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In other countries circumstances are different - there is a dramatic global pandemia with over 30 million infected people. Patients present to care more often late or too late, in particular in Sub-Saharan Africa and Eastern Europe. Many of newly infected people outside of developed countries are unaware to the possibilities of modern medicine and, thus, their perception is really pessimistic. This is shown by the artful expression of an Noah’ Ark (figure 3). Importantly, in many regions, in particular rural areas, treatment possibilities and access to health care system are lacking or still insufficient. However, treatment possibilities are also increasing in Africa and now 6 million people are treated worldwide with the highest increase in Sub-Saharan Africa. This is illustrated by a project in the Kilombero valley of Tanzania supported by the Swiss Tropical- & Public Health Institute and the University Hospitals of Basel and Berne, Switzerland, where more than 5,000 HIV-infected patients are cared in a chronic diseases clinic. For survival aspects such healthcare facilities, the number of doctors and nutrition are essential factors influencing prognosis and the knowledge about one’s own medical fate.

Fig. 3. This picture demonstrates the dramatic situation in Sub-Saharan Africa before the advent of antiretrovirals: in most parts with no cure, no vaccine, use condom, avoid casual sex as inscribed on the flag. Figure courtesy of Marcel Stoeckle, University of Basel, Switzerland. The artist lived in Dares-Salaam, Tanzania and died from AIDS.

In summary, I hope I could demonstrate that knowing one’s medical fate can be very relative on an individual but also epidemological level. Although the example of progress for HIV/AIDS diagnosis and treatment is probably unprecedent in such a short time span, uncertainty and lack of precision is much more the case than assumed by physicians and patients - simply we do not know ahead of time everything even if we are ‘sure’.