y all objective standards, the AIDS epidemic in southern Africa is catastrophic. UNAIDS now estimates that 22.5 million of the 33 million people living with HIV infection reside in sub-Saharan Africa. While the epidemic has stabilized or declined in some parts of Africa, in southern Africa it continues to explode. Countries such as Botswana, Zimbabwe and Zambia have HIV seroprevalence rates above 20%, with 30-50% of pregnant women in urban areas infected. South Africa has the fastest growing epidemic, and UNAIDS now estimates that 10% of the population, or 4 million people, are infected, placing it first in the world in number of infected individuals. The impact of this growth in the epidemic is devastating. Mortality is increasing, hospitals are overflowing, the workforce is becoming depleted (particularly health workers), and the number of orphans is growing. AIDS is now the leading cause of death in sub-Saharan Africa, with tuberculosis being the leading killer amongst people with AIDS.

In a report on the status of the HIV epidemic issued by UNAIDS on the eve of the conference, a number of sobering statistics were revealed. For example, a 15-year-old boy in Botswana today has an 85% probability of dying of AIDS in his lifetime; deaths from AIDS in Africa will eclipse the total mortality from the Black Plague of the 14th century; AIDS has reversed all gains made since 1950 in life-expectancy at birth for a number of African countries. For all of southern Africa, average life-expectancy will decline from 59 years to 45 years by 2010, with declines of more than 20 years in some countries. In Zambia, more than 1300 teachers died of AIDS in 1998, the equivalent of two-thirds of all new teachers trained annually. The AIDS epidemic is a medical, public health, social, political and economic calamity.

While western nations have been accused of an inadequate response to the disaster of AIDS in Africa, African nations themselves also share in the blame. Denial of AIDS as a serious problem and failure to mobilize appropriate resources has been the norm for most African countries. Thus, the theme of this year's conference was "Breaking the Silence," with the aim of directing greater attention to the epidemic and creating an atmosphere of openness for discussing and combating HIV. This was an especially apt theme for the conference, as the AIDS epidemic in South Africa is most intense in KwaZulu Natal, the province in which Durban is located. Just two years ago, a local AIDS activist, Gugu Dhlamini, was murdered by her neighbors after she disclosed her HIV status to encourage others to be tested. Much of the Opening Ceremony was dedicated to a call to break the silence on HIV, and this topic reverberated throughout the conference.