HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
/
AIDS
Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual m ...
originated in Africa in the early 20th century and is a major public health concern and cause of death in many African countries. AIDS rates vary significantly between countries, though the majority of cases are concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total infected worldwide – some 35 million people – were Africans, of whom 15 million have already died.
Sub-Saharan Africa
Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
alone accounted for an estimated 69 percent of all people living with HIV
["Global Fact Sheet", Joint United Nations Programme on HIV and AIDS, 20 November 2012](_blank)
/ref> and 70 percent of all AIDS deaths in 2011. In the countries of sub-Saharan Africa most affected, AIDS has raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, the life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic with life-expectancy in some countries reaching as low as thirty-nine years.
Countries in North Africa
North Africa, or Northern Africa is a region encompassing the northern portion of the African continent. There is no singularly accepted scope for the region, and it is sometimes defined as stretching from the Atlantic shores of Mauritania in ...
and the Horn of Africa have significantly lower prevalence rates, as their populations typically engage in fewer high-risk cultural patterns that promote the spread of the virus in Sub-Saharan Africa. Southern Africa
Southern Africa is the southernmost subregion of the African continent, south of the Congo and Tanzania. The physical location is the large part of Africa to the south of the extensive Congo River basin. Southern Africa is home to a number of ...
is the worst affected region on the continent. As of 2011, HIV has infected at least 10 percent of the population in Botswana
Botswana (, ), officially the Republic of Botswana ( tn, Lefatshe la Botswana, label=Setswana, ), is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory being the Kalahar ...
, Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
, Malawi
Malawi (; or aláwi Tumbuka: ''Malaŵi''), officially the Republic of Malawi, is a landlocked country in Southeastern Africa that was formerly known as Nyasaland. It is bordered by Zambia to the west, Tanzania to the north and northeas ...
, Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, Namibia
Namibia (, ), officially the Republic of Namibia, is a country in Southern Africa. Its western border is the Atlantic Ocean. It shares land borders with Zambia and Angola to the north, Botswana to the east and South Africa to the south and ea ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, Eswatini, Zambia
Zambia (), officially the Republic of Zambia, is a landlocked country at the crossroads of Central Africa, Central, Southern Africa, Southern and East Africa, although it is typically referred to as being in Southern Africa at its most cent ...
, and Zimbabwe
Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and Mozam ...
.
In response, a number of initiatives have been launched in various parts of the continent to educate the public on HIV/AIDS. Among these are combination prevention programs, considered to be the most effective initiative, such as the abstinence, be faithful, use a condom
Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modi ...
campaign or the Desmond Tutu HIV Foundation's outreach programs.
The number of HIV positive people in Africa receiving anti-retroviral
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multip ...
treatment in 2012 was over seven times the number receiving treatment in 2005, with nearly 1 million added in the previous year.["Special Report: How Africa Turned AIDS Around", Joint United Nations Programme on HIV/AIDS, 2013](_blank)
/ref> The number of AIDS-related deaths in Sub-Saharan Africa in 2011 was 33 percent less than the number in 2005. In 2011, new HIV infections in Sub-Saharan Africa decreased by 25 percent from 2001.
''An estimated 420 000 40 000−530 000people died in the African Region from HIV-related causes in 2021, which indicates that mortality has dropped by almost 55% since 2010.''
It reported that 1.1 million people have been newly infected with HIV in 2018.
Overview
In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT
Avert is an international charity that uses digital communications to increase health literacy on HIV and sexual health, among those most affected in areas of greatest need, in order to reduce new infections and improve health and well-being. ...
wrote:
Origins of HIV/AIDS in Africa
The earliest known cases of human HIV
The human immunodeficiency viruses (HIV) are two species of ''Lentivirus'' (a subgroup of retrovirus) that infect humans. Over time, they cause acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune ...
infection were in western equatorial Africa
Equatorial Africa is an ambiguous term that sometimes is used to refer either to the equatorial region of Sub-Saharan Africa traversed by the Equator, more broadly to tropical Africa or in a biological and geo-environmental sense to the intra- ...
, probably in southeast Cameroon
Cameroon (; french: Cameroun, ff, Kamerun), officially the Republic of Cameroon (french: République du Cameroun, links=no), is a country in west-central Africa. It is bordered by Nigeria to the west and north; Chad to the northeast; the C ...
where groups of the central common chimpanzee live. "Phylogenetic analyses revealed that all HIV-1
The subtypes of HIV include two major types, HIV type 1 (HIV-1) and HIV type 2 (HIV-2). HIV-1 is related to viruses found in chimpanzees and gorillas living in western Africa, while HIV-2 viruses are related to viruses found in the sooty mangabey ...
strains known to infect humans, including HIV-1 groups M, N, and O, were closely related to just one of these SIV cpz lineages: that found in P. t. troglodytes an troglodytes troglodytes i.e. the central chimpanzee" It is suspected that the disease jumped to humans from butchering of chimpanzees for human consumption.
Current hypotheses also include that, once the virus jumped from chimpanzees or other apes to humans, medical practices of the 20th century helped HIV become established in human populations by 1930. The virus likely moved from primate
Primates are a diverse order of mammals. They are divided into the strepsirrhines, which include the lemurs, galagos, and lorisids, and the haplorhines, which include the tarsiers and the simians ( monkeys and apes, the latter including ...
s to humans when hunters came into contact with the blood of infected primates. The hunters then became infected with HIV and passed on the disease to other humans through bodily fluid contamination. This theory is known as the "Bushmeat theory".
HIV made the leap from rural isolation to rapid urban transmission as a result of urbanization that occurred during the 20th century. There are many reasons why there is such a high prevalence of AIDS in Africa. One of the most formative explanations is the poverty that dramatically impacts the daily lives of Africans. The book, ''Ethics and AIDS in Africa: A Challenge to Our Thinking'', describes how "Poverty has accompanying side-effects, such as prostitution (i.e. the need to sell sex for survival), poor living conditions, education, health and health care, that are major contributing factors to the current spread of HIV/AIDS."[A., Van Niekerk A., and Loretta M. Kopelman. Ethics & AIDS in Africa: The Challenge to Our Thinking. Walnut Creek, CA: Left Coast, 2005.]
Researchers believe HIV was gradually spread by river travel. All the rivers in Cameroon run into the Sangha River
The Sangha River, a tributary of the Congo River, is located in Central Africa.
