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Preventing and Mitigating AIDS in Sub-Saharan Africa: Research and Data Priorities for the Social and Behavioral Sciences
Ad Hoc Scientific Committee on HIV Vaccines, 1994a, 1994b; Cohen, 1993, 1994a, 1994b). As discussed further below, even if a vaccine or cure were developed, it would probably not be sufficient to bring a speedy end to the epidemic because of imperfect effectiveness, cost, and less than universal distribution and acceptance. In addition, many of the millions of people already infected with HIV are unaware of their status and so represent a pool capable of passing the virus to new cohorts. Therefore, with or without a vaccine, behavior change is necessary.
The purpose of this report is to consider the needs for research and data in the social and behavioral sciences that could help improve and extend existing successful programs and devise more effective strategies for preventing HIV transmission. We do so while recognizing that were such strategies to stop transmission tomorrow, a formidable burden of disease would remain because of the number of current infections. Thus the report also focuses on research and data that could support efforts to mitigate the impact of the AIDS epidemic.
Extent of the Epidemic
With little fanfare, the official number of AIDS cases worldwide since the start of the epidemic passed the 1 million mark near the end of 1994. By December 31, governments had notified the World Health Organization's (WHO) Geneva headquarters of 1,025,073 cases of the disease since the start of record keeping in 1980—a fact that was covered in a six-sentence story on an inside page of The New York Times (January 4, 1995). Moreover, given the chronic underreporting and under-diagnosis in developing countries, the actual number of AIDS cases may be four times as high (World Health Organization, 1995). The official statistics include people who have died, but they do not reflect the millions of people who are already infected with HIV but have yet to develop the symptoms of AIDS.
The situation is critical in sub-Saharan Africa, where WHO estimates that approximately 11 million adults and as many as 1 million children have been infected with HIV and where basic infrastructure, financial, and managerial resources, as well as health-care personnel to deal with the catastrophe, are all extremely scarce (World Health Organization, 1994, 1995). The magnitude of the epidemic varies widely across the continent. All of the most seriously afflicted countries are geographically concentrated in sub-Saharan Africa. With the exception of Côte d'Ivoire in West Africa, they all lie in a region of East and Southern Africa that stretches from Uganda and Kenya southward to include Rwanda, Burundi, Tanzania, Malawi, Zambia, Zimbabwe, and Botswana (U.S. Bureau of the Census, 1994; Stanecki and Way, 1994). In certain cities such as Kampala, Uganda; Lusaka, Zambia; Blantyre, Malawi; and Francistown,