AIDS is striking at the heart of Africa, rolling back accomplishments in health and education, and leaving society weakened at every level. But AIDS is not the only disease threatening African lives and livelihoods. Malaria and water-borne diseases contribute mightily to the continent's vast daily human sacrifice to problems that are crises in poor countries, but that in many cases have been completely overcome in the developed world.

There are no simple cures for AIDS. But there are proven ways of reducing its spread and reducing its impact - in developed countries. Disease is the symptom; poverty is the cause of failure to cope and contain. Its spread in Africa has a great deal to do with the dislocation of normal lives, from the weakening of family stemming from migration to seek income against the background of desperate poverty, and from the poverty-induced consignment of women to commercial sex as a way of making a short living. It is also shaped by gender relations, and the difficulties that poor women have in organizing safe lives for themselves and their children. And reducing impact? It can be contained by access to drugs widely available and used in rich countries - and support to families (increasingly containing only the old and the young - and many, many orphans) and communities jeopardized by the loss of their economic backbone, prime age adults (the so-called disappearing generation), and of family and social savings that are rapidly depleted to care for the sick and compensate for the loss of earnings. Some of this is being done in Uganda - with success. It can and should be done across the continent. It really is not very complex. But it has to be done rapidly and on a large scale.

The large majority of the African poor, and the large majority of Africans effectively and consistently threatened by disease, live in the countryside. They are very small farmers, craftsmen and traders. That is where the battle to reduce poverty and disease has to be fought. Paradoxically, the level of international interest in the development of rural Africa has waned - especially at the most crucial point of the struggle, improving rural livelihoods. This has to be reversed. We have to address poverty and disease where it actually is, and we have to empower poor people - economically, socially, politically and technically - to handle and overcome the crises and challenges they confront. Nobody believes that development in rural Africa is easy. But many of the internal factors that produced bitter disappointment in the past are changing fast. Governments are becoming more interested in helping development rather than commanding it, and political systems are in most cases becoming more open and responsive to broader constituencies. The history of the rich countries shows that the battle against major infectious diseases can be fought and won. It can also be won in Africa, but only if the issue of rural poverty is addressed head-on, and overcome.

Lennart Båge, President of IFAD | Q&A with the President

HIV-AIDS is found almost everywhere, but principally in Africa. In Africa it is found everywhere, but principally in the countryside. It affects all classes, but principally the poor. As Director Kiarostami observes in the film ABC Africa, HIV-AIDS is not transmitted by mosquito bite: it is a social disease. The deadliest of all. It is a complex disease, medically. It is a disease for which there is no known cure - and for which existing treatments are economically and organizationally beyond the reach of most of those who suffer from it. Especially in Africa where hundreds of millions of people live below the recognized ''lines'' of the most extreme poverty.

The social causes of the epidemic and its effects are much better understood. As a social disease it reflects social conditions: the fragility of rural economies and the lack of social power of women. It reflects the high levels of migration of men, impelled by the crisis of agriculture and rural development. It reflects the spread of prostitution as a means of survival. And it reflects the fact that it is poor women in rural society who have the least social power to control their own sexuality.

The social consequences of HIV-AIDS are also well understood. For those who directly suffer from it - and from the much greater number who do not suffer from it, but whose lives are taking new and more threatening shapes. Deepening rural poverty as families sell their possessions and their tools to care for the sick and compensate for lost income. Disorganization of families. Intolerable strains on families and communities. And a crisis in the care and education of the young. The effects on the future development of Africa and the fight against rural poverty are incalculable.

None of this is inevitable. While the race for better treatment and, ultimately, cure continues, the epidemic can be reduced through attacking some of the most important social bases of vulnerability: the local and global crisis of the African peasant economy; the position of women and girl children in rural society. Prevention can work, and it can reduce the medical burden dramatically. Mitigation can work. Communities and families can be effectively helped to regain their strength to deal with the challenge of millions of orphans and loss of the young and able-bodied. The answer to the social challenge of HIV-AIDS in rural Africa is something that can be based only in the initiative and optimism of Africans themselves. That is what is shown in ABC Africa : a willingness to engage and struggle. Among women, among children and among men. While we spend billions on the medical solution we should also be thinking about the social problem and the social solution. And about re-engaging in assistance to social and economic development in rural Africa - without which the prospects for improving the lives of the majority of the poor and controlling HIV-AIDS continentally and globally are dim, indeed.

g.howe@ifad.org