Why AIDS Keeps Spreading in Africa ; A New UN Report, Marking Wednesday's World AIDS Day, Estimates That 5 Million People This Year Got HIV

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Messages about how to prevent HIV have been spread to all corners of Africa. AIDS education programs take place in schools in Kenya, churches in Uganda, workplaces in Botswana, and even bus stations here in Ghana. Yet the stark numbers in a new United Nations report suggests these efforts are failing to persuade millions of Africans to change their sexual behavior.

The UN AIDS Epidemic Update 2004, launched to mark Wednesday's World AIDS Day, estimates about 5 million people over the past year contracted the virus that causes AIDS, and predicts another 5 million will do the same next year. Most of those people - 3.1 million, or 63 percent - are here in Africa.

Awareness levels around the world are higher than they've ever been, but so is the pace at which the virus spread, according to the report. The real hurdle, say observers, is translating awareness into behavior change, and the effort often runs up against longstanding and strongly held cultural values.

"If the same market researchers who are selling Coke were charged with selling safer sex, they'd probably have thrown up their hands by now because it's a much more complicated thing," says Neill McKee, coauthor of the book "Strategic Communication in the HIV/ AIDS Epidemic."

Here in sub-Saharan Africa some of those cultural stumbling blocks include male dominance, a reluctance to talk openly about sex, and a tradition of polygamy that today manifests itself in tacit acceptance of married men having multiple sexual partners. African men who have become disempowered through a history of colonialism, racism, and poor economic prospects are unwilling to give up the power they hold over women, says Suzanne Leclerc- Madlala, head of anthropology at South Africa's University of KwaZulu-Natal.

"I don't think we're putting enough emphasis on changing men's behavior," says Ms. Leclerc-Madlala. She says a key solution is for male African leaders - whether politicians, sports figures, or traditional rulers - to take a stand, admit publicly that men's behavior is a problem, and urge men to change.

"The prevention strategies are missing the point. Women do not have the economic power or social choices over their lives to put the information into practice," said Kathleen Cravero, deputy executive director of the UN joint program on AIDS, during a press conference in London last week. "We tell women to abstain when they have no right. We tell them to be faithful when they cannot ask their partners to be faithful. We tell them to use a condom when they have no power to do so."

Research into whether young people in sub-Saharan Africa are putting into practice the so-called "ABC" principles - abstain, be faithful, or use a condom - shows, at best, mixed results. The country often singled out as Africa's biggest AIDS-prevention success story is Uganda, where HIV infection rates have dropped to 4.1 percent from a peak of 13 percent in the early 1990s. …