Box for anonymous questions about HIV/AIDS at Diemo School, Kenya © Peter Armstrong

The human immunodeficiency virus, first identified in California in 1983, is transmitted by bodily fluids exchanged in sexual relations, or by contaminated blood, or through mother-to-child transmission. Despite prevention services absorbing 50% of HIV/AIDS spending, in 2006 only 50% of young people in developing countries were assessed to have sufficient knowledge to take control of the risks. Achieving universal awareness is a formidable and expensive task although the challenge of communicating effectively to young people in schools and in local communities has provoked endless creativity, with new technologies playing a part where possible.

Advocacy of behaviour change must tackle the strong bonds that exist within local custom, gender relations, the stigma of AIDS and the realities of poverty. Although intervention can only be effective through local community groups, there has been broad application of the ABC concept of Abstinence, Be faithful and use Condoms, each principle having priority over the next but not to an unrealistic extent. Concerns about unavailability or failure to use condoms are such that the World Health Organisation (WHO) has added male circumcision to its list of approved preventative measures, following research showing that the risk of infection was reduced by 60% for circumcised men. For similar reasons great efforts are going into the development of HIV-resistant microbicide gels which would restore a degree of control to women.

Early successes in HIV prevention have been attributed to Thailand, Uganda and Senegal - and more recently in Rwanda and Burkina Faso - with a common feature of determined political leadership at the highest level. By contrast, public doubts expressed by President Mbeki concerning the link between HIV and AIDS denied the natural opportunity for South Africa to display regional leadership and to tackle its status as home to the world's largest number of people living with HIV/AIDS.

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