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We agree with Mr Loefler (October 2002, JRSM1) that the HIV disaster has special dimensions in Africa. He contends that ‘a change in socioeconomic conditions’ is needed to address the pandemic, and accordingly offers a general prescription for ending the postcolonial status of Africa as an exploited society. The implementation of less philosophical responses by organizations such as Global Strategies for HIV Prevention and AMREF by contrast have already registered substantial accomplishments in curbing this disease. One nevirapine tablet given during labour and delivery (followed by a single dose of nevirapine syrup to baby) reduces vertical HIV transmission by 50%. In Tanzania, for example, other multifaceted prevention and treatment approaches have already shown promise by explicitly addressing gender issues that propel the HIV epidemic. Working to make practical programmes such as these function better and reach more people will add considerably to the fight against HIV in Africa, and elsewhere.
When a senior African physician laments ‘I know of no medical school in Africa that teaches medical care appropriate to the circumstances in the country’2, then non-Africans will question why this state prevails there. If it is the case that self-determination has taken African medical schools down a path of medical irrelevancy, then the HIV problem is made needlessly complex. Accordingly, Loefler and other leading African scholars may wish to focus more energy on repairing the local medical education dysfunctions in Africa and on supporting programmes with proven track records in the fight against HIV, rather than on inventing a new world order. Which goals are more likely to be achieved?