HIV/AIDS burden in rural Africa: the people's struggle and response of the international community

nants, which drive the HIV epidemic and maintain, even reinforce, an environment of vulnerability and neglect2,3. International organizations, NGOs, governments, and communities are implementing programs and investing resources in HIV prevention, treatment and care. Nevertheless, with the exception of a few successful efforts, most interventions in resource-poor settings have failed to mitigate the global impact of two decades of HIV/AIDS burden or address the critical situation of affected adults and children. Data from the WHO have shown that just 11% of HIV-positive pregnant women in need of antiretrovirals (ARVs) to prevent mother-to-child transmission of HIV in lowand middle-income countries are receiving them. Global coverage of HIV testing and counseling remains unsatisfactorily low. And, although countries committed themselves to setting targets for universal access to these resources by the end of 2006, only 90 countries have provided data on their achievements. More than 1.3 million people in sub-Saharan Africa were receiving treatment in December 2006, but this only represents coverage for approximately 28% of those in need. The number of children receiving treatment increased by 50% in the past year, but only about 15% of the total estimated to be in need of HIV treatment had access to it4. In most AIDS-affected communities, the situation continuous to be devastating. The high death rates of parents and caregivers has increased poverty and created an environment of neglect for the new generation of orphans and other vulnerable children living in rural areas, making the HIV/AIDS epidemic the direct cause of their suffering. In some cases, single mothers or grandmothers are taking care of these children, but in families where both parents have died of AIDS and no other family members are present, the children themselves are heading households and taking care of younger siblings at the early age of 12 or 13 years. These children and their siblings are particularly vulnerable to exploitation, violence and abuse. Children left without adult care have no access to social assistance. Dropping out of school is common because of a lack of resources for fees, uniforms and transportation. The children are deprived of an education, including opportunities to learn about basic HIV prevention skills, and therefore, are at a higher risk of acquiring HIV infection. Several studies have shown that by providing safe water, food and shelter to vulnerable women and children in the most affected areas, the impact of HIV/AIDS is mitigated at the household level and the risk of suffering sexual abuse, violence, child labor, and other forms of abuse and exploitation is reduced3,5,6. The situation seems difficult to manage for the international community after more than 20 years of advances in HIV/AIDS continues to be a threat for communities and countries in resource-poor settings. Despite more than 20 years of national and international efforts, countries in Africa that already faced a severe economic crisis in the early nineties are now in an even worse situation because of the macroand microeconomic impact of the HIV/AIDS epidemic. At that time, “structural adjustment programs” were imposed by the World Bank to allow the granting of loans. These policies were applied by most of the countries implicated, thereby threatening educational, social and health systems, and preventing access to vital services by the most impoverished communities and individuals. The joint United Nations Program on HIV/AIDS (UNAIDS) 2006 report has estimated that 39.5 million people now live with HIV infection. In the year 2006 alone, a total of 4.3 million people were newly infected and 2.9 million people died of AIDS. This overview includes an estimate that more than 15 million children under the age of 18 have lost one or both parents due to the AIDS epidemic and its consequences. The UNAIDS report has shown that sub-Saharan Africa, particularly southern Africa, continues to be the most highly affected area on the planet, with more than 12 million children orphaned by AIDS and the highest incidence rate among young adults 1524 years old, three-quarters of whom are girls. These rising infection rates among girls and young women in countries with the highest world prevalence are clearly linked to gender-based inequities and violence in homes, schools and personal relationships1. The impact of the disease, especially in the hardest hit countries in Africa, has led to the collapse of public health systems due to the increasing demands for health care and commodities (laboratory reagents, antiretrovirals and drugs for opportunistic infections) and for the allocation of hospital beds. The collapse has also affected economic growth at all levels, human capacity and development, demographic growth and balance by age and sex, the educational system, and national and community social networks. The future impact of the pandemic, despite mathematical and epidemiological projections and models, is still uncertain in most of these areas because of the loss of human resources, demographic gaps, food insecurity, and socioeconomic, legal, political, cultural and gender determi-