With the above considerations in mind, the National Research Council assembled a special panel of international experts in 1994, at the request of the U.S. Agency for International Development, to examine the nature of the HIV/AIDS epidemic in Africa from a social and behavioral viewpoint. The goal of the Panel on Data and Research Priorities for Arresting AIDS in Sub-Saharan Africa was to identify and describe the numerous behavioral and social factors that affect the spread of the HIV/AIDS epidemic in Africa, to identify or clarify strategic opportunities for donors and African governments to develop effective interventions both for preventing the spread of the epidemic and for mitigating its impacts, and to elucidate the most pressing research requirements over the next 5 to 7 years for facilitating the development of more effective prevention and control strategies in the future.
At the outset, the panel realized that this mandate was nearly impossible: the strategies and issues surrounding the HIV/AIDS epidemic are extremely complex and change constantly as the epidemic evolves. No single report could be expected to address the full range of potential issues. Therefore the panel decided to focus its efforts on identifying data and research priorities. Even so, the task is daunting. Sub-Saharan Africa is a geographically, demographically, socially, and culturally heterogeneous region (see Chapter 2). Thus, as suggested above, we do not find homogeneity in the distribution of HIV and AIDS or in the behavioral factors and social contexts that are so vital in shaping the nature and the spread of the epidemic. There are enormous differences within the among countries with regard to the rate of spread, the socioeconomic groups most severely affected, the cultural contexts of practices that place populations at risk, and the male-to-female ratio of new infections. There are also important differences among communities with regard to the level of AIDS awareness and the degree of stigmatization associated with the disease (Kaijage, 1994a, 1994b). Finally, AIDS is contracted from two different viruses—HIV-1 and HIV-2. Although the two have the same modes of transmission, HIV-2 is concentrated in West Africa, is less dangerous, and is far less common and less well understood than HIV-1 (see Chapter 3). Hence, the only way to respond effectively to the epidemic is to plan at the national, or preferably the subnational or regional, level.
A further complication facing the panel from the outset was that if AIDS research is to be successful, it must be perceived as useful and relevant by the community under study. To make the panel's efforts as participatory as possible, several members visited selected sub-Saharan African countries during the course of the panel's work and talked with many African policy makers, researchers, and planners. In addition, in January and February 1995, a subcommittee of the panel spent 3 weeks in Cameroon, Tanzania, and Zambia talking with senior African officials to solicit their views on the extent of the AIDS crisis in their countries and the appropriateness of the existing level of response (see Appendix A).