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Summary:
Sub-Saharan Africa has been more severely affected by AIDS than any other part of the world. The United Nations reports that 26.6 million adults and children are infected with the HIV virus in the region, which has about 10% of the world's population but twothirds of the worldwide total of infected people. The overall rate of infection among adults in sub-Saharan Africa is 7.5%-8.5%, compared with 1.1% worldwide. Twelve countries, mostly in east and southern Africa, have HIV infection rates of more than 10%; the rate has reached 38.8% in Botswana. As of 2003, an estimated 22.9 million Africans had died of AIDS, including 2.3 million who died in that year. AIDS has surpassed malaria as the leading cause of death in Africa, and it kills many times more Africans than war. In Africa, 58% of those infected are women. Experts relate the severity of the African AIDS epidemic to the region's poverty. H eal t h systems are ill-equipped for prevention, diagnosis, and treatment. Poverty forces many men to become migrant workers in urban areas, where they may have multiple sex partners. Poverty leads many women to become commercial sex workers, vastly increasing their risk of infection. AIDS' severe social and economic consequences are depriving Africa of skilled workers and teachers while reducing life expectancy by decades in some countries. An estimated 11 million AIDS orphans are currently living in Africa, facing increased risk of malnutrition and reduced prospects for education. AIDS is being blamed for declines in agricultural production in some countries, and is regarded as a major contributor to the famine threatening southern Africa. Donor governments, non-governmental organizations, and African governments have responded primarily by attempting to reduce the number of new HIV infections and by trying to ameliorate the damage done by AIDS to families, societies, and economies. The adequacy of this response is the subject of much debate. U.N. experts estimate Africa's resource needs for fighting AIDS in 2004 at $8 billion, but project expenditures of $6 billion from all sources, including households. Treatment of AIDS sufferers with medicines that can result in long-term survival is reportedly available to 50,000-75,000 Africans at present. However, U.S. and other initiatives are expected to sharply expand the availability of treatment in the near future. Advocates see expanded treatment as an affordable means of reducing the impact of the pandemic. Skeptics question whether treatment can be widely provided without costly improvements in health infrastructure. U.S. concern over AIDS in Africa grew during the 1980s, as the severity of the epidemic became apparent. Legislation enacted in the 106th and the 107th Congresses increased funding for worldwide HIV/AIDS programs. H.R. 1298, signed into law (P.L. 108-25) on May 27, 2003, authorized $15 billion over five years for international AIDS programs. President Bush announced his Emergency Plan for AIDS Relief (PEPFAR) in the 2003 State of the Union message. Twelve of the 15 focus countries are in subSaharan Africa, and are slated to receive just over $1 billion through the State Department's new Global AIDS Initiative under the FY2005 budget request. Nonetheless, activists and others urge that more be done in view of the scale of the African pandemic.
