I thought to myself: those words capture,

I thought to myself: those words capture, vividly, the greatest double standard which besets the modern world. In the west, HIV/AIDS, with drugs, has become a chronic illness. In the high HIV prevalence countries in Africa, where I do my work for the United Nations, funerals are the leitmotif of life. Attending funerals is a painful and ubiquitous national activity. Three million people died of AIDS last year, the vast majority in Africa. There are an estimated fifteen thousand new infections every day, the vast majority in Africa. Dealing with death, anticipating death, preparing for death, are eerily measurable components of a country's Gross National Product.

Photo by Stephanie Nolen

Second: I was in Botswana last month, a small country - 1.6 million people - but the country with the highest HIV prevalence rate in the world. Between 35 and 40% of everyone between the ages of 15 and 49 is infected with the virus. I was sitting and chatting with several groups of people living with AIDS, represented, as always by women, because women comprise such a hugely disproportionate share of infections, and I asked them, as I always do, what it is that they most need? Food, they said, blankets, money for school fees for their children, soap, and employment. Any kind of income-generating project. Wait a minute, I said, what about treatment? They all looked positively bemused. Treatment, they replied, that's not a problem. It's free; when we need
it we just get it.

I was stunned. No one in Africa had ever said that to me before. But you see, Botswana has money. Reserves of wealth from diamonds, and it has a remarkable public-private partnership with Merck and the Gates Foundation, each of which has contributed $50 million, and it has state
of the art laboratory facilities orchestrated by Harvard, and it has a health infrastructure of reasonable integrity, and most important, it has unprecedented commitment from the government. At the Princess Marina Hospital in the capital city, Gabarone, 5,700 people are in treatment with antiretroviral drugs; the largest public sector programme of its kind on the continent. And it's free for all, because that's government policy. It's an astonishingly impressive initiative, demonstrating what can be done if the circumstances are propitious, although it must be said that even with the infrastructure and the resources, there have been lots of difficulties along the way, and for a variety of reasons, treatment has progressed far more slowly than the Government of Botswana would have wished.

The problem, however, is, that with the possible exception of parts ofSouth Africa, no other country in sub-Saharan Africa has even the approximation of the setup in Botswana. And again, with the possible exception of South Africa, no other country in Africa has the resources, let alone the infrastructure or capacity of Botswana. Botswana has shown what can be done; but at the moment, no one else comes close. So treatment is a mirage for millions.