Three Scenarios

The three scenarios featured in the report are: "Tough Choices: Africa Takes a Stand," "Traps and Legacies: The Whirlpool," and "Times of Transition: Africa Overcomes."

"Tough Choices" tells a story in which African leaders choose to take tough measures that reduce the spread of HIV in the long term. This scenario shows how, with scarce resources, governments and civil society are forced to confront tough choices in improving Africa's future and tackling underdevelopment.

In "Tough Choices," antiretroviral therapy is scaled up, from less than 5% treated at the start of the scenario to just over one third by 2025. The roll-out of antiretroviral therapy increases steadily, reflecting the continued investment in health systems and training, as well as drugs manufacturing capacity within Africa. Compared to "Traps and Legacies," an estimated 24 million HIV infections are averted over the next 20 years. Initiatives to support children orphaned by AIDS also increase, but the number of children orphaned by AIDS almost doubles by 2025.

"Traps and Legacies" is a scenario where AIDS depletes resources and weakens infrastructure. As a result, AIDS deepens the traps of poverty, underdevelopment, and inequality. In this scenario, the HIV prevalence across the continent by 2025 remains at around 5% of the adult population, with some countries above or below this level. Life expectancy drops across many countries, and the number of people living with HIV in Africa increases considerably.

HIV prevention efforts are not effectively scaled up. Efforts to roll out antiretroviral therapy continue (over 20% of people who need ARV therapy have access to it), but huge obstacles remain, including a combination of underdeveloped and overwhelmed systems, and escalating costs.

In "Times of Transition," AIDS is seen as an exceptional crisis requiring an exceptional response. AIDS is viewed in its broader development context. A series of transitions occur in the ways Africa and the rest of the world approach health, development, trade, and security. External aid increases considerably and there is sustained social and infrastructural investment.

In this scenario, Africa's adult HIV prevalence rate drops considerably, external aid to Africa doubles, and ARV coverage is approximately 70% by 2025. Compared to "Traps and Legacies," an estimated 43 million HIV infections are averted by 2025.

Worst Is Still to Come

"Not only is strong leadership vital, strong health systems and development are also necessary in our quest to control the AIDS epidemic," said Dr. Kenneth Kaunda, former President of Zambia, who delivered the keynote address today. "AIDS is going to be around for a long time and needs consistent policy responses over several terms of government. Investing in children as a resource for the future, and keeping their parents uninfected and alive, will make a huge difference."

While the worst of the epidemic's impact is still to come, the scenarios suggest that there is still a great deal that can be done to change the longer-term trajectory of the epidemic and to minimize its impact.