Photo courtesy of CDC	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Three-quarters of the 40 million people living with HIV or AIDS live in sub-Saharan Africa. About 3.5 million new infections occurred in 2002, and nearly 2.4 million sub-Saharan Africans died of AIDS last year.

In a soft, lilting voice, Lucy Nthabiseng Makoae, Ph.D., MPH, RN, described the ravages of an epidemic that is destroying her country, Lesotho, a small African republic in southern Africa.

More than a third of adults in Lesotho are infected with HIV or AIDS. An estimated one in 10 children has the disease. Life expectancy has dropped from 60 to 49 years old, probably because of AIDS. Health workers believe the disease is increasing among infants because, Makoae said, "we just see babies dying maybe after one year, two years. They don't seem to reach four years."

The first time Makoae saw 14-year-old children living with AIDS in the United States, she couldn't believe her eyes, she told a group of nurses and other health professionals who gathered in a conference room at the University of California, San Francisco School of Nursing to hear her speak.

They were running around, playing, talking. "They looked healthy," Makoae said. "Here [in the United States], you see healthy people living with HIV. With us, when you talk about AIDS, you talk about death."

In the United States, Canada, much of Western Europe and parts of the rest of the world, AIDS is a dangerous, chronic disease, but no longer a death sentence. In sub-Saharan Africa, in some of the poorest countries in the world, hundreds die every day from an illness most won't even admit they have.

Nurses like Makoae are bearing the brunt of the epidemic in many of these countries. They run the clinics, care for the sick in hospitals, educate people in the communities and try to ease the incredible stigma around the illness. But a combination of poverty, illness and despair has depleted their ranks considerably. They are exhausted and demoralized, report African and U.S. nurses who have worked in Africa.

Nurses say that in some African countries, this grim picture may be starting to change, thanks to education and prevention programs and the introduction of drugs that have made HIV/AIDS a "manageable" disease in the United States and Western Europe. But without a massive infusion of help from the rest of the world-including the medical and nursing communities-the epidemic will have little chance of abating, say nurses who have worked in Africa.

They add that any aid must support health care workers in Africa who understand their communities and cultures, rather than be imposed by outsiders. To this end, many are involved in small community projects, supporting Africans in creating training programs for health care workers, building clinics and starting drug programs.

According to information from the United Nations, nearly three-quarters of the estimated 40 million people living with HIV or AIDS live in sub-Saharan Africa. About 3.5 million new infections occurred in 2002, and an estimated 2.4 million sub-Saharan Africans died of the disease last year. About 10 million young people, aged 15 to 24, and almost 3 million children are living with HIV. In some countries, an estimated 40 percent of the adult population is infected. No one knows for certain, however, because most people never get tested for HIV.

The pandemic has wreaked havoc on already strained health budgets and, for many countries, erased what little progress they have made in improving health standards. Life expectancy at birth in southern Africa, which rose from 44 years in the early 1950s to 59 in the early 1990s, is expected to drop to 45 years between 2005 and 2010 because of AIDS. The United Nations expects the AIDS death toll to peak at the end of this decade.

"We have never seen a disease like AIDS," Makoae said. "It affects every system of the body. We do not know what we can do."

Universal education

Kathleen Fordham Norr, Ph.D., an associate professor at the University of Illinois at Chicago College of Nursing, has helped research and develop a nurse-coordinated HIV prevention and education program for health care workers in Botswana and Malawi, two African countries where the epidemic has hit hard. Norr, a health sociologist, is working with researchers in Malawi to expand and evaluate the program.

Next Page