As the illness and death from AIDS rose in Africa, some two decades ago, one or two countries reacted quickly. Other countries waited rather longer before intensifying their efforts, but they too are being rewarded for their efforts. There have been a number of success stories which include Senegi Uganda and Zambia. But most countries in Africa lost valuable time because AIDS was not fully understood and its significance as a new epidemic was not grasped. Some action was taken, but not on the scale that was required to stem the tide of the epidemic.
The scale of action necessary does of course increase exponentially along with the epidemic. Early on in a heterosexual epidemic, most new infections are acquired and passed on by a minority of people with an especially high turnover of partners. If condoms are used in most of these transactions, the epidemic can be contained relatively easily. But once HIV has become firmly established in the general population most new infections occur in the majority of adults who do not have an especially high number of partners. This means that prevention campaigns have to be expanded greatly, making them harder and costlier, though still very worthwhile.

Most countries in Africa are at this stage. Yet few have expanded their HIV prevention programmes to the scale that would be needed to make a significant dent in the number of new infections. Since past prevention failures eventually turn into current care needs, failure to head off the epidemic early on also imposes a greater burden of care on countries where HIVprevalence is high. And as the HIV-infected fall ill and die, alleviating the impact on orphans, other survivors, families and communities becomes the third challenge.

Recently researchers have tried to determine how much money would be needed to make a real differenceto the AIDS epidemic in Africa,and it is clear that scaling up the response to Africa's epidemic is not only imperative but it is affordable.
At least US $1.5 billion a year could makeit possible to achieve massively higher levels of implementation of all the major components of successful prevention programmes for the whole of sub-Saharan Africa. These would cover sexual, mother-to-child and transfusion-related HIV transmission, and would involve approaches ranging from awareness campaigns through the mediato voluntary HIV counselling and testing, and the promotion and supply of condoms.

In the area of care for orphans and for people living with HIV or AIDS, costs depend very much on what kind of care is being provided. It is estimated that with at least US $1.5 billion a year, countries in sub-Saharan Africa could buy symptom and pain relief (palliative care) for at least half of AIDS patients in need of it; treatment and prophylaxis for opportunistic infections for a somewhat smaller proportion; and care for AIDS orphans. Atthe moment, the coverage of care in many African countries is negligible, so reaching coverage, at these levels would be an enormous step forward.

Making a start on coverage with combination anti-retrovira ltherapy would ad several billion dollars annually to the bill.

Of course, providing AIDS prevention and care services involves more than just these funds. A country's health, education, communications and other infrastructures have to be well enough developed to be able to deliver these interventions. In some badly affected countries, these systems are already under strain, and they are likely to crumble further under the weight of AIDS. Then, too, money can only be used wisely if there are sufficient people available and the shortage of trained men, women and young is already acute.


These are some of the serious challenges that African countries and their partners in the global community willhave to do far about if they are to make a really difference to the epidemic.