AIDS into the 21st century: some critical considerations

The story of AIDS in the 21st century is likely to be dominated by heterosexuals in Africa and injecting drug users around the world. HIV infection has persisted and grown because people do not like to recognise, much less talk about, the behaviours that spread the virus. Drug injection remains the leading cause of HIV infection in in the countries of the former Soviet Union, the northeastern states of India, the USA, Western Europe, China and parts of the Middle East. In Africa, where the overwhelming majority of infections occur during unprotected sex, a high proportion of girls are infected with HIV during their teens and before marriage. Industrialised countries responded with massive prevention campaigns, open discussion of the potential dangers of unprotected sex, and aggressive condom promotion. In the few developing countries that have taken similar action to contain the epidemic--Thailand, Uganda and Senegal--the initial leadership came from senior politicians. As HIV prevalence rises in a population, the chance of someone encountering an infected partner close to the beginning of their sexual life also rises. It is therefore crucial to reach people with appropriate preventative interventions before they first have sex. However, it is not realistic to expect political commitment to as sensitive a problem as AIDS from any government that has less than a wholehearted commitment to the basic health and welfare of its people. The first challenge in the fight against AIDS, as in the fight for development in general, is to support good government.