Life Expectancy in Africa: Back to the Future?

From 1950 to 1990, life expectancy in sub-Saharan Af-rica steadily rose. It then abruptly plateaued and began to rapidly decline; AIDS accounted for most of this reversal of fortune (1). That a single disease could lead to such a rapid and dramatic setback was shocking. Moreover, because AIDS is transmitted primarily through sex, young adults were being affected dispropor-tionately, tearing at the very fabric of African societies by decimating the ranks of essential workers, including teach-ers, laborers, engineers, nurses, and doctors. By killing their parents, the epidemic also created a generation of orphans, many destined to die of HIV themselves. Africa’s future looked bleak (2). Contemporaneously, the rapid dissemination of highly effective combination HIV antiviral therapies was resulting in precipitous declines in short-term mortality from AID