HIV/AIDS is a major public health concern and cause of death in Africa. Although Africa is home to about 14.5% of the world's population, it is estimated to be home to 69% of all people living with HIV and to 72% of all AIDS deaths in 2009.[1]
Contents |
| World region | Adult HIV prevalence (ages 15–49) |
Total HIV cases |
AIDS deaths in 2005 |
|---|---|---|---|
| Sub-Saharan Africa | 5.0% | 22.5 million | 1.3 million |
| Worldwide | 0.8% | 33.3 million | 1.8 million |
| North America | 0.5% | 1.5 million | 26,000 |
| Western and Central Europe | 0.2% | 820,000 | 8,500 |
The Joint United Nations Programme on HIV/AIDS (UNAIDS) has predicted outcomes for the region to the year 2025. These range from a plateau and eventual decline in deaths beginning around 2012 to a catastrophic continual growth in the death rate with potentially 90 million cases of infection.
Without the kind of health care and medicines (such as antiretrovirals) that are available in developed countries, large numbers of people in Africa will develop AIDS. They will not only be unable to work, but will also require significant medical care. This will likely cause a collapse of economies and societies.
In an article titled "Death Stalks A Continent", Johanna McGeary attempts to describe the severity of the issue. “Society's fittest, not its frailest, are the ones who die—adults spirited away, leaving the old and the children behind. You cannot define risk groups: everyone who is sexually active is at risk. Babies too, [are] unwittingly infected by mothers. Barely a single family remains untouched. Most do not know how or when they caught the virus, many never know they have it, many who do know don't tell anyone as they lie dying”.[4]
Recent theories have linked the earliest known cases of AIDS to west Africa(see: origin of AIDS). Hypotheses include linking the disease to the preparation for consumption of bushmeat in Cameroon, or sexual contact with monkeys, with this last hypothesis being met with skepticism, as this is an extremely uncommon practice in African countries. Current hypotheses also include colonial medical practices of mid-20th-century which, once the virus made the jump from chimpanzees or other apes to humans, may have helped HIV become established in human populations around 1930.[5] It is highly probable that this is where the disease originated since early cases of it have been traced back to colonial Africa in the rubber plantations but no scientific evidence has been found (see: origin of AID theories).
Although many governments in Sub-Saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.
Health spending in Africa has never been adequate, either before or after independence. The health care systems inherited from colonial powers were oriented toward curative treatment rather than preventative programs. Strong prevention programs are the cornerstone of effective national responses to AIDS, and the required changes in the health sector have presented huge challenges.
The global response to HIV and AIDS has improved considerably in recent years. Funding comes from many sources, the largest of which are the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US initiative known as PEPFAR.
Major African political leaders have denied the link between HIV and AIDS, favoring alternate theories.[6] The scientific community considers the evidence that HIV causes AIDS to be conclusive and rejects AIDS-denialist claims as pseudoscience based on conspiracy theories, faulty reasoning, cherry picking, and misrepresentation of mainly outdated scientific data. Despite its lack of scientific acceptance, AIDS denialism has had a significant political impact, especially in South Africa under the former presidency of Thabo Mbeki.
Contributing to the AIDS crisis in Africa is a tendency among many African leaders to ignore the epidemic. For example, not a single African head of state or government attended the 11th international conference on AIDS in Zambia in 1999. Even the president of Zambia Frederic Chiluba, who officially hosted the event, failed to show up (Diseases and Disorders AIDS 51).
