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A special June 23 AIDS issue of the international journal, Science--including research-based articles and an editorial by leading experts, plus an investigative report--documents the agonizing human toll of the disease in sub-Saharan countries:
A boy whose HIV-infected mother had hanged herself, a tuberculosis ward where more than half the patients were HIV-infected, and many other tragedies confronted a Science investigative team. They recall, for example, an infected woman who was lucky enough to receive anti-HIV drugs so that she could give birth to a healthy baby, only to lose the child to AIDS, after transmitting the virus while breastfeeding.
With the African death toll expected soon to surpass the number of Europeans killed during the plague of the 14th century, experts predict global economic, social, and political impacts to result from the sub-Saharan epidemic.
"In the worst-affected countries, AIDS is single-handedly wiping out decades of investments in education and human resource development," writes Peter Piot of the Joint United Nations Programme on HIV/AIDS (UNAIDS).
In Zambia, for example, 1,300 teachers died during the first 10 months of 1998, Piot notes. Some 200,000 AIDS orphans have been counted among the 1.9 million residents of Tanzania's Kagera Region, according to Hans P. Binswanger of the World Bank.
While funding "shows signs of a sharp upward rise," Piot points out, "it is estimated that between $1.6 billion and $2.6 billion is needed annually just to mount an effective response in sub-Saharan Africa."
Home to approximately 24.5 million HIV-infected people, or 70 percent of the global total, sub-Saharan Africa receives only "a fraction of the [funding] devoted to efforts in developed countries, says Jon Cohen, a Science contributing correspondent. With photographer Malcolm Linton, Cohen witnessed first-hand the devastating effects of AIDS in Africa.
"The experience was overwhelming," says Cohen, who has been covering AIDS research for a decade. "When you walk into a modern-day plague, it's hard to process what you're seeing."
His report provides an unusually comprehensive overview of AIDS research in Africa. It also investigates the scientific puzzle of Africa's high HIV-infection rates, and the funding and political challenges faced by the continent's research community.
Too often, preventive tactics and treatments are inaccessible in developing regions, says David Bloom of Harvard University's School of Public Health. "Although educated and relatively wealthy patients have been successful in marshaling the medical and social support necessary to mount an active and ongoing defense against the disease, the situation is much bleaker for most of those infected with HIV," Bloom writes, with coauthors at River Path Associates.
Unfortunately, expanding Africa's regional, "boutique" programs to a national level is easier said than done, Binswanger explains. "Even when only a single sector is involved, there may be several actors, such as a government service, an NGO [nongovernmental organization] (like the Red Cross), and a private-sector laboratory," he writes. Vaccine research, meanwhile, is complicated by the ethical issues involved with testing experimental treatments in developing countries, Salim S. Abdool Karim of the Medical Research Council and Columbia University says in an editorial.
Science's special AIDS issue should help set the stage for the XIII International AIDS Conference, scheduled for July 9-14 in Durban, South Africa. Scientists at the conference will attempt to "break the silence" that "prevails across nations estranged by colossal inequities," event chair Hoosen Coovadia says, by drawing the world's attention to the AIDS crisis in Africa.
The disease has spread rapidly since 1982, when only one African country had an HIV prevalence rate higher than 2 percent. By 1998, one-fourth of the people in two African countries had been infected.
An ongoing scientific debate has complicated the battle against HIV and AIDS, Cohen says. Some researchers, as well as South African President Thabo Mbeki, believe that the African AIDS epidemic "has unique features." While HIV is primarily spread through homosexual contact in the United States, for example, it is largely a heterosexual epidemic in Africa. Infection rates are up to six times higher, too, and tuberculosis strikes 40 percent of all HIV-infected patients, according to one study. Moreover, scientists say distinct strains of HIV-1 are circulating in Africa.
Though HIV and AIDS may have different characteristics in Africa, Cohen concludes that "most researchers, ultimately, never lose sight of the main similarity: HIV, everywhere it goes, destroys immune systems, cuts lives short, and devastates communities."
NOTE: To receive articles, call 202-326-6440, or send e-mail to scipak@aaas.org . Three research-based articles (Binswanger, Bloom, and Piot), and an editorial (Piot) will be available beginning Friday, 16 June. Jon Cohen's report will be available on Wednesday, 21 June. All materials are embargoed until 2 p.m. U.S. Eastern Time Thursday, 22 June 2000. Cohen, the author of a forthcoming book on AIDS vaccine research, is available for embargoed media interviews.
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