effectiveness. IAVI is working to draw world attention to various challenges dogging the vaccine search.
The pipeline of vaccine candidates now in small-scale human trials is narrowly focused on a single hypothesis for how a vaccine might confer protection. Furthermore, many of these candidates are difficult to manufacture.
Although more than 30 candidates are now in small-scale trials, the candidates are very similar to each other. Nearly all are based on the hypothesis that a vaccine can confer protection by eliciting a cell-mediated immune response.
The cell-mediated hypothesis is just beginning to be tested in large scale trials, and results are not due until late 2007 at the earliest. If the hypothesis is proven incorrect, the pipeline of candidates now in trails will be rendered mostly irrelevant.
Strong alternative hypotheses have been largely neglected. The first is that an effective vaccine will elicit a broadly neutralizing antibody immune response. None of the candidates in trials elicits this response.
A second neglected hypotheses is that an effective vaccine will elicit immune responses in the mucosal linings of the genitalia, given that HIV is most often transmitted sexually.
A third avenue that deserves more attention is understanding why live-attenuated AIDS vaccine candidates have shown protection in monkeys that is better than any of other type of candidate. Although current live-attenuated candidates cannot be used in humans because there is a safety risk that they will cause HIV infection, researchers should try to understand the mechanism by which live-attenuated candidates work. With this insight they may be able to design candidates that achieve the same effect safely.
For many of the vaccine candidates now in trials, the process for manufacturing them is slow, expensive and, in a few cases, not feasible on a large scale. Little is being done to engineer better manufacturing processes.
Vaccine candidates are advancing through small-scale trials without global consensus about how to assess which are most deserving to large-scale trials. In most developing countries, there is no capacity to conduct large-scale trials.
As candidates are identified for large-scale clinical trials, there are major deficiencies in world wide capacity to conduct these trails.
Specifically, although the past four years have seen growth in developing countries capacity to conduct small-scale trials, there are no sites with capacity for large-scale trials in Africa. There are no large-scale sites in Asia with the exception of Thailand. Few efforts are underway to develop these sites.
Capacity to conduct AIDS vaccine trials in developing countries is further compromised by a lack of regulatory expertise and infrastructure to review and approve trials in a timely fashion. Going forward, IAVI advocates that the pipeline of 30 similar candidates now in small-scale trials be prioritized.
In determining which candidates are most promising, feasibility of manufacturing should be considered. Now facilities will be needed to supply vaccine candidates for more small and large trials.
Intensified research is needed to design new vaccine candidates, focusing on three areas. First vaccine candidates that elicit a broadly neutralizing antibody immune response need to be designed and tested.
Second, researchers should work to understand the mechanism by which live-attenuated candidates show protection in monkeys. Third, candidates that elicit mucosal immune responses need to be designed and tested.

HOW AFRICA IS FIGHTING THE SCOURGE