Geography
The Sangha River is formed at the confluence of the Mambéré River and the Kadéï River at Nola, Central African Republic, Nola in the western Central Af ...
, which joins the Congo River
The Congo River ( kg, Nzâdi Kôngo, french: Fleuve Congo, pt, Rio Congo), formerly also known as the Zaire River, is the second longest river in Africa, shorter only than the Nile, as well as the second largest river in the world by discharge ...
running past Kinshasa
Kinshasa (; ; ln, Kinsásá), formerly Léopoldville ( nl, Leopoldstad), is the capital and largest city of the Democratic Republic of the Congo. Once a site of fishing and trading villages situated along the Congo River, Kinshasa is now one o ...
in the Democratic Republic of the Congo
The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
. Trade along the rivers could have spread the virus, which built up slowly in the human population. By the 1960s, about 2,000 people in Africa may have had HIV, including people in Kinshasa
Kinshasa (; ; ln, Kinsásá), formerly Léopoldville ( nl, Leopoldstad), is the capital and largest city of the Democratic Republic of the Congo. Once a site of fishing and trading villages situated along the Congo River, Kinshasa is now one o ...
whose tissue samples from 1959 and 1960 have been preserved and studied retrospectively. The first epidemic of HIV/AIDS is believed to have occurred in Kinshasa in the 1970s, signaled by a surge in opportunistic infections such as cryptococcal meningitis
Cryptococcosis is a potentially fatal mycosis, fungal infection of mainly the lungs, presenting as a pneumonia, and brain, where it appears as a meningitis. Cough, shortness of breath, difficulty breathing, chest pain and fever are seen when the ...
, Kaposi's sarcoma
Kaposi's sarcoma (KS) is a type of cancer that can form masses in the skin, in lymph nodes, in the mouth, or in other organs. The skin lesions are usually painless, purple and may be flat or raised. Lesions can occur singly, multiply in a limit ...
, tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
, and pneumonia
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity ...
.
History
Acquired immunodeficiency syndrome (AIDS) is a fatal disease caused by the slow-acting human immunodeficiency virus (HIV). The virus multiplies in the body until it causes immune system damage, leading to diseases of the AIDS syndrome. HIV emerged in Africa in the 1960s and spread to the United States and Europe the following decade. In the 1980s it spread across the globe until it became a pandemic. Some areas of the world were already significantly impacted by AIDS, while in others the epidemic was just beginning. The virus is transmitted by bodily fluid contact including the exchange of sexual fluids, by blood, from mother to child in the womb, and during delivery or breastfeeding. AIDS first was identified in the United States and France in 1981, principally among homosexual men. Then in 1982 and 1983, heterosexual Africans also were diagnosed.
In the late 1980s, international development agencies regarded AIDS control as a technical medical problem rather than one involving all areas of economic and social life. Because public health authorities perceived AIDS to be an urban phenomenon associated with prostitution, they believed that the majority of Africans who lived in "traditional" rural areas would be spared. They believed that the heterosexual epidemic could be contained by focusing prevention efforts on persuading the so-called core transmitters—people such as sex workers and truck drivers, known to have multiple sex partners—to use condoms. These factors retarded prevention campaigns in many countries for more than a decade.
Although many governments in Sub-Saharan Africa
Sub-Saharan Africa is, geographically, the area and regions of the continent of Africa that lies south of the Sahara. These include West Africa, East Africa, Central Africa, and Southern Africa. Geopolitically, in addition to the List of sov ...
denied that there was a problem for years, they have now begun to work toward solutions.
AIDS was at first considered a disease of gay men and drug addicts, but in Africa it took off among the general population. As a result, those involved in the fight against HIV began to emphasize aspects such as preventing transmission from mother to child, or the relationship between HIV and poverty, inequality of the sexes, and so on, rather than emphasizing the need to prevent transmission by unsafe sexual practices or drug injection. This change in emphasis resulted in more funding, but was not effective in preventing a drastic rise in HIV prevalence.[, pp. iv-v.]
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
The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) is an international financing and partnership organization that aims to "attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, t ...
and the President's Emergency Plan for AIDS Relief
The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President Geo ...
.
According to the Joint United Nations Program on HIV/AIDS (UNAIDS), the number of HIV positive people in Africa receiving anti-retroviral treatment rose from 1 million to 7.1 million between 2005 and 2012, an 805% increase. Almost 1 million of those patients were treated in 2012. The number of HIV positive people in South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
who received such treatment in 2011 was 75.2 percent higher than the number in 2009.
Additionally, the number of AIDS-related deaths in 2011 in both Africa as a whole and Sub-Saharan Africa alone was 32 percent less than the number in 2005. The number of new HIV infections in Africa in 2011 was also 33 percent less than the number in 2001, with a "24% reduction in new infections among children from 2009 to 2011". In Sub-Saharan Africa, new HIV positive cases over the same period declined by 25%. According to UNAIDS, these successes have resulted from "strong leadership and shared responsibility in Africa and among the global community".
Prevention of HIV infections
Public education initiatives
Numerous public education initiatives have been launched to curb the spread of HIV in Africa.
The role of stigma
Many activists have drawn attention to stigmatization of those testing as HIV positive. This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and prejudices brought on by a cultures beliefs. "When HIV/AIDS became a global disease, Some African leaders played ostrich and said that it was a gay disease found only in the West and Africans did not have to worry because there were no gays and lesbians in Africa". Africans were blind to the already huge epidemic that was infesting their communities. The belief that only homosexuals could contract the diseases was later debunked as the number of heterosexual couples living with HIV increased. Unfortunately there were other rumors being spread by elders in Cameroon. These "elders speculated that HIV/AIDS was a sexually transmitted disease passed on from Fulani women only to non-Fulani men who had sexual contact with them. They also claimed if a man was infected as a result of having sexual contact with a Fulani woman, only a Fulani healer could treat him". This communal belief is shared by many other African cultures who believe that HIV and AIDS originated from women. Because of this belief that men can only get HIV from women many "women are not free to speak of their HIV status to their partners for fear of violence". In general HIV carries a negative stigma in Sub-Saharan Africa. Unfortunately This stigma makes it very challenging for Sub-Saharan Africans to share that they have HIV because they are afraid of being an outcast from their friends and family. In every Sub-Saharan community HIV is seen as the bringer of death. The common belief is that once you have HIV you are destined to die. People seclude themselves based on these beliefs. They don't tell their family and live with guilt and fear because of HIV. However, there is a way to treat HIV and AIDS the problem is that many are just not aware of how HIV is spread or what effects it has on the body. "80.8% of participants would not sleep in the same room as someone who was HIV positive, while 94.5% would not talk to someone who was HIV positive".
