Director of World Bank Global HIV/AIDS Program discusses magnitude of a long-term epidemic, strategies for saving lives.
Countries will have to take up the grim work of planning to replace teachers, farmers, medical professionals, and others that AIDS has been killing off for a generation.
To save their populations from the worldwide HIV/AIDS epidemic, says Debrework Zewdie, who directs the World Bank's efforts to prevent and treat the disease, nations must have the will to protect vulnerable and stigmatized groups, to work around restrictions placed on donated funds, to improve healthcare systems across the board, and to understand patterns of disease transmission that vary among countries and locales. Zewdie, an Ethiopian-born, British-educated immunologist with long experience in Africa and public health, spoke Feb. 22 to a packed Royce Hall auditorium.
The James S. Coleman African Studies Center hosted the talk, co-sponsored by the UCLA Globalization Research Center–Africa, the Department of French and Francophone Studies, the Department of World Arts & Cultures, and the Schools of Public Affairs and Public Health.
Today, more than 40 million people live with HIV/AIDS, up from just under 13 million in 1992. In the hard-hit southern African countries of Botswana, Zimbabwe, and South Africa, life expectancies have plummeted, mostly during the 1990s. Meanwhile, the fastest rates of new infections in the global epidemic are being observed in Eastern Europe, Zewdie said, with China and India not far behind. Although the cost of antiretroviral treatment has dropped significantly, she said, AIDS victims still do not have equal access to the drugs, so that the disease remains a death sentence for most.
Zewdie said that the pandemic—far from being a short-term crisis, as it is still widely perceived even by major donors—"is going to stay with us." Countries will have to take up the grim work of planning to replace teachers, farmers, medical professionals, and others that AIDS has been killing off for a generation. World Bank projections show a looming economic crisis for the countries most affected, Zewdie said, explaining why an organization devoted to development views work on HIV/AIDS as key to its mission.
Start With the Last Thousand
The talk looked at challenges and progress in fund-raising, donor and agency coordination, and program implementation. Zewdie stressed the importance of understanding patterns of HIV transmission within a given country. One of the few countries that has collected good data on transmission is Thailand, which, like Cambodia and Uganda, recognized and began to confront the AIDS crisis early on. The Thai government data describe a developing epidemic, which in the early 1990s often spread from sex workers to men and by 2000 was spreading in much greater proportion to women from their husbands.
In general, she said, women are bearing the brunt of the crisis, in part because of expectations in many cultures that they will care for the ill.
The first time Zewdie saw Thai figures analyzing HIV transmission, she "wanted to do this for every single African country." In order to plan country-specific programs, she said, you have to know at least where the last 1,000 infections happened. Epidemics within groups of intravenous drug users, sex workers, and gays demand certain responses, as do broader patterns of infection. As a rule, condoms remain very important to the fight.
But recent years have yielded some new discoveries, in addition to improved treatments. For example, Zewdie said, there is a striking correlation between male circumcision and lower rates of HIV infection. In Kenya, uncircumcised men become infected about four times as often as circumcised men. So in Botswana a practice that was abandoned during the period of British colonial rule is coming back because of its apparent protective effect, according to Zewdie.