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If you are an HIV-infected person alive today, there is about a 66 per cent chance you live in sub-Saharan Africa. So estimates the World Health Organization. In the US, HIV infection rates among urban gay men range in percentage from around 20 to the mid-40s. Among female sex workers in Harare, Zimbabwe, the infection rate is 90 percent. Nationally in the US there are an estimated .5 HIV-positive persons for every 10,000 adults. In Canada the rate is less than .2. In Botswana, by contrast, the comparable rate of infection is more than 18 per 10,000.

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Africa remains the HIV epidemic's center of gravity. Reporters filing dispatches from the worst-affected areas tell stories of overflowing morgues, grandparents who've lost a dozen children and grandchildren, villages where the frequency of deaths has transformed the rituals of mourning. Many African countries face AIDS caseloads 100 times higher than in the West, with available funding usually many hundred times less.

Still, there were some hopeful signs in Kampala last December at the Ninth International Conference on AIDS and STD in Africa. A number of studies showed dramatic declines in infections in Uganda, one of the worst-hit countries, where some 150,000 to 200,000 Ugandans die every year of the disease. In the Masaka district, south of Kampala, where 11.4 percent of men in their 20s were infected in 1989, only 2.4 percent were in 1994, with a decline somewhat less steep for females ages 13 to 19. The undeniability of the epidemic, combined with a vigorous government-sponsored safer sex campaign, has yielded significant behavior changes, of the sort familiar in the North American gay communities riding the first shock wave of AIDS deaths.

But the virus in Africa is unevenly spread, and many parts of rural Africa, where the majority live, have not been so obviously affected. Getting the message out to the villages about AIDS poses special challenges.

"AIDS is an issue Africans feel inhibited talking about. In Europe, our inhibitions focus more on representation. We talk a lot about fellatio, sodomy, and so on, but we don't represent them," says Nathan Clumek, an Egyptian researcher into the AIDS epidemic in Africa, and a professor at Brus sels' Free University. "It's quite the reverse in Africa, where there are countless phallic images of all kinds and some quite unequivocal statues. Sex is exuberant, it makes people laugh, but they don't talk about it. If they do, it's in a way that prevents the dimension of disease or death from being introduced," he said in an interview with Le Monde.

With Africa's limited resources, how do you fight the epidemic? In a countries where per capita spending on health care may be around ten dollars a year, there's little prospect for dispensing the anti-viral drugs that are the treatment of choice in the West. Preventing of infection, rather, has to be the focus.

In particular, health workers at the conference emphasized the benefits of focusing aggres sively on sexually transmitted diseases (STDs). People with sore-free genitals are much less prone to becoming infected during sex with a partner who has HIV. Providing high-quality STD care in local health clinics can lead to dramatic reductions in new infections, one African study found, cutting them by almost half.

African health workers also stress the need to offer girls and women new ways to protect themselves during sex with males, besides convincing possibly resistant partners to don a condom. They look to female condoms and virus-killing vaginal sprays, as well as improving women's skills at negotiating sex and medical care. While women are more than half of those infected in Africa, they go to the doctor and seek admission to hospitals less often than men.

While there's plenty to be done, resources are scarce. The African AIDS crisis has become old news. As Asia has emerged as a new frontline of the epidemic, internataional aid has shifted there. The fight against AIDS in Africa takes place amidst economic stagnation and increased con straints on social spending imposed by Western creditors. "The most important message of the conference was that the HIV can be managed, even in the African environment in which fiscal resources are scarce," said Joeseph Perriens, a UN AIDS official, after the Kampala conference. Is that optimism or just realpolitik? **

Editor's Note: from The Guide, May 1996