Social stigma plays a significant role in the state of HIV and AIDS infection in Africa. "In a normatively HIV/AIDS-stigmatizing Sub Saharan African communities, this suspicion of one's status by others is also applicable to individuals who are not HIV positive, but who may wish to utilize healthcare services for preventive purposes. This group of individuals under fear of suspicion may avoid being mistakenly identified as stigmatized by simply avoiding HARHS utilization." (151)
"At the individual level, persons living with HIV/AIDS in Sub-Saharan Africa likely want to conceal their stigmatized identities whenever possible in order to gain these rewards associated with having a 'normal' identity. The rewards of being considered normal' in the context of high-HIV-prevalence Sub-Saharan Africa are varied and great... such rewards for which there is empirical support in this context include perceived sexual freedom, avoidance of discrimination, avoidance of community or family rejection, avoidance of losing one's job or residence, and avoidance of losing one's sexual partners. Other potential rewards of being considered normal include avoidance of being associated with promiscuity or prostitution, avoidance of emotional, social and physical isolation and avoidance of being blamed for others' illness" (150).
Combination prevention programs
The Joint United Nations Program on HIV/AIDS defines combination prevention programs as:
"It is the consensus in the HIV scientific community that abstinence, be faithful, use a condom
Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modi ...
ABC)principles are vital guides for public health intervention, but are better bundled with biomedical prevention approaches; lone behavioral change approaches are not likely to stop the global pandemic." Uganda
}), is a landlocked country in East Africa
East Africa, Eastern Africa, or East of Africa, is the eastern subregion of the African continent. In the United Nations Statistics Division scheme of geographic regions, 10-11-(16*) territor ...
has replaced its ABC strategy with a combination prevention program because of an increase in the annual HIV infection rate. Most new infections were coming from people in long-term relationships who had multiple sexual partners.
Abstinence, be faithful, use a condom
The abstinence, be faithful, use a condom
Abstinence, be faithful, use a condom, also known as the ABC strategy or abstinence-plus sex education, also known as abstinence-based sex education, is a sex education policy based on a combination of "risk avoidance" and harm reduction which modi ...
(ABC) strategy to prevent HIV infection promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut. The implementation of ABC differs among those who use it. For example, the President's Emergency Plan for AIDS Relief
The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President Geo ...
has focused more on abstinence and fidelity than condoms while Uganda
}), is a landlocked country in East Africa
East Africa, Eastern Africa, or East of Africa, is the eastern subregion of the African continent. In the United Nations Statistics Division scheme of geographic regions, 10-11-(16*) territor ...
has had a more balanced approach to the three elements.
The effectiveness of ABC is controversial. At the 16th International AIDS Conference in 2006, African countries gave the strategy mixed reviews. In Botswana
Botswana (, ), officially the Republic of Botswana ( tn, Lefatshe la Botswana, label=Setswana, ), is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory being the Kalahar ...
,
In Nigeria
Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
,
In Kenya
)
, national_anthem = "Ee Mungu Nguvu Yetu"()
, image_map =
, map_caption =
, image_map2 =
, capital = Nairobi
, coordinates =
, largest_city = Nairobi
, ...
,
Eswatini in 2010 announced that it was abandoning the ABC strategy because it was a dismal failure in preventing the spread of HIV. "If you look at the increase of HIV in the country while we've been applying the ABC concept all these years, then it is evident that ABC is not the answer," said Dr. Derek von Wissell, Director of the National Emergency Response Council on HIV/AIDS.
Prevention efforts
In 1999, the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation
The Bill & Melinda Gates Foundation (BMGF), a merging of the William H. Gates Foundation and the Gates Learning Foundation, is an American private foundation founded by Bill Gates and Melinda French Gates. Based in Seattle, Washington, it was ...
provided major funding for the Love Life website, an online sexual health and relationship resource for teenagers.
In 2011, the Botswana Ministry of Education
The Ministry of Education and Skills Development is a government ministry of Botswana. Its offices are in Gaborone. The Ministry of Tertiary Education, Research Science and Technology exists to provide and build knowledge and innovation through ...
introduced new HIV/AIDS educational technology in local schools. The TeachAids
TeachAids (pronounced ) is a nonprofit social enterprise that develops global health education technology products for HIV/AIDS, concussions, and COVID-19, based on an approach invented through research at Stanford University.
The TeachAids so ...
prevention software, developed at Stanford University
Stanford University, officially Leland Stanford Junior University, is a private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. Stanford is consider ...
, was distributed to every primary, secondary, and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide.
African Union's efforts
AIDS Watch Africa
During the Abuja African Union
The African Union (AU) is a continental union consisting of 55 member states located on the continent of Africa. The AU was announced in the Sirte Declaration in Sirte, Libya, on 9 September 1999, calling for the establishment of the Africa ...
Summit on HIV/AIDS in April 2001, the heads of state and heads of government of Botswana
Botswana (, ), officially the Republic of Botswana ( tn, Lefatshe la Botswana, label=Setswana, ), is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory being the Kalahar ...
, Ethiopia
Ethiopia, , om, Itiyoophiyaa, so, Itoobiya, ti, ኢትዮጵያ, Ítiyop'iya, aa, Itiyoppiya officially the Federal Democratic Republic of Ethiopia, is a landlocked country in the Horn of Africa. It shares borders with Eritrea to the ...
, Kenya
)
, national_anthem = "Ee Mungu Nguvu Yetu"()
, image_map =
, map_caption =
, image_map2 =
, capital = Nairobi
, coordinates =
, largest_city = Nairobi
, ...
, Mali
Mali (; ), officially the Republic of Mali,, , ff, 𞤈𞤫𞤲𞥆𞤣𞤢𞥄𞤲𞤣𞤭 𞤃𞤢𞥄𞤤𞤭, Renndaandi Maali, italics=no, ar, جمهورية مالي, Jumhūriyyāt Mālī is a landlocked country in West Africa. Mali ...
