At the national level, the 21 countries with the highest HIV prevalence are in Africa. In at least 10 African countries, prevalence rates among adults exceed 10 percent.

At the individual level, the arithmetic of risk is horrific.In Zimbabwe and Botswana, one in four adults carries the virus. A child born in Zambia or Zimbabwe today is more likely than not to die of AIDS.

There are 13 million children orphaned by AIDS Worldwide, 10 million of them in sub-Saharan Africa.

In short, as a result of the HIV/AIDS epidemic, much of Africa will enter the 21st century watching the gains of the 20th evaporate. Tragically, mass killers are nothing new in Africa. Malaria still claims about as many African lives as AIDS, and preventable childhood diseases kill millions of others. What sets AIDS apart, however, is its unprecedented impact on regional development. Because it kills so many adults in the prime of their working and parenting lives, it decimates the workforce, fractures and impoverishes families, orphans millions, and shreds the fabric of communities.

The huge gap in HIV infection rates and AIDS deaths between Africa and the rest of the world, is likely to grow even larger in the next century. Massive national and international are needed to end the stifling silence that continues to surround HIV in many countries, to explode myths and misconceptions that translate into dangerous sexual practices, to expand prevention initiatives such as condom promotion that can reduce sexual transmission, to create conditions in which young children have the knowledge and the emotional and financial support to grow up free of HIV, and to devote real money to providing care for those infected with HIV and support to their families.

A trail of successful responses has already been blazed by a small number of dedicated communities and governments. The challenge for the leaders of Africa and their partners in development is to adapt and massively expand successful approaches that make it harder for the virus to spread, and that make it easier for those affected to live full and rewarding lives.