Excerpt: "The End of Poverty" by Dr. Jeffrey Sachs

Excerpted from THE END OF POVERTY by Jeffrey D. Sachs. Reprinted by arrangement with The Penguin Press, a member of Penguin Group (USA), Inc. Copyright © Jeffery D. Sachs, 2005.

Africa's AIDS Cataclysm

From these lessons, it was but a small step to HIV/AIDS. The same three questions applied for AIDS as for malaria. What does the disease do to economic growth and poverty? What accounts for Africa's special circumstances? And what must be done? The answers are similar, but with one important difference. As of today, there is no solid explanation for why Africa's AIDS prevalence is at least an order of magnitude higher than anywhere else in the world.

The simplest answer, widely believed, is that in Africa there is more sexual activity outside of long-term stable relationships. The data, however, repeatedly cast doubt on that simple and widely-believed hypothesis. Perhaps the sexual networking is different in Africa (for example with more relationships between older men and younger women, or more concurrent relationships although not more lifetime partners). Perhaps HIV/AIDS is transmitted more easily in Africa because the population has other untreated ailments (malaria, other sexually transmitted diseases), or because men are much less frequently circumcised, or because condoms are less frequently used in casual sexual relations. Perhaps the viral subtypes (known as "clades") are different in Africa. The truth is that nobody is sure. The only thing that is certain is that HIV/AIDS is an unmitigated tragedy and a development disaster throughout Africa, especially in the hardest hit regions of Eastern and Southern Africa.

As for the economic costs of the disease, these certainly rival or exceed malaria in the disaster at hand. Africa is losing its teachers and doctors, its civil servants, and farmers, its mothers and fathers. There are already more than 10 million orphaned children. Business costs have soared, due to disarray from massive medical costs for workers, relentless absenteeism, and an avalanche of worker deaths. Foreign investors from outside of Africa are deterred from stepping into Africa's AIDS morass. And millions of households are battling with the illness of the head of household and the incredible toll in time and expense, to say nothing of emotional trauma on the rest of the family.

Once again, I looked at what was being done and what could be done. By the late 1990s, AIDS in the rich countries was being treated, with growing success, by anti-retroviral medicines given in three-drug combinations, so called highly active anti-retroviral therapy (HAART) or simply antiretroviral therapy (ARV). This therapy was changing the face of the disease in the rich countries. Individuals infected with HIV now saw hope. Others who thought they might be infected were willing to come forward for testing. The prospect of drug treatment, and therefore the readiness of more people to submit to voluntary counseling and testing, meant that prevention and treatment programs worked in a mutually supportive manner.

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