In 2009, approximately 33.3 million people globally were living with HIV; an estimated 2 million people died as a result of HIV/AIDS; and 2.6 million people, including 370,000 children, were newly infected (UNAIDS, 2010). Of those global HIV infections, 22.5 million were in Africa; this figure represents 68 percent of the global total, while the number of newly infected in the region represents 69 percent of the global total (UNAIDS, 2010). According to the World Health Organization’s (WHO’s) most recent guidelines, just 36 percent of those needing treatment are receiving it (WHO, 2010). Moreover, the committee’s projections indicate that the need for treatment will increase dramatically over the next decade.

In addition to its toll on individuals and households, HIV/AIDS has had devastating impacts on four key sectors of African society: development, health, the state, and academia. The burden of the epidemic has compromised the achievement of key Millennium Development Goals in Africa and has led to declines in the growth of total gross domestic product (GDP) in the most affected countries.

Although countries in Africa share many similarities, they also differ greatly in culture, history, politics, and education. As such, it is not surprising to find that HIV epidemics across Africa range from highly concentrated to highly generalized, and the responses by African nations have been equally varied, ranging from intense interventions to complete denial of HIV disease. Given this heterogeneity, as well as the diversity of African institutions and circumstances, the programs and policies recommended in this report require tailoring to local circumstances. The committee was not constituted to recommend specific actions for particular African countries; rather, in keeping with the theme of shared responsibility, the committee recommends approaches for African countries that can be adapted to their needs and priorities.

In 2020, the morbidity, mortality, and resource and financial burdens faced by the U.S. government and African countries for the ensuing decades will depend on decisions made today:

• Currently, people are becoming in need of treatment more rapidly than they are being placed on treatment. Therefore, although the death rate from AIDS has fallen, deaths among those in need of treatment will con-