, Nigeria
Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
, Rwanda
Rwanda (; rw, u Rwanda ), officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of Central Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, and Uganda
}), is a landlocked country in East Africa
East Africa, Eastern Africa, or East of Africa, is the eastern subregion of the African continent. In the United Nations Statistics Division scheme of geographic regions, 10-11-(16*) territor ...
established the AIDS Watch Africa (AWA) advocacy platform. The initiative was formed to "accelerate efforts by Heads of State and Government to implement their commitments for the fight against HIV/AIDS, and to mobilize the required national and international resources." In January 2012, AWA was revitalized to include all of Africa and its objectives were broadened to include malaria and tuberculosis.
Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa
In 2012, the African Union
The African Union (AU) is a continental union consisting of 55 member states located on the continent of Africa. The AU was announced in the Sirte Declaration in Sirte, Libya, on 9 September 1999, calling for the establishment of the Africa ...
adopted a ''Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa''.
This Roadmap presents a set of practical African-sourced solutions for enhancing shared responsibility and global solidarity for AIDS ... responses in Africa on a sustainable basis by 2015. The solutions are organized around three strategic pillars: diversified financing; access to medicines; and enhanced health governance. The Roadmap defines goals, results and roles and responsibilities to hold stakeholders accountable for the realization of these solutions between 2012 and 2015.
Preventing HIV transmission from pregnant women to children
The Joint United Nations Program on HIV/AIDS reported that the following sixteen African nations in 2012 "ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child": Botswana
Botswana (, ), officially the Republic of Botswana ( tn, Lefatshe la Botswana, label=Setswana, ), is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory being the Kalahar ...
, Gabon
Gabon (; ; snq, Ngabu), officially the Gabonese Republic (french: République gabonaise), is a country on the west coast of Central Africa. Located on the equator, it is bordered by Equatorial Guinea to the northwest, Cameroon to the north ...
, Gambia, Ghana
Ghana (; tw, Gaana, ee, Gana), officially the Republic of Ghana, is a country in West Africa. It abuts the Gulf of Guinea and the Atlantic Ocean to the south, sharing borders with Ivory Coast in the west, Burkina Faso in the north, and To ...
, Mauritius
Mauritius ( ; french: Maurice, link=no ; mfe, label=Mauritian Creole, Moris ), officially the Republic of Mauritius, is an island nation in the Indian Ocean about off the southeast coast of the African continent, east of Madagascar. It incl ...
, Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, Namibia
Namibia (, ), officially the Republic of Namibia, is a country in Southern Africa. Its western border is the Atlantic Ocean. It shares land borders with Zambia and Angola to the north, Botswana to the east and South Africa to the south and ea ...
, Rwanda
Rwanda (; rw, u Rwanda ), officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of Central Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator ...
, São Tomé and Principe
SAO or Sao may refer to:
Places
* Sao civilisation, in Middle Africa from 6th century BC to 16th century AD
* Sao, a town in Boussé Department, Burkina Faso
* Saco Transportation Center (station code SAO), a train station in Saco, Maine, U.S. ...
, Seychelles
Seychelles (, ; ), officially the Republic of Seychelles (french: link=no, République des Seychelles; Creole: ''La Repiblik Sesel''), is an archipelagic state consisting of 115 islands in the Indian Ocean. Its capital and largest city, V ...
, Sierra Leone
Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierr ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, Eswatini, Tanzania
Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands and ...
, Zambia
Zambia (), officially the Republic of Zambia, is a landlocked country at the crossroads of Central Africa, Central, Southern Africa, Southern and East Africa, although it is typically referred to as being in Southern Africa at its most cent ...
and Zimbabwe
Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and Mozam ...
.
Causes and spread
Behavioral factors
High-risk behavioral patterns are largely responsible for the significantly greater spread of HIV/AIDS in Sub-Saharan Africa than in other parts of the world. Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity. HIV transmission is most likely in the first few weeks after infection, and is therefore increased when people have more than one sexual partner in the same time period. In most of the developed world outside Africa, this means HIV transmission is high among prostitutes and other people who may have more than one sexual partner concurrently. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to be carrying on sexual relations with more than one person, which promotes HIV transmission.[ This practice is known as concurrency, which Helen Epstein describes in her book, ''The Invisible Cure: Africa, the West, and the Fight against AIDS'', in which her research into the sexual mores of Uganda revealed the high frequency with which men and women engage in concurrent sexual relationships. In addition, in sub-Saharan Africa AIDS is the leading killer and a large reason for the high transmission rates is because of the lack of education provided to youth. When infected, most children die within one year because of the lack of treatment. All demographic populations in Sub-Saharan Africa have been infected with HIV, from men to women, and from pregnant woman to children. Rather than having more of a specific group infected, male or female, the ratio of men and women infected with HIV are quite similar. With the HIV infection, 77% of men, women, and children, develop AIDS, and die in Sub-Saharan Africa. In addition, "more than 90% of AIDS orphans and children ereinfected with HIV".
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, ]patent
A patent is a type of intellectual property that gives its owner the legal right to exclude others from making, using, or selling an invention for a limited period of time in exchange for publishing an enabling disclosure of the invention."A p ...
s on many drugs have hindered the ability to make low cost alternatives.[Susan Hunter, "Black Death: AIDS in Africa", Palrave Macmillan 2003 chapter 2]
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.[Samuels, Fiona (2009]
HIV and emergencies: one size does not fit all
, London: Overseas Development Institute Emergencies can also lead to greater exposure to HIV infection through new patterns of sex work. In Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, an influx of humanitarian workers and transporters, such as truck drivers, attracted sex workers from outside the area. Similarly, in the Turkana District
Turkana County is a county in the former Rift Valley Province of Kenya. It is Kenya's largest county by land area (followed by Marsabit County), and also its northwesternmost. It is bordered by the countries of Uganda to the west; South Sudan an ...
of northern Kenya
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, drought led to a decrease in clients for local sex workers, prompting the sex workers to relax their condom use demands and search for new truck driver clients on main highways and in peri-urban settlements.
Health industry
Sub-Saharan "Africans have always appreciated the importance of health care because good health is seen as necessary for the continuation and growth of their lineage". Without proper health the culture will not be able to thrive and grow. Unfortunately, "health services in many countries are swamped by the need to care for increasing numbers of infected and sick people. Ameliorative drugs are too expensive for most victims, except for a very small number who are affluent". The greatest number of sick people with the fewest doctors, Sub-Saharan Africa "has 11 percent of the world's population but carries 24 percent of the global disease burden. With less than 1 percent of global health expenditure and only 3 percent of the world's health workers".
