Professor Eyitope O. Ogunbodede

The objectives of this study were to determine the cost of a prescribed treatment plan; to compare the costs in an academic hospital cost with that of private pharmacy; and to determine the average treatment cost per visit. The descriptive, retrospective study that investigated the cost implications of the treatment of five oral lesions associated with HIV/AIDS: oral candidiasis, oral hairy leukoplakia, periodontal diseases, oral ulcers and Kaposi's sarcoma. One hundred and twenty four cases with oral HIV lesions were selected from the list of 181 HIV patients listed in the attendance registers of three hospitals in the selected study sites. A data capture sheet was used to obtain information related to diagnosis, investigations done, staging of the disease, treatment plan and treatment outcome. None of the patients were on antiretroviral therapy. The association between the number of hospital visits and the total cost of treatment was significant (p < 0.05). Also, there was a significant negative relationship between the outcome of treatment and the total hospital costs (p < 0.05). The lower the hospital treatment cost, the better the outcome. There was no significant association between staging of the disease and the hospital cost (p > 0.05), but the CD4 count significantly influenced the hospital cost (p<0.05). The average hospital treatment and private pharmacy cost was 207.06 and 357.85 rands respectively (16.21 euros and 28.02 euros respectively). There is a need to evaluate the current treatment protocols, as some treatments may be ineffective. Governments should endeavour to provide antiretroviral and other relevant drugs, at no cost, to HIV/AIDS patients.

This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population.A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife and General Hospital, Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medication, Dental, Mental, Home care, Hospital admission, access to antiretroviral therapy and emergency services.
One or more unmet needs were reported by 79.4% of the sample. Needs for medication, home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p < 0.05).
Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs.

This study set out to determine the self-reported unmet health needs of people living with HIV/AIDS (PLWHA) in a Nigerian population.A prospective study conducted among consecutive 209 consenting PLWHA in the South-western Nigeria; who sought for care in the Obafemi Awolowo University Teaching Hospitals complex, Ile-Ife and General Hospital, Ilesa were recruited. Participants completed a comprehensive survey seeking information to determine their unmet needs in the following areas: Medication, Dental, Mental, Home care, Hospital admission, access to antiretroviral therapy and emergency services.
One or more unmet needs were reported by 79.4% of the sample. Needs for medication, home-based care and mental care were more likely to be unmet. There was a statistically significant relationship between unmet needs and living arrangements (p < 0.05).
Perceived oral health status was the factor that best predicted the unmet need. Perceived oral health status of these patients should be improved to reduce the level of the unmet needs.

Objective: To determine the coping ability of people living with HIV/AIDS (PLWHA) across demographic variations of gender, duration of living with HIV infection, marital status and living arrangements either with the family or alone.Method: The research design adopted in this study was descriptive survey. The population consisted of all PLWHA in Nigeria. The sample comprised of 117 PLWHA attending clinic regularly at General Hospital Ilesa, Osun State, Nigeria. The subjects had all been exposed to voluntary counselling and testing (VCT). Only those who consented participated in the study. A structured questionnaire developed for the purpose of this research was used to collect data.
Result: Marital status, living arrangements and gender do not significantly influence coping ability of the PLWHAs (p>0.05); however duration of living with the infection had significant influence on the coping ability of PLWHAs (p<0.05).
Conclusion: The length of period of living with HIV/AIDS had a significant effect on the coping abilities of PLWHA (p< 0.05). The results also showed no significant difference in the coping ability of PLWHA by gender, marital status and living arrangements (p=0.05). Developing adaptive coping skills to deal with stress of living with HIV/AIDS may be a particularly effective strategy for improving overall health among the study population and not just on the medical needs.

The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. VOLUNTEERS AND MATERIAL: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers.Forty seven students (7.8%) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services.
Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. VOLUNTEERS AND MATERIAL: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers.Forty seven students (7.8%) indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services.
Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

The purpose of this study was to determine the prevalence of the oral manifestations of HIV/AIDS and to correlate the prevalence of these lesions with the stages of the disease in the Ife-Ijesa zone, Nigeria. No comprehensive data were available for correlating it with the staging of HIV/AIDS in this region.The pattern of oral HIV lesions as classified by the EC-Clearinghouse was studied in 225 confirmed consecutive HIV-infected patients in this zone.
Clinical dental examinations were conducted under natural daylight on all consenting HIV patients, sitting in an upright chair, using dental mirrors and probes.
The prevalence of oral HIV lesions was 84.0%, with lesions ranging in number from one to six. The commonest HIV lesion was pseudo-membranous candidiasis (43.1%) followed by erythematous candidiasis (28.9%), angular cheilitis (28.9%), linear gingival erythema (24.0%) and ulcerations (8.9%). Lesions less commonly found were oral hairy leukoplakia (1.3%) and salivary gland swellings (1.3%). Heterosexual intercourse was the most common mode of transmission (94.7%) and HIV-1 (96.9%) the most prevalent pathogen among the study population. The majority of the patients were in the WHO clinical stage III (59.1%) and presented late.
The prevalence of oral HIV lesions in the present study was high.

