Sub-Saharan Africa contains only 10 percent of the world's population, but is home to 60 percent of all people living with HIV, the virus that causes AIDS. On the eve of World AIDS Day, the continent's situation continues to be bleak, with infection rates generally showing few signs of letting up.
One of the continent's bright spots in the fight against HIV/AIDS is Kenya.
The most dramatic decreases in HIV prevalence rates in Sub-Saharan Africa have been among pregnant women in the Kenyan towns of Busia, Meru, Nakuru, and Thika.
According to the U.N. 2005 AIDS Epidemic Update report, the median prevalence rates in these towns plummeted from 28 percent in 1999 to nine percent in 2003.
Other urban centers in the East African country have shown similar encouraging results. Overall, the HIV rate in Kenya dropped from 10 percent in the late 1990s to seven percent in 2003.
Dr. Patrick Orege is director of the National AIDS Control Council of Kenya. He attributes the dramatic drops to a range of programs such as Voluntary Testing and Counseling, known as "VCTs," and initiatives to prevent pregnant HIV-positive mothers from passing the virus along to their babies.
"One is enhanced campaign," he explained. "Two, the provision of condoms - there is increased condom use. Three, we have put in PMCTs, mother to child transmission [programs], scaled up VCT services where people now know their status and taken appropriate decisions, intensive campaign on behavior change including abstinence among the youth."
Dr. Orege says his country is following the so-called "ABC" approach to behavioral change: abstain; be faithful to one partner; use a condom. He says that most Kenyans have been directly or indirectly affected by AIDS, a major factor in their behavioral change.
Uganda, Zimbabwe, and parts of Burkina Faso have also shown significant decreases in prevalence rates. But outside of those countries prevalence rates in Sub-Saharan Africa continue to be the same or have increased.
Southern Africa remains the AIDS epicenter, with Botswana, Lesotho, Namibia, and Swaziland in particular recording very high rates, often exceeding 30 percent among pregnant women.
The report says Zimbabwe is the notable exception in the region, with HIV prevalence among pregnant women declining from 26 percent in 2002 to 21 percent in 2004. The U.N. report attributes high condom use, a reduction in the reported number of sexual partners in recent years, and the leveling off of mortality rates to this decline.
Mark Heywood, the head of the South Africa-based AIDS Law Project, says that Southern Africa has what he calls a "centuries-old pattern" of workers moving from their homes to earn a living in the mines.
"And migrant labor is definitely a factor," he said. "As people go to urban centers, they work on mines away from their families, become infected with HIV, and then carry HIV infection back into rural areas or neighboring countries and then spark another epidemic."
Mr. Heywood says poverty, illiteracy, government inaction, and inequality between men and women combine to make the situation worse.
A big problem the U.N. report points out is that knowledge about AIDS and HIV transmission routes is still generally low in Sub-Saharan Africa, with women being typically less informed about the virus than men.
For instance, in 24 Sub-Saharan African countries such as Cameroon, Uganda and Nigeria, two-thirds or more of women aged 15 to 24 years lack comprehensive information about HIV and how it is passed along.
Kingsley Obom-Egbulem is information officer with a group called Journalists Against AIDS - Nigeria.
He says there is much misunderstanding about HIV/AIDS in Nigeria's rural areas in particular.
"For those who do not know what AIDS is all about, when people are sick, they feel they are suffering from one inexplicable disease or the other," he said. "Some also feel there they are under some spiritual attack. Some even feel their [disease] is witchcraft."
Mr. Obom-Egbulem says most organizations that deal with AIDS - and therefore would be the ones to educate people - are located in the cities far from the rural areas. He recommends that cellular network companies send out frequent text messages about HIV/AIDS to mobile phones everywhere in the country.
He says he thinks that men travel to cities more frequently than women, and are therefore more exposed to information about HIV/AIDS.
The U.N. report says that education levels make a huge difference in knowing about and understanding HIV/AIDS. For instance, young women in Rwanda with secondary or higher education were five times more likely to know the main HIV transmission routes than were young women who with no formal education.
Overall, HIV/AIDS continues to wreck havoc in Sub-Saharan Africa. The U.N. report says that this year, an estimated 3.2 million people became newly infected, while 2.4 million adults and children died of AIDS.
Among young people aged 15 to 24 years, an estimated 4.6 percent of women and 1.7 percent of men are living with HIV this year.