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 organizations where there is a need for medical professionals. Unfortunately, many individuals who get a medical degree end up leaving Sub-Saharan Africa to work abroad "either to escape instability or to practice where they have better working conditions and a higher salary". Many low income communities are very far away from a hospital and they cannot afford to bus there or pay for medical attention once they arrive. "Healthcare in Africa differs widely, depending on the country and also the region – those living in urban areas are more likely to receive better healthcare services than those in rural or remote regions". It is very common to just wait out a sickness or seek help from a neighbor or relative. Currently antiretroviral therapy is the closest to a cure. However, many hospitals lack enough antiretroviral drugs to treat everyone. This may be because most Sub-Saharan African countries invest "as little as 1-4 dollars per capita, ooverseas aid is a major source of funding for healthcare". Many overseas organizations are very hesitant to give antiretroviral drugs to Sub-Saharan Africa because they are expensive, which means that there is only so much they can give. Relying on other countries for help in general requires more paperwork and faith in another country very far away. Also, delivery of drugs and other aid takes many month and years to arrive in the hands of those that need help.
Medical factors
Circumcision
According to a 2007 report, male and female circumcision were statistically associated with an increased incidence of HIV infection among the females in Kenya
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and the males in Kenya, Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
, and Tanzania
Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands and ...
who self-reported that they both underwent the procedure and were virgins.[Kenyan females: 3.2 percent versus 1.4 percent. Kenyan males: 1.8 percent versus 0.0 percent. Lesotho males: 6.1 percent versus 1.9 percent. Tanzanian males: 2.9 percent versus 1.0 percent.] "Among adolescents, regardless of sexual experience, circumcision was just as strongly associated with prevalent HIV infection." Circumcised adults, however, were statistically less likely to be HIV positive than their uncircumcised counterparts, especially among older age groups.[Kenyan females: 4.8 percent versus 12.2 percent. Kenyan males: 4.0 percent versus 25.4 percent. Lesothoan males: 26.3 percent versus 28.8 percent. Tanzanian males: 8.5 percent versus 10.8 percent.]
Similarly, a randomized, controlled intervention trial in South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
from 2005 found that male circumcision "provides a degree of protection against acquiring HIV infection y males equivalent to what a vaccine of high efficacy would have achieved".
Medical suspicion
There are high levels of medical suspicion throughout Africa, and there is evidence that such distrust may have a significant impact on the use of medical services. The distrust of modern medicine is sometimes linked to theories of a "Western Plot" of mass sterilization or population reduction, perhaps a consequence of several high-profile incidents involving western medical practitioners.
Pharmaceutical industry
African countries are also still fighting against what they perceive as unfair practices in the international pharmaceutical industry.[Meier, Benjamin Mason: International Protection of Persons Undergoing Medical Experimentation: Protecting the Right of Informed Consent, Berkeley journal of international law 085-5718Meier yr:2002 vol:20 iss:3 pg:513 -554] Medical experimentation occurs in Africa on many medications, but once approved, access to the drug is difficult.
South African scientists in a combined effort with American scientists from Gilead Sciences
Gilead Sciences, Inc. () is an American biopharmaceutical company headquartered in Foster City, California, that focuses on researching and developing antiviral drugs used in the treatment of HIV/AIDS, hepatitis B, hepatitis C, influenza, and C ...
recently tested and found effective a tenofovir
Tenofovir disoproxil, sold under the trade name Viread among others, is a medication used to treat chronic hepatitis B and to prevent and treat HIV/AIDS. It is generally recommended for use with other antiretrovirals. It may be used for preven ...
-based anti-retroviral vaginal gel that could be used as pre-exposure prophylaxis. Testing of this gel was conducted at the University of KwaZulu-Natal
The University of KwaZulu-Natal (UKZN) is a university with five campuses in the province of KwaZulu-Natal in South Africa. It was formed on 1 January 2004 after the merger between the University of Natal and the University of Durban-Westville. ...
in Durban
Durban ( ) ( zu, eThekwini, from meaning 'the port' also called zu, eZibubulungwini for the mountain range that terminates in the area), nicknamed ''Durbs'',Ishani ChettyCity nicknames in SA and across the worldArticle on ''news24.com'' from ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
. The FDA in the US is in the process of reviewing the drug for approval for US use. The AIDS/HIV epidemic has led to the rise in unethical medical experimentation in Africa African countries have been sites for clinical trials by large pharmaceutical companies, raising human rights concerns.Washington, Harriet A. ''Medical Apartheid'', Anchor Books 2006 p390 Incidents of unethical experimentation, clinical trials lacki ...
.
Since the epidemic is widespread, African governments sometimes relax their laws in order to get research conducted in their countries which they would otherwise not afford. However, global organizations such as the Clinton Foundation, are working to reduce the cost of HIV/AIDS medications in Africa and elsewhere. For example, the philanthropist Inder Singh oversaw a program which reduced the cost of pediatric HIV/AIDS drugs by between 80 and 92 percent by working with manufacturers to reduce production and distribution costs. Manufacturers often cite distribution and production difficulties in developing markets, which create a substantial barrier to entry.
Political factors
Major African political leaders have denied the link between HIV and AIDS, favoring alternate theories. 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.
Subtype factor
In Africa, subtype
Subtype may refer to:
* Viral subtypes, such as Subtypes of HIV
* Subtyping
In programming language theory, subtyping (also subtype polymorphism or inclusion polymorphism) is a form of type polymorphism in which a subtype is a datatype that is ...
C of HIV-1 is very common, whereas it is rare in America or Europe. People with subtype C progress to AIDS faster than those with subtype A, the predominant subtype in America and Europe (see HIV disease progression rates#HIV subtype variation and effect on progression rates).
Religious factors
Pressure from both Christian and Muslim religious leaders has resulted in the banning of a number of safe-sex campaigns, including condom promoting advertisements being banned in Kenya.
Health Care delivery
While there is currently no cure or vaccine for HIV/AIDS there are emerging treatments. It has been extensively discussed that antiretroviral drugs (ART) are crucial for preventing the acquiring of AIDS. AIDS is acquired at the final stage of the HIV virus, which can be completely averted. It is overwhelmingly possible to live with the virus and never acquire AIDS. The proper obedience to ART drugs can provide an infected person with a limitless future. ART drugs are key in preventing the diseases from progressing as well as ensuring the disease is well controlled, thus forbidding the disease from becoming resistant to the treatments. In countries like Nigeria and the Central African Republic, a mere less than 25% of the population has access to the ART drugs. Funds devoted to ART drug access were measured at $19.1 billion in 2013 in low and middle-income countries among the region, however the funds were short of the UNAIDS' previous resource needs estimates of $22–24 billion by 2015.
