Pennies a Day Can Stop Spread of AIDS

In a slum outside Abuja, Nigeria, the capital of Africa’s most populous country, we had an appointment with a group of prostitutes.

Seated in front of a colorful poster that announced, “No condom, no sex,” Angela told us her story. Angela’s path to becoming a commercial sex worker is typical. She was orphaned at a young age and forced into sex work to support herself and her younger brothers and sisters.

Each of the 5,000 prostitutes who work in that locale must service about 10 clients a day to scrape out a meager living.

Their risk of contracting HIV is extremely high, but their importance in stopping the spread of HIV is even higher.

Angela is part of an organization that trains prostitutes to negotiate condom use with clients, one of the most cost-effective HIV/AIDS strategies in the world, saving thousands more lives for the money than other approaches.

We traveled recently to South Africa, Nigeria and Kenya to promote low-cost, high-impact interventions and to urge leaders in Africa and around the world to dramatically increase the resources they dedicate to defeating HIV/AIDS.

HIV/AIDS is one of the most urgent public health issues humanity has ever faced. Twenty-two million people already have died. Forty million are living with HIV/AIDS. One hundred million are likely to be infected by 2005 unless we see what South African Archbishop Desmond Tutu has called “a very significant and decisive intervention.”

As shocking as the numbers are, they don’t come close to conveying the human cost. Eighty percent of those dying from AIDS are between the ages of 20 and 50. These are the people who enforce the laws, harvest the food, heal the sick, teach the students and raise the children.

Without farmers and teachers and mothers and fathers, things fall apart.

Yet the truly startling news is not how bad it is but how much better we can make it.

Uganda has shown how to bring HIV prevalence from 30% to below 10%. Senegal has shown how to keep its prevalence consistently below 2%.

Both nations did it by using proven tools, many of which are very inexpensive.

Heads of state must stress that HIV/AIDS is a direct threat to the country and to each individual. Every nation needs a massive public education effort combined with aggressive programs of condom distribution, especially to groups at the highest risk of contracting and spreading the disease. In sub-Saharan Africa, the total condom supply now equals three per man per year.

In Kenya, we visited the AIDS Vaccine Initiative, where an AIDS vaccine is undergoing human testing. While we believe an AIDS vaccine is the best hope to end the pandemic, the world also needs to support proven and affordable interventions now.

Sexually transmitted infections, which increase susceptibility to HIV infection, must be treated. Nevirapine, which cuts by half the risk of mother-to-child transmission for $4 a treatment, must be provided. Voluntary counseling and testing must be available. In Nigeria, out of 3.1 million people infected, 3 million don’t know their status. National support groups for people with HIV/AIDS must be expanded to reduce the stigma of HIV/AIDS.

Foundations and nonprofits can support research, sponsor programs and identify what works. But knowing what works is not enough. It will be impossible to reverse the HIV/AIDS epidemic without a dramatic increase in health funding.

Developing countries need to make their own health spending a greater priority and establish clear accounting procedures to give people confidence that the money is going where it ought to go. Wealthy countries, urged on by citizens who care about this issue, must also dramatically increase funding, and the United States should lead.

Polls show that many Americans fear that corrupt or inefficient governments often waste foreign assistance. But because of the intense personal interest that we witnessed in Africa by suffering or concerned people, waste or corruption is minimal in the crucial area of health spending.

The more we realize that pennies a day can save millions of lives, the more we should insist that the world’s wealthiest nation continue to increase its health aid and take a lead role in ending this disease.

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Jimmy Carter was the 39th president of the United States. Bill Gates Sr. is the co-chairman and CEO of the Bill and Melinda Gates Foundation.