Scientists and clinicians gathered in South Africa in July for an international meeting on HIV-AIDS. The highest rates of AIDS infection and death are in Sub-Saharan Africa; South Africa has rates higher than any other country in the world. But the entire African continent is plagued by HIV-AIDS.

According to estimates, 34 million are HIV-AIDS infected worldwide. Slightly over 22 million are in Sub-Saharan Africa; less than 1 million in North America; 1.4 million in Latin America; and 500 thousand in Western Europe. But the U.S. should not become complacent. Our nation reportedly has the highest infection rate among the world's industrialized countries.

Africa is singled out for attention because the epidemic there is continent-wide, although it is most fatal and dangerous in the South. Sub-Saharan Africa is poor and under-developed, although South Africa is more comparable to developed nations. But even here the picture is murky because outlying tribal neighborhoods are more affected and less capable of dealing with the problem than the cities.

The patterns of the epidemic are also different and more ominous in southern Africa. HIV-AIDS affects women as well as men, with high rates of mother-to-infant transmissions. This escalates infant mortality as well as childhood death rates. The countries lack health care systems and medical centers for diagnosis and treatment or necessary research, and the cost of drugs is prohibitive, even when drugs are discounted by international pharmaceutical companies.

One consequence of the African AIDS epidemic is the present and future depletion of the work force, productivity, agricultural development and inter-country commerce.

The responses to the African situation on the part of international specialists were sober, serious and humane. There was overwhelming support for pharmaceutical companies providing free or low-cost drugs, and several promised immediate help.

An area that received serious attention was mother-to-child infection. Low-cost drugs are available to prevent mothers from infecting their unborn children. In another approach, a drug is given to the mother during labor and to the newborn at delivery. Questions have been raised, however, as to whether breast-feeding undermines the effectiveness of these drugs and this raises the old controversy of breast-feeding versus formula. Breast-feeding is culturally favored and in most instances necessary because of the absence of clean water or the inability of infants to tolerate formula. Without breast-feeding many more babies will die of malnutrition or other diseases. Some propose that mothers consider, where possible, breast-feeding for six months and then changing to formula, or opting for formula from birth.

My concern, however, is that the proposed strategies--availability of drugs, treatment of other diseases such as TB, education and "safe sex"--all ignore some of the basic causes of the spread of the disease and the moral and cultural issues at root.

Continent-wide education programs are needed to break down longstanding myths and errors. A concerted effort is necessary to change attitudes toward polygamy and sexual permissiveness, both of which are widespread in parts of Africa. Some tribal leaders, who have enormous power, have already begun educating young males. Dealing with polygamy is difficult because it remains a cultural institution in many tribes and areas. Persuading tribal leadership for such cultural change is indispensable.

The rapid, widespread transmission of HIV-AIDS is highly influenced by prostitution. There are reports of truck routes where drivers stop, engage in prostitution, and then return home to infect their wives and concubines and other partners. Moral education must be brought in to emphasize that prostitution is wrong. This is a challenge to the churches and other voluntary organizations. But governments must also adopt and enforce laws that prevent prostitution, even if it requires stronger policing efforts, for instance, at the truck stops.

In effect, combating the African AIDS epidemic must include moral education that emphasizes fidelity, permanence and partnership in marriage, sexual abstinence outside of marriage, protection and care of one's spouse and children, and active religious practice. Experts from western countries are hard-pressed to encourage, much less provide support for this approach because of the prevailing sexual permissiveness in the West. I recently read a proposal of a scholar whose only sexual ethic is to allow every adult to do whatever he or she chooses to do so long as there is mutual agreement, a view often expressed at international meetings by the representatives of the wealthy and educated nations.

As I see it, we underestimate the AIDS threat in South Africa and worldwide. Medical and educational approaches that lack moral education have not succeeded and are not likely to do so in the future. The worldwide epidemic is a greater challenge than we admit, and science alone will not save us.

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Bishop James T. McHugh is the bishop of Rockville Centre and a member of the NCCB Committee for Pro-Life Activities.

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