Challenge for Africa too

EDITOR—The 24 January issue on antenatal HIV testing emphasised the need to promote routine voluntary HIV counselling and testing to maximise the opportunity for interventions in those found to be infected. More than 20 million of the 30 million people estimated to be infected with HIV at the end of 1997 live in sub-Saharan Africa, where some spend less than $15 (£9) per capita on health each year and over 90% of those infected are unaware of their infection. The opportunities for the medical interventions discussed are therefore limited.

Nevertheless, although individual benefits may be small, the potential benefits for society are huge. HIV/AIDS “exceptionalism” in parts of Africa has led to an environment of stigma and denial, with the tacit support of policy makers and healthcare staff. HIV is rarely entered in African death certificates, yet treatment decisions are made on the assumption that a patient is infected. Half of those counselling others to consider HIV testing …