It is becoming as hard to recall the terror of Aids as it is the Cold War. And yet, only 30 years ago it was laying the world to waste, taking an appalling toll on gay people, users of shared needles and other vulnerable groups. In one part of the world, it was having a comparable impact on the majority population as well – and that was where it all started, in sub-Saharan Africa. Aids remains a massive problem in this huge region today, but the good news is that now Africa is a laboratory for work that may not merely alleviate the misery of acquired immunodeficiency syndrome, but may also finally stop the disease in its tracks.
Tomorrow concludes The Independent’s week-long series of reports from the front line of the war against Aids, one that – despite its appalling human cost – risks becoming as forgotten as the continent’s military conflicts.
The good news is that inroads have been made, thanks to an increasing supply of anti-retroviral drugs. But new problems have arisen, too. Energetic, well-funded campaigns to encourage the use of condoms have reduced the spread of the disease among sex workers and their clients. And yet in Uganda, the first African country to be hit, the first to respond vigorously and the first to see cases fall, they are once again rising. One reason is that growing prosperity means that more men have more money in their pockets, and in the only part of the world where multiple, overlapping heterosexual partnerships are the norm, that encourages more sexual partners.
Another reason is that condom use has become so closely identified with prostitution that when a partner in a stable relationship suggests their use, it creates mistrust. Furthermore, because ARV drugs allow those with Aids to lead normal lives, the spectre of a horrible death is no longer ever present, galvanising the vulnerable into taking preventive measures.
Widespread dislike of condoms, combined with fears that existing efforts to stem Aids may unravel, have driven researchers to try new approaches. Male circumcision, which can reduce the risk by 60 per cent, is traditionally rejected by some tribes, but courageous leaders have broken the taboo. Similarly, the need to give women a practicable way of protecting themselves has driven tests of a vaginal ring, for which there are high hopes, in five countries across southern Africa.
The most remarkable development comes from the most discouraging setting, however. In the South African province of KwaZulu-Natal, one in four people have HIV – the highest regional rate in a country which is itself the world’s worst affected. But a medical breakthrough has prompted a trial programme with great promise. The aim is to enrol 10,000 patients – including those in their twenties, and therefore at their most sexually active – in mobile clinics, in the hope that the early studies suggesting that ARV treatment can both halt the disease and cut its transmission can be replicated.
Thus, from the most benighted corner of the continent comes the most optimistic experiment, one which could tackle the disease at its source. That, indeed, is the fundamental challenge. As they say in Africa: “You can’t mop the floor with the tap still running.”