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More than 90 percent of adults infected with HIV live in developing countries.Two-thirds of the total number of people in the world living with HIV are in Sub-SaharanAfrica. While Central and Western Africa remain the hardest hit by HIV/AIDS, Sub-SaharanAfrica is the region in which the epidemic is growing fastest. Nearly all (over 97percent) of infected Africans do not know they are infected, mainly because they lackawareness of or access to HIV testing. Contrary to conventional wisdom, heterosexualtransmission accounts for most infections and at least 43 percent of all infected adultsin developing countries are women.

The consequences of this epidemic are far-reaching. As AIDS mortality rises, a growingnumber of children will be orphaned. This will exacerbate poverty and inequality. By theyear 2010, AIDS will have made orphans of almost 40 million children in Sub-SaharanAfrica. Very young orphans whose mothers are infected or die of AIDS have higher mortalityrates than other orphans because roughly one-third of them are themselves infected withHIV at or around the time of birth. Also, AIDS orphans are more likely to becometwo-parent orphans because HIV is transmitted sexually.

In Sub-Saharan Africa, 7.4 percent of all those aged 15-49 are believed to be infectedwith HIV (this contrasts with 0.5 percent of adults infected in the United States). Thepotential for political and economic instability is tremendous. Only a small number ofindividuals with HIV-related disease can afford effective new drug regimens and most willdie within 5-7 years of becoming infected. Further, HIV/AIDS causes illness and deathamong adults in the most productive age groups, resulting in significantly slower growthof the labor force and heightening educational needs among a population which is losingthe well-educated as well as the under-educated. Most Sub-Saharan African countries facethe dual challenge of lowering HIV prevalence and of coping with the impact of existinghigh prevalence on their health systems and societies.

Early government commitment and intervention can slow the spread of AIDS decisively.While incidence is still high, recent trend data in Uganda show that government effortscan be extremely effective. In 1997, 5-9 percent of Ugandan adults were infected, comparedto 7-12 percent in 1996. This decrease is most pronounced among Ugandan youth, concurringwith studies which have shown that they are adopting safer sexual behavior (includinglater sexual initiation, fewer partners and increased condom use).

To combat and contain the spread of HIV/AIDS, there remains continued need forheightened public awareness and government intervention. The U.S. Government has focusedits efforts on prevention of heterosexual transmission of HIV in approximately 30countries via programs that: change risky behavior through education, motivation andinnovation; promote condom use; reduce sexually transmitted infections that increase therisk for HIV; improve the policy environment to reduce the transmission of HIV; conductresearch to improve program cost-effectiveness; and increase commitment through advocacy,voluntary counseling and testing programs.

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