New African visions for combating AIDS: for Africa, ending poverty and fighting AIDS go hand in...

The next decades could see Africa either turn the corner in its battle against AIDS or struggle desperately to keep from losing ground. The difference will depend on more than medicine.

Sub-Saharan Africa holds barely 10% of the world's total population but more than 60% of all those

now living with HIV. As 2004 ended, UN estimates put this figure at about 25.4 million--a total that has remained fairly stable in recent years. But this only means that the number of people newly infected each year (some 3.1 million in 2004) is largely offset by those who die of AIDS (2.3 million in 2004).

So far, efforts to combat AIDS throughout the region have achieved only limited local successes, despite medical expertise and material support from many donors. But now the joint United Nations Program on HIV/AIDS (UNAIDS) has taken a new approach, inviting Africans to develop and compare scenarios that go beyond statistical projections to explore possibilities for coming to grips with the AIDS epidemic in the next 20 years.

In their new report, "AIDS in Africa: Three Scenarios to 2025," the UNAIDS team offers narratives illustrating the results that might be produced by different policy approaches and decisions.

1. Tough Choices. This scenario is patterned on the model of Uganda, one of the countries most successful at fighting AIDS. Unable to rely on appropriate and timely help from the developed Western nations, courageous national leaders consistently aim to maximize long-term benefits even when this means diverting limited resources away from immediate needs (i.e., they promote HIV prevention over AIDS treatment). Despite inevitable conflicts pitting the interests of the nation as a whole against those of local communities or individuals, this approach, which places health within the context of overall development goals, shows how much determination and sustained effort might accomplish with only a modest increase to the resources currently available.

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2. Traps and Legacies. In this scenario, the past effectively dictates the future. Unable to overcome existing weaknesses of poverty, poor education, ethnic conflict, and under-development, African efforts to fight AIDS are doomed to frustration. Foreign donor and local leaders both seek quick results that waste resources and ultimately discourage needed long-term efforts. In 2025, overall conditions in the region are little improved. The problem is not lack of means or insufficient effort, but failure to cooperate and plan ahead.

3. Times of Transition. This is what could happen if Africans, and the world, work for peace and development everywhere. Firm commitments by Western nations to fund sustained treatment for existing AIDS victims, combined with national programs across Africa to boost HIV-prevention efforts, promote education, reduce poverty, expand opportunities for women, and enhance human rights, could "fundamentally alter the future course of Africa" in the twenty-first century. More than that, such cooperation on a global scale would contribute to the achievement of peace among nations, for it would involve recognizing the interdependence of Africa and the world.

The UNAIDS team presents each of these three scenarios first in the form of a folktale, in which different animals interact to deal with a crisis in their village. These folktales might seem to be only a touch of local color inserted to dress up an otherwise Western-style rational analysis, but in fact the stories enhance creative futures thinking, helping readers to engage their emotions while weighing alternatives and envisioning outcomes.

"AIDS in Africa" is not intended as a prediction of what the future must be, or even a prescription to be followed in detail to produce the best possible outcome for every African nation and individual concerned with the ongoing dangers posed by HIV/AIDS. The report does provide an intriguing and, on the whole, encouraging example of how even seemingly overwhelming problems can be tackled when looked at in relation to other serious concerns and when desired results can be evaluated over time frames longer than the usual one to five years.

Source: "AIDS in Africa: Three Scenarios to 2025," Joint United Nations Program on HIV/AIDS (UNAIDS), 2005. UNAIDS, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Web site www.unaids.org.