The advent of globalization has changed our perspectives radically. It presents increased understanding of world affairs, new challenges and exciting opportunities. The inequitable distribution and use of finite energy resources and global warming are just two examples of challenges that can only be addressed by concerted international collaboration. Globalization has become an increasingly important influence on dentistry and dental education. The International Federation for Dental Educators and Associations (IFDEA) welcomes the challenges it now faces as a player in a complex multifaceted global community. This report addresses the new circumstances in which IFDEA must operate, taking account of the recommendations made by other working groups. The report reviews the background and evolution of IFDEA and describes the extensive developments that have taken place in IFDEA over the past year with the introductions of a new Constitution and Bylaws overseen by a newly established Board of Directors. These were the consequence of a new mission, goals and objectives for IFDEA. An expanded organization is planned using http://www.IFDEA.org as the primary instrument to facilitate the exchange of knowledge, programmes and expertise between colleagues and federated associations throughout the world, thereby promoting higher standards in oral health through education in low-, middle- and high-income countries of the world. Such aspirations are modified by the reality and enormity of poverty-related global ill health.

To determine the prevalence of problems associated with chewing and the relationship with body mass index, the self-reported rating of oral health and normative oral hygiene assessment among the elderly.This was a descriptive community based study carried out in three locations in Ife-Ijesa zone (south western Nigeria). Elderly persons of 55 years and above were recruited through the religious organisations. All elderly who volunteered were assisted in completing a questionnaire on their socio-demographic status, chewing ability, any quadrant associated with problems and self-rating of oral health. An oral examination under a natural daylight using sterile wooden spatulae and an upright chair was carried out. The Oral Hygiene Index of Greene and Vermillion [Journal of the American Dental Association (1964) 61, p. 172] was used to determine the oral hygiene status.
The lower right quadrant had the highest frequency of complaint on difficulty with chewing (15.6%), and 44.1% of the subjects had problems with chewing. Twenty-nine per cent rated their oral health as poor or very poor. There was a statistically significant association between the rating of oral health and the presence of calculus (p = 0.022). This was also true for oral hygiene and having any problem with chewing (p = 0.001). The self-rating of oral health was not in agreement with that of the normative finding.
Health promotion focusing on the oral health of the elderly is a significant requirement for the study population. Proper evaluation of the effectiveness of traditional dentifrices must be carried out and interventions designed to address the possibility of improper usage.

The objective of this study was to determine the oral health status and needs of people living with HIV/AIDS(PLWHA) in Ife-Ijesa zone, Nigeria. Materials and methods: An anonymous, administered questionnaire survey
among 209 PLWHA who provided informed, written consent was conducted. Information on socio-demographics,
perceived oral health status and professional care obtained. Clinical oral examinations were conducted using a dental
explorer and mirror in natural daylight. The oral examinations were carried out to determine, presence of oral HIV
lesions, normative needs-oral hygiene and periodontal status, restorative and surgical needs. Results: There was a
statistically significant relationship between the presence of an oral HIV lesion and perceived oral health status.
Patients that reported the need for oral health care are more than those of medical needs (p<0.05). The oral health
needs increased as the clinical stage of the disease advanced (p<0.05). There was poor oral health status among the
PLWHA and their needs were routine. Conclusions: The oral health status of the examined PLWHAs was poor. The
normative and the perceived oral health evaluation were not in agreement in this study. The normative oral health
care needs of PLWHAs are not complex and hence district oral health care centres should be equipped to meet these
needs.

The purpose of this study was to investigate knowledge about HIV/AIDS among classroom secondary school teachers and document any efforts at educating their pupils about HIV prevention. A self-administered questionnaire addressed issues on demography, knowledge and awareness on HIV/AIDS and their roles in HIV/AIDS prevention. All consenting school teachers in the Irewole local government area of Osun State, Nigeria, participated in this study. The response rate was 91.7% (n = 180). There were more males (76.4%) than females (23.0%) The mean (± SD) age of the respondents was 41.5 (±15.5) years. More than 90% had adequate knowledge of HIV/AIDS and indicated that it could be prevented. Furthermore, 86.1% wanted HIV/AIDS preventive education to be made compulsory in the secondary school curriculum. There were 131 (n = 165, 79.4%) teachers who did not teach HIV/AIDS prevention, while 32 (19.4%) teachers believed that the pupils were too young and that the non-availability of guidelines and resources are reasons for not teaching it. One hundred and fifty-three (92.7%) of the respondents would like to attend a course/programme/workshop to update their knowledge and 139 (84.2%) of teachers would like to be part of an HIV/ AIDS prevention group for their community. There is a need for school teachers to be trained adequately and provided with a structured educational programme to follow in order to enhance effectiveness in HIV/ AIDS preventive education to pupils.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.