Measurement
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- to 24-year-old pregnant women attending antenatal clinics is sometimes used as an approximation. The test done to measure prevalence is a sero survey in which blood is tested for the presence of HIV.
Health units that conduct sero surveys 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.
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 percent of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity. The World Health Organization states that about 2.5 percent of HIV infections in Sub-Saharan Africa are caused by unsafe medical injection practices and the "overwhelming majority" by unprotected sex.
Regional prevalence
In contrast to areas in North Africa and the Horn of Africa, traditional cultures and religions in Sub-Saharan Africa have generally exhibited a more liberal attitude to female out-of-marriage sexual activity. The latter includes practices such as multiple sexual partners and unprotected sex, high-risk cultural patterns that have been implicated in the much greater spread of HIV in the subcontinent.
North Africa
Horn of Africa
As with North Africa, the HIV infection rates in the Horn of Africa are quite low. This has been attributed to the Muslim nature of many of the local communities and adherence to Islamic morals.
Ethiopia's HIV prevalence rate has decreased from 3.6 percent in 2001 to 1.4 percent in 2011. The number of new infections per year also has decreased from 130,000 in 2001 to 24,000 in 2011.
Central Africa
HIV infection rates in central Africa are moderate to high.
Eastern Africa
HIV infection rates in eastern Africa are moderate to high.
Kenya
Kenya
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, according to a 2008 report from the Joint United Nations Program on HIV/AIDS, had the third largest number of individuals in Sub-Saharan Africa living with HIV. It also had the highest prevalence rate of any country outside of Southern Africa. Kenya's HIV infection rate dropped from around 14 percent in the mid-1990s to 5 percent in 2006, but rose again to 6.2 percent by 2011. The number of newly infected people per year, however, decreased by almost 30 percent, from 140,000 in 2001 to 100,000 in 2011.
As of 2012, Nyanza Province had the highest HIV prevalence rate at 13.9 percent, with the North Eastern Province having the lowest rate at 0.9 percent.
Christian men and women also had a higher infection rate than their Muslim counterparts. This discrepancy was especially visible among women, with Muslim women showing a rate of 2.8 percent versus 8.4 percent among Protestant women and 8 percent among Catholic women. HIV was also more common among the wealthiest than among the poorest (7.2 percent versus 4.6 percent).
Historically, HIV had been more prevalent in urban than rural areas, although the gap is closing rapidly. Men in rural areas are now more likely to be HIV-infected (at 4.5 percent) than those in urban areas (at 3.7 percent).
Tanzania
Between 2004 and 2008, the HIV incidence rate in Tanzania
Tanzania (; ), officially the United Republic of Tanzania ( sw, Jamhuri ya Muungano wa Tanzania), is a country in East Africa within the African Great Lakes region. It borders Uganda to the north; Kenya to the northeast; Comoro Islands and ...
for ages 15–44 slowed to 3.37 per 1,000 person-years (4.42 for women and 2.36 for men). The number of newly infected people per year increased slightly, from 140,000 in 2001 to 150,000 in 2011. There were also significantly fewer HIV infections in Zanzibar
Zanzibar (; ; ) is an insular semi-autonomous province which united with Tanganyika in 1964 to form the United Republic of Tanzania. It is an archipelago in the Indian Ocean, off the coast of the mainland, and consists of many small islan ...
, which in 2011 had a prevalence rate of 1.0 percent compared to 5.3 percent in mainland Tanzania.[''Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12''](_blank)
authorized by the Tanzania Commission for AIDS (TACAIDS) and the Zanzibar Commission for AIDS; implemented by the Tanzania National Bureau of Statistics in collaboration with the Office of the Chief Government Statistician (Zanzibar); funded by the United States Agency for International Development
The United States Agency for International Development (USAID) is an independent agency of the U.S. federal government that is primarily responsible for administering civilian foreign aid and development assistance. With a budget of over $27 b ...
, TACAIDS, and the Ministry of Health and Social Welfare, with support provided by ICF International
ICF International, Inc. is a Reston, Virginia-based global consulting and technology services company, which provides a range of services for governments and businesses, including strategic planning, management, marketing and analytics.
The compa ...
; data collected 16 December 2011 to 24 May 2012; report published in Dar es Salaam in March 2013
Uganda
Uganda
}), is a landlocked country in East Africa
East Africa, Eastern Africa, or East of Africa, is the eastern subregion of the African continent. In the United Nations Statistics Division scheme of geographic regions, 10-11-(16*) territor ...
has registered a gradual decrease in its HIV rates from 10.6 percent in 1997, to a stabilized 6.5-7.2 percent since 2001. This has been attributed to changing local behavioral patterns, with more respondents reporting greater use of contraceptives and a two-year delay in first sexual activity as well as fewer people reporting casual sexual encounters and multiple partners.
The number of newly infected people per year, however, has increased by over 50 percent, from 99,000 in 2001 to 150,000 in 2011. More than 40 percent of new infections are among married couples, indicating widespread and increasing infidelity
Infidelity (synonyms include cheating, straying, adultery, being unfaithful, two-timing, or having an affair) is a violation of a couple's emotional and/or sexual exclusivity that commonly results in feelings of anger, sexual jealousy, and ri ...
. This increase has caused alarm. The director of the Centre for Disease Control – Uganda, Wuhib Tadesse, said in 2011 that,
Western Africa
Western Africa has moderate levels of infection of both HIV-1 and HIV-2. The onset of the HIV epidemic in the region began in 1985 with reported cases in Senegal, Benin, and Nigeria. These were followed in 1986 by Côte d'Ivoire. The first identification of HIV-2 occurred in Senegal by microbiologist Souleymane Mboup
Souleymane Mboup (born 1951) is a Senegalese microbiologist, medical researcher, and colonel in the Armed Forces of Senegal. In 1985, he was a member of the first team to identify HIV-2, a form of HIV that is typically found in West Africa and ...
and his collaborators.
