African viewpoint: Status update

As wars rage, governments fall, economies crumble and the planet's climate disintegrates, we would be hard-pressed to find a more persistent silent presence than the big disease with the little name.

After all, Aids has lined our cemeteries, ripped families apart and changed the social make-up of our populations drastically - as if legions of people had never lived, except in our heads. But the grave-diggers will testify that the facts were never far wrong - from the awful truth of how many people have been swept aside.

As we marked World Aids Day on 1 December, the Global Aids Fund to Aids, Tuberculosis and Malaria said some 33 million people had lost their lives in the three-decade long scourge, and the drop in figures in the 21st Century is just that - a drop in figures - not an indication that the disease has taken a sabbatical or that the fightback with new improved HIV drugs is gaining the upper hand.

There are many things to unpick about World Aids Day. For a start, given the depth of loss, this one day seems hopelessly inadequate.

Imagine yourself the Ugandan mother of 11 siblings - none of whom have seen the 21st Century and all of whom had birthdays and death days. Then, your thoughts would consider this one day as just one of many in the anguish Aids has wrought.

But what the day does bring is the truth that all of mankind - from the 2.5 million living with HIV in India to the 22.5 million infected on the African continent to the heroin addicts on Sumatra Island in Indonesia and the Chinese teenagers born HIV-positive to the Russian prostitutes - all have been affected by a disease that is blind to colour, race, religion and creed.

To those of us of a certain age, our popular culture was invaded all those years ago with advertisements that urged us "not to die of ignorance", and we lived in a state of high anxiety over our own prospects for parenthood and normality. Any African will know someone who knows someone for whom the fight against the disease is a constant and urgent battle.

Despite putting our best and most renowned statesmen and women to the cause, the war on Aids remains one of fluctuating fortunes with no real prospect of final victory.

In the last three decades, though, science has done its utmost to give us a realistic chance - there are now 6.6 million people living on life-saving anti-retroviral drugs, and new research claims that early ARV treatment may slash the rate of HIV infection by up to 60%. This is incredible news for a continent carrying, at the last count, some 14 million Aids orphans and which, despite having only 11% of the world's population, has 67% of those living with HIV/Aids on the planet.

In the 21st Century, even the testing technology has changed so much that gone are the weeks of waiting for results. With a needle puncture on your finger and a drop of blood, the magic of modern science can give you a rapid HIV test in seconds, and so, knowing your status, you are better able to negotiate the rocky road of surviving HIV where timely detection is key.

But human nature is not so straightforward and despite hundreds of rapid HIV test centres in many capitals the knee-jerk response is not to want to know, as if the mere fact of discovering a status that is positive will be like being placed on death row - and the hour glass of time will have shed a billion grains of sand with the news that the disease has touched you.

The ensuing logic says that after that, you are at the mercy of fear and stress, which will carry you to your grave quicker than time intended.

It is this attitude which may account for the continuing high rates of infection and, as the world shields itself from a global recession, how long can Africa expect generosity in funding ARVs for the needy.

Even here the figures are not so uniform - it may be easier to be HIV positive in Cape Town than in Juba or Harare, as the government wallet still determines access to medicines.

In Africa the disease has tended to condemn the most vulnerable. Perhaps just as important to knowing your status is knowing your partner's status. And on a continent where women still struggle for equality, how do wives negotiate this?

Women are twice as likely to be infected than men. They also carry the burden of mother-to-child transmission - and are the carers of Aids patients and children orphaned by the illness are women. Should marriage be based on compulsory testing? What of those who are not married? Isn't it true that some prostitutes charge more to work without condoms?

And in the minefield of Aids funding, aren't the decision-makers mainly men when many victims are women? There are still more questions than answers. And while the continent grapples with the idea of treatment for all, testing and detection should never be abandoned because even as the self-righteous moralise about abstinence and better diets, there has never been any indication that subsequent generations to those millions we have buried are less keen on sex and therefore more immune to this disease of our time.

Come World Aids Day 2012, we should be revising the pandemic's figures downwards, and giving hope to those who have dared to live longer by knowing their status early on.