As a result of several high profile incidents involving Western medical practitioners[7] as well as historically poor treatment by outside powers, there are high levels of medical suspicion throughout Africa. This distrust for modern medicine is often linked to theories of a "Western Plot"[8] of mass sterilization or population reduction. There is evidence that such rumors may have a significant impact on the use of medical services.[9][10]
Lack of money is an obvious challenge, although a great deal of aid is distributed throughout developing countries with high HIV/AIDS rates. For African countries with advanced medical facilities, patents on many drugs have hindered the ability to make low cost alternatives.[11] VaxGen, a California company, has come up with the most advanced vaccine called AIDSVAX, but this has only been found effective in the Asian and black populations, thus[11][12] funding for further research for this has been lacking since money cannot be obtained from poor African governments, and once it is found, the vaccine would not be able to be made, the costs would be prohibitive to poor Asian and Africans.[11][12]
Natural disasters and conflict are also major challenges, as the resulting economic problems people face can drive many young women and girls into patterns of sex work in order to ensure their livelihood or that of their family, or else to obtain safe passage, food, shelter or other resources.[13] Emergencies can also lead to new patterns of sex work, for instance, in Mozambique the influx of humanitarian workers and transporters, such as truck drivers, can cause sex workers to move to the area.[13] In northern Kenya, for instance, drought has led to a decrease in clients for sex workers, and the result is that sex workers are less able to resist their clients' refusal to wear condoms.[13]
African countries are also still fighting against what they perceive as unfair practices in the international pharmaceutical industry.[14] Medical experimentation occurs in Africa on many medications, but once approved, access to the drug is difficult.[14] Drug companies are often concerned with making a return on the money they invested on the research and obtain patents that keep the prices of the medications high. Patents on medications have prevented access to medications as well as the growth in research for more affordable alternatives. These pharmaceuticals insist that drugs should be purchased through them. South African scientists in a combined effort with American scientists from Gilead recently came up with an AIDS gel that is 40% effective in women as announced in a study conducted at the University of KwaZulu-Natal in Durban, South Africa. This is a groundbreaking drug and will soon be made available to Africans and people abroad. The South African government has indicated its willingness to make it widely available. The FDA in the US is in the process of reviewing the drug for approval for US use.[15][16] The AIDS/HIV epidemic has led to the rise in unethical medical Experimentation in Africa.[14] Since the epidemic is widespread, African governments relax their laws in order to get research conducted in their countries which they would otherwise not afford.[14] However, global organizations such as the Clinton Foundation, are working to reduce the cost of HIV/AIDS medications in Africa and elsewhere. For example, Inder Singh oversaw a program which reduced the cost of pediatric HIV/AIDS drugs by 80 to 92% by working with manufacturers to reduce production and distribution costs.[17] Manufacturers often cite distribution and production difficulties in developing markets, which create a substantial barrier to entry.
When family members get sick with HIV or other sicknesses, family members often end up selling most of their belongings in order to provide health care for the individual. Medical facilities in many African countries are lacking. Many health care workers are also not available, in part due to lack of training by governments and in part due to the wooing of these workers by foreign medical organisations where there is a need for medical professionals.[18] This is done largely through immigration laws that encourage recruitment in professional fields (special skill categories) like doctors and nurses in countries like Australia, Canada, and the U.S.
The African health care industry has been hard hit by a brain drain. Many qualified doctors, nurses or other health care professionals emigrate to other countries. For example, in Malawi, the University of Malawi graduates medical doctors that end up working abroad. (This is illustrated when at a certain point, there were more Malawian doctors in Manchester than in the entire country of Malawi.[19][20]
Response to the epidemic is also hampered by lack of infrastructure, corruption within both donor agencies and government agencies, foreign donors not coordinating with local government, and misguided resources.
Prevalence measures include everyone living with HIV and AIDS, and present a delayed representation of the epidemic by aggregating the HIV infections of many years. Incidence, in contrast, measures the number of new infections, usually over the previous year. There is no practical, reliable way to assess incidence in sub-Saharan Africa. Prevalence in 15–24 year old pregnant women attending antenatal clinics is sometimes used as an approximation. The test done to measure prevalence is a serosurvey in which blood is tested for the presence of HIV.
Health units that conduct serosurveys rarely operate in remote rural communities, and the data collected also does not measure people who seek alternate healthcare. Extrapolating national data from antenatal surveys relies on assumptions which may not hold across all regions and at different stages in an epidemic.
Recent national population or household-based surveys collecting data from both sexes, pregnant and non-pregnant women, and rural and urban areas, have adjusted the recorded national prevalence levels for several countries in Africa and elsewhere. These, too, are not perfect: people may not participate in household surveys because they fear they may be HIV positive and do not want to know their test results. Household surveys also exclude migrant labourers, who are a high risk group.
Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries.