HIV prevalence in western Africa is lowest in Senegal and highest in Nigeria, which has the second largest number of people living with HIV in Africa after South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
. Nigeria's infection rate (number of patients relative to the entire population), however, is much lower (3.7 percent) compared to South Africa's (17.3 percent).
In Niger in 2011, the national HIV prevalence rate for ages 15–49 was 0.8 percent while for sex workers it was 36 percent.
Southern Africa
In the mid-1980s, HIV and AIDS were virtually unheard of in southern Africa. However, it is now the worst-affected region in the world. Currently, Eswatini and Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
have the highest and second highest HIV prevalence rates in the world, respectively. Of the nine southern African countries (Botswana
Botswana (, ), officially the Republic of Botswana ( tn, Lefatshe la Botswana, label=Setswana, ), is a landlocked country in Southern Africa. Botswana is topographically flat, with approximately 70 percent of its territory being the Kalahar ...
, Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
, Malawi
Malawi (; or aláwi Tumbuka: ''Malaŵi''), officially the Republic of Malawi, is a landlocked country in Southeastern Africa that was formerly known as Nyasaland. It is bordered by Zambia to the west, Tanzania to the north and northeas ...
, Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, Namibia
Namibia (, ), officially the Republic of Namibia, is a country in Southern Africa. Its western border is the Atlantic Ocean. It shares land borders with Zambia and Angola to the north, Botswana to the east and South Africa to the south and ea ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, Eswatini, Zambia
Zambia (), officially the Republic of Zambia, is a landlocked country at the crossroads of Central Africa, Central, Southern Africa, Southern and East Africa, although it is typically referred to as being in Southern Africa at its most cent ...
, and Zimbabwe
Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and Mozam ...
), four are estimated to have an infection rate of over 15 percent.
In Botswana, the number of newly infected people per year has declined by 67 percent, from 27,000 in 2001 to 9,000 in 2011. In Malawi, the decrease has been 54 percent, from 100,000 in 2001 to 46,000 in 2011. All but two of the other countries in this region have also recorded major decreases (Namibia, 62 percent; Zambia, 54 percent; Zimbabwe, 47 percent; South Africa, 38 percent; Eswatini, 32 percent). The number has remained virtually the same in Lesotho and Mozambique.
Zimbabwe's first reported case of HIV was in 1985.
There are widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners. Men's sexual networks, in particular, tend to be quite extensive, a fact that is tacitly accepted or even encouraged by many communities. Along with having multiple sexual partners, unemployment and population displacements resulting from drought and conflict have contributed to the spread of HIV/AIDS. According to Susser and Stein (2000), men refuse to use condoms during intercourse with girls or women performing sex work (p. 1043-1044). Unfortunately, the girls and women are in desperate need of money and do not have a choice. This leads to multiple sex partners, which increases the likelihood of their infection with HIV/AIDS.
A 2008 study in Botswana, Namibia, and Eswatini found that intimate partner violence, extreme poverty, education, and partner income disparity explained almost all of the differences in HIV status among adults aged 15–29 years. Among young women with any one of these factors, the HIV rate increased from 7.7 percent with no factors to 17.1 percent. Approximately 26 percent of young women with any two factors were HIV positive, with 36 percent of those with any three factors and 39.3 percent of those with all four factors being HIV-positive.
Eswatini
As of 2011, the HIV prevalence rate in Eswatini was the highest in the world at 26.0 percent of persons aged 15–49. The United Nations Development Program
The United Nations Development Programme (UNDP)french: Programme des Nations unies pour le développement, PNUD is a United Nations agency tasked with helping countries eliminate poverty and achieve sustainable economic growth and human dev ...
wrote in 2005,
The HIV epidemic in Eswatini has reduced its life expectancy at birth to 49 for men and 51 for women (based on 2009 data). Life expectancy at birth in 1990 was 59 for men and 62 for women.
Based on 2011 data, Eswatini's crude death rate of 19.51 per 1,000 people per year was the third highest in the world, behind only Lesotho and Sierra Leone. HIV/AIDS in 2002 caused 64 percent of all deaths in the country.
Tuberculosis coinfections
Much of the deadliness of the epidemic in Sub-Saharan Africa is caused by a deadly synergy between HIV and tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, in ...
, termed a "co-epidemic". The two diseases have been "inextricably bound together" since the beginning of the HIV epidemic. "Tuberculosis and HIV co-infections are associated with special diagnostic and therapeutic challenges and constitute an immense burden on healthcare systems of heavily infected countries like Ethiopia." In many countries without adequate resources, the tuberculosis case rate has increased five to ten-fold since the identification of HIV. Without proper treatment, an estimated 90 percent of persons living with HIV die within months after contracting tuberculosis. The initiation of highly active antiretroviral therapy
The management of HIV/AIDS normally includes the use of multiple antiretroviral drugs as a strategy to control HIV infection. There are several classes of antiretroviral agents that act on different stages of the HIV life-cycle. The use of multip ...
in persons coinfected with tuberculosis can cause an immune reconstitution inflammatory syndrome with a worsening, in some cases severe worsening, of tuberculosis infection and symptoms.
An estimated 874,000 people in Sub-Saharan Africa were living with both HIV and tuberculosis in 2011, with 330,000 in South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, 83,000 in Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, 50,000 in Nigeria
Nigeria ( ), , ig, Naìjíríyà, yo, Nàìjíríà, pcm, Naijá , ff, Naajeeriya, kcg, Naijeriya officially the Federal Republic of Nigeria, is a country in West Africa. It is situated between the Sahel to the north and the Gulf o ...
, 47,000 in Kenya
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, and 46,000 in Zimbabwe
Zimbabwe (), officially the Republic of Zimbabwe, is a landlocked country located in Southeast Africa, between the Zambezi and Limpopo Rivers, bordered by South Africa to the south, Botswana to the south-west, Zambia to the north, and Mozam ...
. In terms of cases per 100,000 population, Eswatini's rate of 1,010 was by far the highest in 2011. In the following 20 African countries, the cases-per-100,000 coinfection rate has increased at least 20 percent between 2000 and 2011: Algeria
)
, image_map = Algeria (centered orthographic projection).svg
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, Angola
, national_anthem = " Angola Avante"()
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, Chad
Chad (; ar, تشاد , ; french: Tchad, ), officially the Republic of Chad, '; ) is a landlocked country at the crossroads of North and Central Africa. It is bordered by Libya to the north, Sudan to the east, the Central African Republic ...
