The Traffic in Lusaka

LUSAKA -- It is one measure of American influence that a meeting in the White House can affect the traffic in Lusaka.

About a year and a half after the 2002 Oval Office policy session in which the President's Emergency Plan for AIDS Relief (PEPFAR) -- the largest effort to fight a single disease in history -- was outlined in a black briefing book, Dr. Jeffrey Stringer received a call from an American embassy official. Stringer, the director of the Center for Infectious Disease Research in Zambia (CIDRZ), was asked if he could put 1,000 people on AIDS treatment within two months -- a nearly impossible request.

Stringer and his team, lacking office space, put up tents in which to meet with patients. Without sufficient staff, the work of doctors was performed by physician's assistants, the work of physician's assistants by nurses. People already on treatment took the blood pressure of new patients. Working around the clock, the goal was met.

By July of this year, CIDRZ will have 100,000 patients on AIDS treatment -- twice the number treated in all sub-Saharan Africa just five years ago. About half the people in Zambia who need AIDS drugs are currently receiving them, largely because of PEPFAR -- one of the most remarkable achievements in the history of public health.

Stringer also talks of a more subjective measure of success. Five years ago, when driving across Lusaka, he would need to leave himself extra time to navigate the traffic jams created by regular funeral processions. Now it is no longer necessary.

It is sometimes asserted that this massive effort to treat AIDS in Africa pulls health professionals away from other fields, or that funds might be better spent on other health priorities. But these arguments make little sense in a place such as Zambia, where one in six people is infected with HIV. Stringer estimates that a Zambian boy of 15 today has a 70 percent chance of getting the disease over his lifetime. "If we don't deal with this," says Stringer, "there is no point dealing with diabetes or tropical diseases."

The ultimate answer is AIDS prevention. But this is a long-term goal. Since the virus can take eight to 10 years to develop into AIDS, there is a massive queue of people who will need treatment, even if premarital abstinence and marital faithfulness and condom use were suddenly universal, or if an AIDS vaccine were developed tomorrow.