A minority of scientists claim that as many as 40% of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity.[21] The World Health Organization states that about 2.5% of AIDS infections in sub-Saharan Africa are caused by unsafe medical injection practices and the "overwhelming majority" by unprotected sex.[22]
In this article, east and central Africa consists of Uganda, Kenya, Tanzania (more to the south east), Rwanda and Burundi(central east), Democratic Republic of the Congo(central and central east), the Congo Republic, Gabon, Equatorial Guinea (central west), the Central African Republic, Ethiopia and Eritrea on the Horn of Africa (north-east). In 1982, Uganda was the first state in the region to declare HIV cases. This was followed by Kenya in 1984 and Tanzania in 1985.
| Country | Adult prevalence[1] | Total HIV Cases[1] | Deaths in 2009[1] |
|---|---|---|---|
| Tanzania | 5.6% | 1,400,000 | 86,000 |
| Kenya | 6.3% | 1,500,000 | 80,000 |
| Congo | 3.4% | 77,000 | 5,100 |
| Congo DR | 1.2-1.6% | 430,000-560,000 | 26,000-40,000 |
| Uganda | 6.5% | 1,200,000 | 64,000 |
Some areas of east Africa are beginning to show substantial declines in the prevalence of HIV infection. In the early 1990s, 13% of Ugandan residents were HIV positive; this has now dropped to 4.1% by the end of 2003. Evidence may suggest that the tide may also be turning in Kenya: prevalence fell from 13.6% in 1997–1998 to 9.4% in 2002. Data from Ethiopia and Burundi are also hopeful. HIV prevalence levels still remain high, however, and it is too early to claim that these are permanent reversals in these countries' epidemics.
Most governments in the region established AIDS education programmes in the mid-1980s in partnership with the World Health Organization and international NGOs. These programmes commonly taught the 'ABC strategy' of HIV prevention, which is a combination of abstinence, sexual fidelity to one's partner, and condom use. The efforts of these educational campaigns appear now to be bearing fruit. In Uganda, awareness of AIDS is demonstrated to be over 99% and more than three in five Ugandans can cite two or more preventative practices. Youths are also delaying the age at which sexual intercourse first occurs.
There are no non-human vectors of HIV infection. The spread of the epidemic across this region is closely linked to the migration of labour from rural areas to urban centres, which generally have a higher prevalence of HIV. Labourers commonly picked up HIV in the towns and cities, spreading it to the countryside when they visited their home. Empirical evidence brings into sharp relief the connection between road and rail networks and the spread of HIV. Long distance truck drivers have been identified as a group with the high-risk behaviour of sleeping with prostitutes and a tendency to spread the infection along trade routes in the region. Infection rates of up to 33% were observed in this group in the late 1980s in Uganda, Kenya and Tanzania.
Western Africa includes the coastal countries of Mauritania, Senegal, The Gambia, Cape Verde, Guinea-Bissau, Guinea, Sierra Leone, Liberia, Côte d'Ivoire, Ghana, Togo, Benin, Cameroon, Nigeria and the landlocked states of Mali, Burkina Faso and Niger.
| Country | Adult prevalence[1] | Total HIV cases[1] | Deaths in 2009[1] |
|---|---|---|---|
| Cameroon | 5.3% | 610,000 | 37,000 |
| Côte d'Ivoire | 3.4% | 450,000 | 36,000 |
| Liberia | 1.5% | 37,000 | 3,600 |
| Guinea-Bissau | 2.5% | 22,000 | 1,200 |
| Togo | 3.2% | 120,000 | 8,700 |
| Nigeria | 3.6% | 3,300,000 | 220,000 |
| Gambia | 2.0% | 18,000 | <1000 |
| Burkina Faso | 1.2% | 110,000 | 7,100 |
| Ghana | 1.8% | 260,000 | 18,000 |
| Benin | 1.2% | 60,000 | 2,700 |
| Mali | 1.0% | 76,000 | 4,400 |
| Sierra Leone | 1.6% | 49,000 | 2,800 |
| Guinea | 1.3% | 79,000 | 4,700 |
| Niger | 0.8% | 61,000 | 4,300 |
| Senegal | 0.9% | 59,000 | 2,600 |
| Mauritania | 0.7% | 14,000 | <1,000 |
The region has generally high levels of infection of both HIV-1 and HIV-2. The onset of the HIV epidemic in west Africa began in 1985 with reported cases in Côte d'Ivoire, Benin and Mali. Nigeria, Burkina Faso, Ghana, Cameroon, Senegal and Liberia followed in 1986. Sierra Leone, Togo and Niger in 1987; Mauritiana in 1988; The Gambia, Guinea-Bissau, and Guinea in 1989; and finally Cape Verde in 1990.