In many communities of South Africa, traditional healers are often the only means of health care delivery available. The level of knowledge and ability to recognize oral lesions of 32 traditional healers and 17 care-givers were assessed after a two-day workshop. The data collection instrument was a structured questionnaire, complimented by enlarged clinical photographs of the common oral manifestations of HIV/AIDS. Prior to the workshop, 46 (93.9%) of the 49 respondents had never had any formal information on oral health and 43 (87.8%) were unfamiliar with the symptoms of oral diseases. Thirty-five (71.4%) recognized bleeding gums from A4-size photographs and 11 (22.4%) recognized oral thrush. The recognition of other oral manifestations of HIV/AIDS were; oral hairy leukoplakia (41.0%), angular cheilitis (43.6%), herpes virus infection (56.4%), oral ulcerations (56.8%), and in children, parotid enlargement (27.3%), and moluscum contagiosum (56.8%). Traditional healers and caregivers constitute an untapped resource with enormous potential. A positive bridge should be built to link traditional healing with modem medicine in the struggle against HIV/AIDS.

The aim of this study was to assess the erosive potential of some soft drinks commonly consumed in Nigeria. A range of popular carbonated drinks (cola and non-cola) and fruit juices were selected. On two occasions, the followings were determined; (1) the pH, measured by a digital pH meter on opening of th e packaging can or bottle. (2) The volume of 1.0M sodium hydroxide required to raise the pH of 50 ml of the drinks to pH 5.5 and pH 7.0. The pH before titration ranges from 2.70 to 4.48 for the carbonated drinks and 3.54-3.91 for the fruit juices. The soft drinks and the fruit juices investigated had pH before titration lower than the critical pH 5.5 for enamel dissolution. The volume of 1.0M sodium hydroxide required to bring the drinks to pH 5.5 ranged from 0.5 to 6.1mls and 1.8 to 8.2 mls of the base needed to neutralize the drinks to pH 7.0. The fruit juices needed the most base to neutralize its acidity. Despite having a lower pH than the fruit drinks, the carbonated drinks required a relatively lower base to neutralize. This study concludes that all the popular soft drinks in Nigeria selected for this study had significant erosive potential. They had pH below the critical pH of enamel dissolution. The erosive potential of the fruit juices was more than the carbonated cola and non-cola drinks. This information will be of use to clinicians when counseling patients with tooth surface loss.

The aim of this study was to assess the erosive potential of some soft drinks commonly consumed in Nigeria. A range of popular carbonated drinks (cola and non-cola) and fruit juices were selected. On two occasions, the followings were determined; (1) the pH, measured by a digital pH meter on opening of th e packaging can or bottle. (2) The volume of 1.0M sodium hydroxide required to raise the pH of 50 ml of the drinks to pH 5.5 and pH 7.0. The pH before titration ranges from 2.70 to 4.48 for the carbonated drinks and 3.54-3.91 for the fruit juices. The soft drinks and the fruit juices investigated had pH before titration lower than the critical pH 5.5 for enamel dissolution. The volume of 1.0M sodium hydroxide required to bring the drinks to pH 5.5 ranged from 0.5 to 6.1mls and 1.8 to 8.2 mls of the base needed to neutralize the drinks to pH 7.0. The fruit juices needed the most base to neutralize its acidity. Despite having a lower pH than the fruit drinks, the carbonated drinks required a relatively lower base to neutralize. This study concludes that all the popular soft drinks in Nigeria selected for this study had significant erosive potential. They had pH below the critical pH of enamel dissolution. The erosive potential of the fruit juices was more than the carbonated cola and non-cola drinks. This information will be of use to clinicians when counseling patients with tooth surface loss.

