The authors of “Reassessing HIV Prevention,” an article in the most recent issue of Science, question the assumptions behind current HIV prevention interventions in Africa. The authors challenge the commonly accepted belief that poverty and political instability increase a population’s vulnerability to HIV infection, arguing that it is not supported by the evidence. They point to data demonstrating that “African regions suffering from conflict, genocide, and rape, such as Rwanda, Congo, and Angola, are much less affected by AIDS than peaceful, wealthier, and more literate countries such as Botswana or Swaziland, which have the world’s highest HIV prevalence.”

Studies have shown that civil war and the breakdown of health service delivery result in an increase in preventable deaths—such as those due to malnutrition, diarrhea, and malaria—but perhaps HIV follows a different pattern. Clearly, there is a need for research that compares the spread of HIV/AIDS in politically stable, wealthier African countries with those torn by conflict.

At a 2007 ECSP event on the human cost of war, Dr. Frederick Burkle of the Harvard Humanitarian Initiative—who will discuss public health management after natural disasters on June 17—admitted that the direct impact of poverty, inequality, and cultural incompatibilities on the spread of infectious diseases and mortality during complex emergencies is “difficult, if not impossible,” to measure.