East Africa is a key point along the migratory routes of many wild birds, and it is only a matter of time before outbreaks occur on the continent, said participants at a flu conference in New York.

In addition to existing concerns that the spread of avian influenza will be assisted by the lack of a strong medical infrastructure and government funding to fight the disease -- as well as living conditions that see large numbers of people living in close proximity to each other and birds -- there is a more serious concern specific to the region: the prevalence of HIV and AIDS.

It has been widely reported that Dr. Robert G. Webster, speaking at an avian-influenza conference hosted by the Council on Foreign Relations earlier this week in New York, said that he feared AIDS patients would facilitate the spread of avian influenza.

That is not the whole story, and in fact experts at the conference disagreed on the effects of avian influenza on a host infected with HIV.

While Dr. Webster expressed concern that an immuno-suppressed person may harbor H5N1 for a long time, while new mutations developed and reproduced and were shed by the host, the statement was an extrapolation based on his experiences with cancer patients and could not be said to definitely apply to those with HIV.

Stephen Wolinsky, chief of the infectious diseases division at the Feinberg School of Medicine, concurred that prolonged shedding of the virus was a definite problem but referred to a study published earlier this week that stated that immunodeficiency may in fact be a benefit in the face of avian influenza.

The study, published in the journal Respiratory Research, indicated that the young and healthy may be those most seriously affected by avian influenza, as the body's immuno-response was to produce a storm of cytokines that can lead to respiratory difficulties.

Wolinsky opined that, for Africa, the lack of access to doctors and hospitals may prove to be a greater concern in the fight against avian influenza than the continent's HIV/AIDS epidemic.

In a later session of the conference Laurie Garrett, senior fellow for global health at the Council on Foreign Relations, remarked, "Africa has the most fragile public health system in the world," and while we have no certain knowledge of the effects of the combination of H5N1 and HIV/AIDS, "Africa could be truly devastated, and may play a completely different role in the world in two years' time."

On the last point alone can all experts agree.

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