Malaria is an important disease in the tropics, and its role as a predisposing factor or co morbidity has been investigated in many diseases including HIV infection and tuberculosis. There are very few studies, which have investigated its role in oral and dental diseases. Our study aimed to demonstrate the possible role of malaria in predisposing to pericoronitis, an infection affecting impacted third molars predominantly.Thirty-eight patients presenting with pericoronitis were tested for malaria parasites and results compared with that obtained from controls that were equally susceptible to pericoronitis but did not have the infection.
19.7% of the study group compared to 6.6% of control group had malaria parasite in their blood. This difference was statistically significant, P=0.018 (Fisher's exact). The odds ratio was 4.3 (95% CI=1.2-17.0).
Malaria appears to be a predisposing factor to pericoronitis in this study. There is a need for further studies on the possible role of malaria in oral and dental diseases.

Oral manifestations of diabetes mellitus have been documented, but the effect of glycemic control on the oral tissues has been scantily reported. The oral health status of 65 metabolically controlled adult diabetic patients attending the Diabetes Clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, was prospectively assessed over six months and compared with that of 54 non-diabetic acting as controls. The mean duration of diabetes was 100.5+/-85.1 months. The difference in periodontal status of the patients and control, assessed using the Community Periodontal Index of Treatment Needs (CPITN), was not statistically significant (p=0.07). The degree of hyposalivation between the two groups was, however, statiscally significant (p<0.05). No significant difference was observed in the altered taste, burning mouth sensation, angular cheilitis, glossitis, and stomatitis status of the two groups. We conclude, with adequate metabolic control, the oral health status of a diabetic may not be significantly different from that of a non-diabetic except for xerostomia. A good understanding of the interactions between systemic diseases and oral health is imperative for physicians and dental practitioners. The need for early detection and closer linkages between the dental and medical professions in managing diabetic patients is emphasized.

The study investigated the relationship between gender and knowledge, attitude and practice of infection control among oral health care workers in the management of patients with HIV/AIDS in Osun State of Nigeria. It was a cross-sectional survey using 85 oral Health care workers (OHCWs) enlisted in the public dental health clinics. A self-administered questionnaire was designed and used for data collection. A total of 85 questionnaires were distributed. The response rate was 93%; 42 (53%) were males and 37 (47%) females. The majority of the respondents were in the 25-40 year old age group and the mean age was 37.3 years. This study found significant differences in gender and ability to identify HIV/AIDS oral manifestations (p<0.001) and recognition of HIV/AIDS risk factors (p<0.001). There was statistically significant gender difference and infection control practices (p=0.02) among the OHCWs. Males were more compliant to the universal cross-infection control principle than the female respondents. A significant association (p< 0.001) was found between OHCW gender and their attitude to the management of HIV/AIDS patients with males showing a better attitude towards the care of HIV/AIDS patients. This study shows that there are significant gender difference in attitudes, behaviour and practices of OHCW with males faring better than the females. National AIDS Control Programme, Health Control bodies, Health educators and other organizations should make efforts to improve the attitude and practice of oral health care workers regarding the management of patients with HIV/AIDS.

The first case of HIV infection was reported in Nigeria in 1986. Since then, the prevalence has risen from less than 0.1% in 1987 to 5.8% in 2002, and an estimated 3.6 million Nigerians now live with HIV/AIDS. More than 40 oral manifestations of HIV infection have been recorded and between 70% and 90% of persons with HIV infection will have at least one oral manifestation at sometime during the course of their disease. Oral health-care workers (OHCWS) are expected to play active roles in the prevention and control of HIV/AIDS. In this study, a one-day workshop was organized for 64 oral health workers in Ile-Ife, Nigeria, focusing on the epidemiology of HIV/AIDS, the oral manifestations, control and prevention of HIV in a dental environment, oral care of the infected patient and the ethical, legal and social aspects of HIV/AIDS. Participants' knowledge and practices of infection control were assessed with an infection control checklist administered pre- and post-workshop. Sixty (90.8%) respondents believed that HIV/AIDS was not yet a problem in Nigeria, and 58 (90.6%) believed that drugs have been developed which can cure HIV infection and AIDS. The men complied more with waste disposal regulations than women (P = 0.010). Twenty-nine of 58 (50.0%) did not discard gloves which were torn, cut or punctured. Seven (12.1%) did not change gloves between patients' treatment. Conscious efforts should be made to train OHCWS on all aspects of HIV/AIDS prevention and care. It must never be assumed that adequate information will be acquired through tangential sources.

To evaluate dentists' prescription writing patterns and their appreciation of the characteristics of antibiotics.Evaluation of drug prescriptions written over a six-month period.
Dental Hospital, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.
Retrospective analysis of 313 prescriptions written by dentists attending to outpatient dental patients.
The total number of drugs on one prescription ranged from one to seven with Penicillins being the most commonly prescribed drug. Some prescriptions were found to be incorrect with regards to dose, frequency, and duration. Instructions as to the best time of administering drugs with regards to meals were not stated in any prescription.
Improvement through continuing education is desired on the part of prescribers to ensure a good standard of care and avoid practices that may increase antimicrobial resistance. Drug information services including side effects and drug interactions for professionals and consumers at the hospital is highly desirable.

