Why so little attention to such a big disease?

As HIV/Aids sweeps through Africa, many universities are acting as if it is business as usual, writes Alan Whiteside.

HIV is probably the most studied virus of all time. Since it was identified, fewer than 20 years ago, a huge amount has been learnt about how it functions and how it is transmitted. We also know that developing a cure or vaccine will be difficult.

The spread of HIV has been staggering. It is estimated that 60 million people have been infected, some 40 million adults and children are living with the virus, there were 3 million deaths from the disease in 2001 alone, and there are 14 million Aids orphans. In sub-Saharan Africa, 28.5 million people are infected, 2.2 million died in 2001 and there are 11 million orphans.

A decade ago, predictions were for an epidemic only half this size, but these data hide even worse figures.

In Botswana it is estimated that 38.8 per cent of adults aged 15 to 49 are infected. Rates of more than 30 per cent have been reported from Lesotho, Swaziland and Zimbabwe, and over 20 per cent in Namibia, South Africa and Zambia.

HIV/Aids poses a number of challenges for higher education institutions. What effect will Aids illness and deaths have on academic and non-academic staff? What will this mean for universities' ability to educate and research? What are the consequences of the disease for the student body? Are tertiary establishments having to deal with sick students and can they cope?

Universities must face the challenges posed by the possibility that infections are happening on campus and how this impacts on their mandate to provide a skilled labour force.

While some institutions are aware of the issues, most are behaving as though it is business as usual. The only possible defence for this inaction is the lack of data. Universities do not know what the infection levels are on their campuses. The only consistent data are measures of prevalence among women attending antenatal clinics.

In South Africa, HIV prevalence varies by age, gender, race, religion, education and geographic location and origin. We know that infection rates are likely to be highest among black females in KwaZulu-Natal and lowest in the Muslim females in the Western Cape. But we do not know how to use this information. Using computer modelling, a number of universities have carried out assessments of the potential impact of Aids on staff. For most establishments, it is predicted that there will be some loss of life but that this will not be crippling. The recent availability of anti-retroviral therapy should further mitigate the impact of the disease.

The same cannot be said for universities in the rest of Africa, where appalling pay and deteriorating conditions have combined with Aids and brain drain to cripple institutions.

In terms of students, the picture is slightly different. Most will have been infected relatively recently and so will survive their university education. Nonetheless, the reality is that all university health services are seeing increased demands from ill students. One particularly difficult aspect of this is when the students who fall ill are foreign. They do not have families and support networks available to them and, while they may get a good quality of care, they cannot be cured.

The question of prevention on campus is clear, even if most people are infected before they get to university: we have to ensure that sex is safe and consensual. Condoms must be made available.

Years ago "manpower planning" meant that human resource needs of economies were assessed and governments tried to strike a balance between broad educational outputs and skill requirements. Aids means that we will lose skilled people soon after they graduate. Huge shortages of teachers are being forecast. We may need to ask if we can afford to put students through degree courses. What effect will deaths have on student loan systems, which are, after seed funding, expected to be self-sustaining. HIV/Aids means we cannot treat higher education as business as usual.

But there is a glimmer of hope. On most campuses students are responding to the epidemic. There are chapters of the Treatment Action Campaign, students are mobilising around prevention and care and recognising Aids for what it is, a threat to their futures and to the just and equitable societies that we all want.

Senior academics have yet to acknowledge the threat that Aids poses. They may not be typified by the vice-chancellor of a central African university, who said at a conference on this topic, "condoms should not be distributed to students because they encourage promiscuity", but they have a long way to go.

Alan Whiteside is director of the Health Economics and HIV/Aids Research Division at the University of Natal, and a speaker at a THES -supported conference organised by the Canon Collins Trust for Education in Southern Africa.