, Comoros
The Comoros,, ' officially the Union of the Comoros,; ar, الاتحاد القمري ' is an independent country made up of three islands in southeastern Africa, located at the northern end of the Mozambique Channel in the Indian Ocean. It ...
, Republic of the Congo
The Republic of the Congo (french: République du Congo, ln, Republíki ya Kongó), also known as Congo-Brazzaville, the Congo Republic or simply either Congo or the Congo, is a country located in the western coast of Central Africa to the w ...
, Democratic Republic of the Congo
The Democratic Republic of the Congo (french: République démocratique du Congo (RDC), colloquially "La RDC" ), informally Congo-Kinshasa, DR Congo, the DRC, the DROC, or the Congo, and formerly and also colloquially Zaire, is a country in ...
, Equatorial Guinea
Equatorial Guinea ( es, Guinea Ecuatorial; french: Guinée équatoriale; pt, Guiné Equatorial), officially the Republic of Equatorial Guinea ( es, link=no, República de Guinea Ecuatorial, french: link=no, République de Guinée équatoria ...
, The Gambia
The Gambia,, ff, Gammbi, ar, غامبيا officially the Republic of The Gambia, is a country in West Africa. It is the smallest country within mainland AfricaHoare, Ben. (2002) ''The Kingfisher A-Z Encyclopedia'', Kingfisher Publicatio ...
, Lesotho
Lesotho ( ), officially the Kingdom of Lesotho, is a country landlocked country, landlocked as an Enclave and exclave, enclave in South Africa. It is situated in the Maloti Mountains and contains the Thabana Ntlenyana, highest mountains in Sou ...
, Liberia
Liberia (), officially the Republic of Liberia, is a country on the West African coast. It is bordered by Sierra Leone to Liberia–Sierra Leone border, its northwest, Guinea to its north, Ivory Coast to its east, and the Atlantic Ocean ...
, Mauritania, Mauritius
Mauritius ( ; french: Maurice, link=no ; mfe, label=Mauritian Creole, Moris ), officially the Republic of Mauritius, is an island nation in the Indian Ocean about off the southeast coast of the African continent, east of Madagascar. It incl ...
, Morocco
Morocco (),, ) officially the Kingdom of Morocco, is the westernmost country in the Maghreb region of North Africa. It overlooks the Mediterranean Sea to the north and the Atlantic Ocean to the west, and has land borders with Algeria to ...
, Mozambique
Mozambique (), officially the Republic of Mozambique ( pt, Moçambique or , ; ny, Mozambiki; sw, Msumbiji; ts, Muzambhiki), is a country located in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi ...
, Senegal
Senegal,; Wolof: ''Senegaal''; Pulaar: 𞤅𞤫𞤲𞤫𞤺𞤢𞥄𞤤𞤭 (Senegaali); Arabic: السنغال ''As-Sinighal'') officially the Republic of Senegal,; Wolof: ''Réewum Senegaal''; Pulaar : 𞤈𞤫𞤲𞤣𞤢𞥄𞤲𞤣𞤭 ...
, Sierra Leone
Sierra Leone,)]. officially the Republic of Sierra Leone, is a country on the southwest coast of West Africa. It is bordered by Liberia to the southeast and Guinea surrounds the northern half of the nation. Covering a total area of , Sierr ...
, South Africa
South Africa, officially the Republic of South Africa (RSA), is the southernmost country in Africa. It is bounded to the south by of coastline that stretch along the South Atlantic and Indian Oceans; to the north by the neighbouring countri ...
, Eswatini, Togo
Togo (), officially the Togolese Republic (french: République togolaise), is a country in West Africa. It is bordered by Ghana to the west, Benin to the east and Burkina Faso to the north. It extends south to the Gulf of Guinea, where its c ...
, and Tunisia
)
, image_map = Tunisia location (orthographic projection).svg
, map_caption = Location of Tunisia in northern Africa
, image_map2 =
, capital = Tunis
, largest_city = capital
, ...
.
Since 2004, however, tuberculosis-related deaths among people living with HIV have fallen by 28 percent in Sub-Saharan Africa, which is home to nearly 80 percent of the people worldwide who are living with both diseases.
See also
* 28: Stories of AIDS in Africa
* Demographics of Africa
The population of Africa has grown rapidly over the past century and consequently shows a large youth bulge, further reinforced by a low life expectancy of below 50 years in some African countries. Total population as of 2020 is estimated at ...
* The Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund to Fight AIDS, Tuberculosis and Malaria (or simply the Global Fund) is an international financing and partnership organization that aims to "attract, leverage and invest additional resources to end the epidemics of HIV/AIDS, ...
* HIV/AIDS in Eswatini
* HIV/AIDS in Malawi
, approximately 1,100,000 people in Malawi are HIV-positive, which represents 10.8% of the country's population. Because the Malawian government was initially slow to respond to the epidemic under the leadership of Hastings Banda (1966–1994), ...
* HIV/AIDS in Asia
* HIV/AIDS in Australia
The history of HIV/AIDS in Australia is distinctive, as Australian government bodies recognised and responded to the AIDS pandemic relatively swiftly, with the implementation of effective disease prevention and public health programs, such as n ...
* HIV/AIDS in Europe
In Western Europe, the routes of transmission of HIV are diverse, including paid sex, sex between men, intravenous drugs, mother to child transmission, and heterosexual sex. However, many new infections in this region occur through contact ...
* HIV/AIDS in North America
* HIV/AIDS in South America
* Origin of AIDS
* President's Emergency Plan for AIDS Relief
The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President Geo ...
* South African model of the pandemic
* Syphilis in sub-Saharan Africa
* United Nations Special Envoy for HIV/AIDS in Africa The United Nations Special Envoy for HIV/ AIDS in Africa
Africa is the world's second-largest and second-most populous continent, after Asia in both cases. At about 30.3 million km2 (11.7 million square miles) including adja ...
Notes
References
Further reading
*
*
*
*
External links
''AIDS Turns Africa's Demographics Upside Down''
Allianz Knowledge, October 18, 2007
AIDS: Voices From Africa
- slideshow by '' Life magazine''
Aids Clock (UNFPA)
Visualization tool for HIV/AIDS prevalence in sub-Saharan Africa from 2000-2017
Information about STD's in Africa
{{DEFAULTSORT:Hiv Aids In Africa
Development in Africa
Health disasters in Africa