Using story-telling methods, the Joint UN Programme on HIV/AIDS (UNAIDS) has devised three scenarios to estimate how decisions made today may alter the pandemic's course in Africa, with the best offering hope to save 43 million people on the continent.
"The scenarios highlight the various choices that are likely to confront African countries in the coming decades," he added. "Millions of new infections can be prevented if Africa and the rest of the world decide to tackle AIDS as an exceptional crisis that has the potential to devastate entire societies and economies."
According to the UNAIDS 2004 report, "Sub-Saharan Africa is home to just over 10 per cent of the world's population – and almost two-thirds of all people living with HIV," or 25 million to 28 million of the world's 34 million to 46 million, while North Africa and the Middle East combined have 420,000 to 730,000 infected.
The scenarios, conceived by 150 people, mainly African, spotlight the factors that has made many African countries the worst affected by the disease.
The "Traps and Legacies" scenario spotlights how poverty causes malnutrition and the inability to procure expensive protection, gender inequality disempowers wives who wish to end relations with infected husbands, and overall underdevelopment limiting the spread of prevention messages.
Under this prediction, the scramble to roll out retroviral therapy "leaves few lasting benefits and takes precedence over the much-needed scale-up of prevention." African leaders and their donor partners, keen to show quick results, are unable to invest in long-term change. Aid donors fail to live up to promises, while "the so-called war on global terrorism spills over into Africa, determining donor funding patterns."
If these negative actions continue and if HIV is merely medicalized and seen as an issue of individual behaviour change, by 2025 AIDS will remain at an adult prevalence of about 5 per cent, the report says. "Because there is a failure to get ahead of the epidemic in terms of prevention, the costs continue to rise and this rise continues into the foreseeable future."
The scenario called "Tough Choices" describes the future if African leaders take a long-term view of prevention, even if the short-term scene is bleak. It would require "navigating between helpful and risk-enhancing cultural traditions," choosing between rural needs and urban benefits, and balancing continental alliances and nation building.
Despite population growth, the number of people living with AIDS would "fall to levels similar to what they are today and continue to fall as long as long-term investments in social, economic and human capital over the next two decades begin to pay off."
The best-case prediction, "Times of Transition: Africa Overcomes," envisages what might happen "if all of today's good intentions were translated into the coherent and integrated development response necessary to tackle HIV and AIDS in Africa."
In this scenario, a rapid rollout of treatment and effective prevention strategies would be supported by a very active civil society.
The countries concerned would reduce poverty, spur development while collaborating better with "their external partners," make radical improvements in their positioning in global trade, and implement conflict prevention and security promotion policies within and among countries. Aid flows would not promote dependency.
With these measures – estimated to require cumulative investments of $200 billion – the number of people living with HIV and AIDS would halve between 2003 and 2025, despite the fact that the population would double. Forty-three million new infections would be averted.