HIV prevalence in west Africa is lowest in Chad, Niger, Mali, Mauritania and highest in Burkina Faso, Côte d'Ivoire, and Nigeria. Nigeria has the second largest number of people living with HIV in Africa after South Africa, although the infection rate (number of patients relative to the entire population) based upon Nigeria's estimated population is much lower, generally believed to be well under 7%, as opposed to South Africa's which is well into the double-digits (nearer 30%).
The main driver of infection in the region is commercial sex. In the Ghanaian capital Accra, for example, 80% of HIV infections in young men had been acquired from women who sell sex. In Niger, the adult national HIV prevalence was 1% in 2003, yet surveys of sex workers in different regions found a HIV infection rate of between 9 and 38%.
In the mid-1980s, HIV and AIDS were virtually unheard of in southern Africa—it is now the worst-affected region in the world. Of the eleven southern African countries (Angola, Namibia, Zambia, Zimbabwe, Botswana, Malawi, Mozambique, South Africa, Lesotho, Swaziland, Madagascar) at least seven are estimated to have an infection rate of over 15%.[24] Angola presents one of the lowest infection rates at 2.1%.[24] This is not the result of a successful national response to the threat of AIDS but of the long-running Angolan Civil War (1975–2002).
Aside from polygynous relationships, which can be quite prevalent in parts of Africa, there are also widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners.[25] Men’s sexual networks, in particular, tend to be quite extensive, a fact that is tacitly accepted by many communities. Cultural or social norms often indicate that while women must remain faithful men are able and even expected to philander irrespective of their marital status. Along with the occurrence of multiple sexual partners, unemployment and population displacements that result from drought and conflict contribute to the spread of HIV/AIDS.
There are a few indicators of countrywide declines in infection. In its December 2005 report, UNAIDS reports that Zimbabwe has experienced a drop in infections; however, most independent observers find the confidence of UNAIDS in the Mugabe government's HIV figures to be misplaced, especially since infections have continued to increase in all other southern African countries (with the exception of a possible small drop in Botswana). Almost 30% of the global number of people living with HIV live in an area where only 2% of the world's population reside.
Most HIV infections found in southern Africa are HIV-1, the world's most common HIV infection, which predominates everywhere except west Africa, home to HIV-2. The first cases of HIV in the region were reported in Zimbabwe in 1985.
The HIV infection rate in Swaziland is unprecedented and the highest in the world at 26.1% of all adults,[26] and at over 50% of adults in their 20s.[27] This has stopped possible economic and social progress, and is at a point where it endangers the existence of its society as a whole. The United Nations Development Program has written that if the expansion continues unabated, the "longer term existence of Swaziland as a country will be seriously threatened".[27]
Swaziland's HIV epidemic has reduced life expectancy to only 32 years as of 2009, which is the lowest in the world by six years. The next highest is 38 years in Angola, also from HIV. From another perspective, HIV/AIDS currently causes 61% of all deaths in the country. With an unmatched crude death rate of 30 per 1,000 people per year, about 2% of Swaziland's total population dies of HIV/AIDS every year.[28]
Much of the deadliness of the epidemic in sub-Saharan Africa has to do with a deadly synergy between HIV and tuberculosis,[29] though this synergy is by no means limited to Africa. In fact, tuberculosis is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS.[30]
Because HIV has destroyed the immune systems of at least a quarter of the population in some areas, far more people are not only developing tuberculosis but spreading it to otherwise healthy neighbours.[29]
There are numerous initiatives and campaigns which have been used to curb the spread of HIV in Africa, such as the Abstinence, be faithful, use a condom or ABC campaign.
One of the greatest problems many African countries face, due to high prevalence rates, is "HIV fatigue", where populations are not interested in hearing more about a disease they hear about constantly. In order to address this, novel approaches are often required. In 2011, the Botswana Ministry of Education will be introducing new HIV/AIDS educational technology for schools. The TeachAIDS prevention software, developed at Stanford University, will be distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide.[31]
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