Worldwide AIDS figures are staggering, and nowhere more so than in sub-Saharan Africa, where two-thirds of the last quarter-century's 39 million HIV infections have occurred. At least 10 countries in sub-Saharan Africa have an infection rate exceeding 10 percent of the adult population, and several have rates exceeding 25 percent. The disease has orphaned 13 million children worldwide, including 10 million in sub-Saharan Africa."There's a view out there that says the resolution of crises like this is the responsibility of national governments and international agencies but is not something for-profit corporations should get directly involved in," said Lee Branstetter, the Daniel W. Stanton Associate Professor of Business, in his introductory remarks to a guest lecture on Merck & Co.'s efforts to combat the AIDS epidemic in Botswana. "Merck has consistently taken a different view: a view that says for-profit corporations can and should play a part in the resolution of these crises."Jeffrey Sturchio, Merck vice president of external affairs and human health in Europe, the Middle East and Africa, addressed students as part of the School's Individual, Business and Society (IBS) curriculum, which explores corporate social responsibility and personal accountability. He spoke about Merck's efforts, in partnership with the Bill and Melinda Gates Foundation and the government of Botswana, to transform that country's approach to the AIDS crisis.The Botswana PartnershipIn Botswana, two out of every five people between the most economically productive ages of 15 to 49 are infected with HIV. As a result of the epidemic, life expectancy has dropped 50 percent - from 60 to 30 - over the past decade.In July 2000, Merck and the Gates Foundation each donated $50 million to form the Africa Comprehensive HIV/AIDS Partnership (ACHAP), which has worked with the government of Botswana to develop a national strategic framework for strengthening Botswana's health care system and expanding community initiatives. ACHAP focuses on five areas: preventing infection, providing care and support, managing the national response to the crisis, mitigating the epidemicÍs impact and protecting victims from discrimination.In early 2002, ACHAP implemented what has become the largest government-sponsored HIV treatment program in Africa. It constructed 32 HIV clinics, established six HIV/AIDS health resource centers and 17 counseling and coping centers and brought HIV specialists from the United States and Europe to train about 2,000 Botswanan health care workers. The partnership also built laboratories and trained teachers. Merck has committed to providing antiretroviral medicines to ACHAP free of charge until 2010. As a result, more than 32,000 Botswanans are currently receiving treatment, and that number is growing by about 2,000 a month."We think that dealing with problems like the AIDS pandemic really is a strategic necessity for companies like Merck," Sturchio said. But because the issues are so complex, the company believes it can be most successful working in strategic partnerships with private-sector firms, community-based organizations and local governments. "We understand that we can't solve these problems on our own, even with the resources that a company the size of Merck has," Sturchio said.ACHAP has benefited from lessons Merck learned in previous partnerships to combat public health crises around the world. In 1987, the company began a broad, multisectoral medicine donation program in cooperation with UNICEF, the World Health Organization, dozens of ministries of health and NGOs to treat and prevent river blindness in equatorial Africa. Since then, Merck has collaborated with numerous public- and private-sector organizations on AIDS treatment and prevention programs in Africa, Thailand, Brazil and Romania.UN Secretary-General Kofi Annan has called global challenges like the AIDS pandemic "problems without passports." "What you need when you have problems without passports," Sturchio said, "are blueprints without borders. These kinds of partnerships help provide these blueprints."Learning Along the WayAn important feature of ACHAP is that it is largely run and administered by the local government and community organizations. "It's critical that the people most directly affected should be determining the needs and priorities," Sturchio said. "It's the people who are there every day, who are living with these problems, who really have the answers and have to implement them over the long term."As of the end of last year, Botswana had the highest rate of treatment for people with HIV of any country in Africa. In 2004, the government implemented a program of routine HIV testing whenever people visit a doctor, rather than testing only at stand-alone clinics. "That led to a tremendous increase in the number of people who were willing to have a test," Sturchio said. But it also put a strain on ACHAP's human resources."What we found when we went to Botswana, and what other people are finding, is that it's not simply a question of resources," Sturchio said. "You can stuff more money into one end of the pipeline; it doesn't mean you're going to get more results out of the other." The bottleneck, he said, is not only insufficient laboratory resources to perform tests and monitor patients but also a lack of trained doctors and nurses. The Botswanan government is establishing the country's first medical school in part as a result of what it has learned from the first few years of the partnership. But there are other challenges as well."There are still issues around stigma and denial," Sturchio said. "Only a minority of the population knows its HIV status. The government bureaucracy isn't as efficient as one would like to see it, there isn't as much engagement at the village level as ultimately there needs to be and there still are continuing issues around coordination of all the funding and donors and programs to make sure they're using these resources as effectively as possible."Together with its partners in Botswana and around the world, Merck is learning important lessons that Sturchio hopes will help overcome some of these obstacles in current and future programs. "I think that the effort of this partnership and the comprehensive approach in Botswana across the entire spectrum of prevention, care, treatment and support has really begun to have a tremendous impact," Sturchio said. "We're hopeful now that we'll be able to take the lessons learned there and apply them elsewhere."