So why aren't we using all of our weapons?
ON THURSDAY, the world observed the 18th annual World AIDS day. There was no celebration. For despite nearly two decades of effort, the plague shows no signs of abating. Indeed, the news is gloomy: At best, HIV/AIDS has leveled off in some places. In many others, it's exploding, leaving a trail of human misery no government can alleviate. Consider:
According to the United Nations, AIDS killed 3.1 million people in 2004, 18 percent of them children under the age of 15;
New infections rose 7 percent, to 4.9 million people;
Sub-Saharan Africa accounted for 77 percent of the deaths, and 65 percent of the new infections in 2004;
AIDS is increasing in women;
Epidemics are anticipated in Pakistan and Indonesia.
One piece of positive news: HIV/AIDS transmission among male homosexuals in the West has stabilized. Education, prevention, and the availability of treatment is helping stem the tide and prolong lives. Still, in the United States, new infections number around 40,000 per year; black and Latino communities are the hardest hit. Of U.S. women newly diagnosed with HIV, 72 percent are African-American.
Worldwide, half of the 2 million children under the age of 15 who have HIV/AIDS will die before they reach age 35. The entire younger generation in some countries (such as Sudan) is being devastated. Women increasingly are victims, infected through rape (especially in war-torn countries), by unfaithful partners exerting their conjugal "rights," by intravenous drug use, and through prostitution. In Bombay, India (the country with the second largest number of infected persons), an estimated half of the prostitutes carry HIV/AIDS.
What can we do? Jim Yong Kim, director of the HIV-AIDS Department of the World Health Organization says, "Current prevention, treatment, and care efforts are too episodic, ad hoc, and lack the intensity, pace, and rhythm needed to make an impact." Thoraya Ahmed Obaid, executive director of UNFPA, says "HIV/AIDS will not be stopped unless leaders at all levels act now to boost comprehensive prevention efforts targeting women, injecting drug users, and sex workers."
Both are correct: the enormity of the AIDS crisis demands a comprehensive effort linking education, prevention, treatment, and testing.
Treatment of AIDS through anti-retroviral drugs is essential, but the drugs are expensive and require a level of health-care follow-up beyond what many nations now can provide. Upgrading medical-delivery systems will help, but to beat AIDS over the long term, the focus is on education, prevention, and testing efforts.
Little successes are instructive. In Uganda, the "ABC" program (a bstinent before marriage, b e faithful after, use c ondoms) has been credited with reducing the prevalence of HIV/AIDS from 15 percent in the early 1990s to 4.1 percent in 2003. In the United States, the Centers for Disease Control has tried widespread, routine testing for HIV, finding that transmission rates for those who know they are HIV-positive are very low. South African officials found that testing was more attractive once treatment became available. And the tiny African nation of Lesotho, hard-hit by the plague, is trying to get everyone in the kingdom tested.
The world should follow suit. According to the United Nations, 90 percent of the 12,000 people who will be infected with HIV/AIDS today won't discover they have the disease until around 2013--ample time to infect many others. Some activists argue that routine testing violates an individual's human rights, but the scope of the AIDS epidemic requires hard information and strong action.
The war against AIDS will not be won by ignoring any of the components or by caving to groups with a mixed agenda. Education, prevention, treatment, testing--these are the four white horsemen needed to avoid the AIDS apocalypse.