Challenges

AIDS and Poverty in the United States and other economically advanced countries, antiviral medications have contributed significantly to the lessening of mother-child transmission of HIV, to delaying progression of HIV disease to AIDS, and to improving the quality and duration of life of AIDS sufferers. Newer drugs have also decreased transmission of HIV somewhat, thereby slowing the progress of the epidemic. The cost in the United States, while high, amounts to less than 1% of the total health care expenditure.

Antiviral medications have provided little benefit to most of the world's AIDS sufferers because they cannot afford them. Although HIV disease is spreading rapidly in India and China, two countries that together contain more than one-third of the world's population, and in the Caribbean, Southeast Asia, and Eastern Europe, the situation is the most desperate in African countries south of the Sahara desert. In this area, over 11.5 million people have already died of the disease, and another 28 million currently infected with HIV are expected to die over the next decade. Few of them know that they have the disease, because funds for testing are limited. In one city in Zambia, 46% of young pregnant women attending a prenatal clinic were found to be HIV positive. At a hospital in a city of South Africa, 20 children per day are admitted, most with AIDS, many brought in by relatives because their parents have died of the disease. In Uganda, an estimated 250,000 children have lost both parents to AIDS; by the year 2010 an estimated 41 million African children will have lost one or both parents to the disease. Average life expectancy is projected to drop from almost 60 years, early in the last decade, to 45.

Summary 761

The humanitarian, social, and economic implications of these statistics are enormous. Unimaginable suffering, large numbers of starving, uneducated street children, loss of productive work years, spread of other infectious diseases, breakdown of public health, and setbacks for economic development are possible consequences that can affect neighboring countries and the rest of the world.

The challenge is to find effective control measures for the world's poor.

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