To highlight oral diseases found in an elderly Nigerian population. The records of 494 elderly patients were retrospectively reviewed. The presenting complaints, relevant extraoral and intraoral findings, clinical diagnosis and investigations carried out were recorded. The ages ranged from 55 years to 120 years with almost half (44.0%) in the 60 to 69 year age group. Pain was the commonest presenting complaint (66.2%). Attrition was present in only 8% and was not related to age or sex. Coronal and root surface caries was present in 12.8% and 0.8% respectively and caries was significantly commoner in females and those who were presenting for the first time (p<0.05 and 0.01 respectively). Chronic periodontitis was the most prevalent oral disease (73.9%) and appeared to worsen with age, and decline with the state of the oral hygiene (p<0.05). Denture sore mouth was present in only females (p<0.01). Majority of the elderly (96.0%) had more than 20 teeth while only 16(3.2%) were edentulous. Squamous cell carcinoma was found in 11 patients and it affected significantly more males than females (p<0.05). Significant differences exist in the pattern of oral diseases in Nigeria when compared with the findings in other countries. Such differences might be due to socio-cultural, genetic and environmental factors.

The advent of Information Technology gave birth to Telemedicine, which has led to electronic-based consultations such as electronic referral system in hospitals. In Nigeria, all the state hospitals are having problems in referring patients from one hospital to another. Most of the time before a patient could be referred from one hospital to another (specialist), the patient would have given up the ghost and led to design a system that will handle referral of patients form one hospital to another electronically in Osun State, Nigeria. This paper focuses on referral of patients from one hospital to another over a computer network among the hospitals in Osun State, Nigeria. Patients were referred from one zone to another; the patient's case file and examination data were transmitted over the network among the zones successfully. In conclusion, the HOspital Referral System (HORS) has the ability to guarantee the security of patients' case note, examination data and effective referral of patients, which in turns makes patients treatment timely, efficient and cost effective.

The HIV/AIDS pandemic marks a severe development crisis in Africa, which remains by far the worst affected region in the world. Forty-two million people now live with HIV/AIDS of which 29.4 million (70.0%) are from sub-Saharan Africa. Approximately 5 million new infections occurred in 2002 and 3.5 million (70.0%) of these were also from sub-Saharan Africa. The estimated number of children orphaned by AIDS living in the region is 11 million. In 2002, the epidemic claimed about 2.4 million lives in Africa, more than 70% of the 3.1 million deaths worldwide. Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. HIV/AIDS stigma is still a major problem despite the extensive spread of the epidemic. A complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in Africa. However, too many partners and unprotected sex appear to be at the core of the problem, Even if exceptionally effective prevention, treatment and care programmes take hold immediately, the scale of the crisis means that the human and socio-economic toll will remain significant for many generations. Although 70% of people living with HIV/AIDS are in Africa, only 6,569 (4.7%) of the 140,736 scientific publications on HIV/AIDS, from 1981 to 2000, are directly related to Africa. Effective responses to the epidemic require a multisectoral approach, including governments, the business sector and civil society.

The HIV/AIDS pandemic marks a severe development crisis in Africa, which remains by far the worst affected region in the world. Forty-two million people now live with HIV/AIDS of which 29.4 million (70.0%) are from sub-Saharan Africa. Approximately 5 million new infections occurred in 2002 and 3.5 million (70.0%) of these were also from sub-Saharan Africa. The estimated number of children orphaned by AIDS living in the region is 11 million. In 2002, the epidemic claimed about 2.4 million lives in Africa, more than 70% of the 3.1 million deaths worldwide. Average life expectancy in sub-Saharan Africa is now 47 years, when it would have been 62 years without AIDS. HIV/AIDS stigma is still a major problem despite the extensive spread of the epidemic. A complex interaction of material, social, cultural and behavioural factors shape the nature, process and outcome of the epidemic in Africa. However, too many partners and unprotected sex appear to be at the core of the problem, Even if exceptionally effective prevention, treatment and care programmes take hold immediately, the scale of the crisis means that the human and socio-economic toll will remain significant for many generations. Although 70% of people living with HIV/AIDS are in Africa, only 6,569 (4.7%) of the 140,736 scientific publications on HIV/AIDS, from 1981 to 2000, are directly related to Africa. Effective responses to the epidemic require a multisectoral approach, including governments, the business sector and civil society.