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HIV/AIDS in Africa

2007 Schools Wikipedia Selection. Related subjects: African Geography

   AIDS education at a school in Uganda.
   Enlarge
   AIDS education at a school in Uganda.

   The HIV/AIDS epidemics spreading through the countries of Sub-Saharan
   Africa are highly varied. Although it is not correct to speak of a
   single African epidemic, Africa is without doubt the region most
   affected by the virus. Inhabited by just over 12% of the world's
   population, Africa is estimated to have more than 60% of the
   AIDS-infected population.

      World region    Adult HIV prevalence
                      (ages 15–49)        Total HIV
                                          cases      AIDS deaths
                                                     in 2005
   Sub-Saharan Africa 11%                 24.5m      2.0m
   Worldwide          1.0%                38.6m      2.8m
   North America      0.8%                1.3m       27,000
   Western Europe     0.3%                720,000    12,000
   Regional comparisons of HIV (Source: UNAIDS, 2006 Report on the global
                               AIDS epidemic)

General overview

   HIV prevalence is stable throughout most of Sub-Saharan Africa, is
   still rising in a few countries such as Madagascar and Swaziland and is
   falling in smaller areas in several other countries. Uganda has had the
   world's most successful national response to date reducing from 11%
   prevalence to around 6%, and has witnessed consistent national declines
   since the early 1990s. However, several agencies have cautioned against
   viewing the stablized infection levels as the beginning of the end of
   the pandemic in Africa. Such trends often result from rising death
   rates from AIDS, which conceal a continuing high rate of new
   infections. When HIV prevalence falls, as in Uganda, the number of new
   infections can remain high. National prevalence statistics can also
   conceal much higher levels of infections in certain areas or among
   high-risk groups.

   It is likely that the very high prevalence levels in the richest
   southern countries of Africa such as South Africa, Botswana, Swaziland
   and Zimbabwe is attributable to the fact that reasonably efficient
   medical care is available to HIV infected people from those countries
   who can thus maintain a healthy appearance. However, because of stigma
   in admitting to HIV infection and in the use of condoms they often
   continue to engage in unsafe sexual practices which thus spreads HIV to
   new sexual partners.

   Furthermore, in Southern Africa there is widespread denial that HIV
   does in fact cause AIDS. Thabo Mbeki and Robert Mugabe have both
   propounded the theory that AIDS in fact stems from poverty rather than
   HIV infection. In addition, many Africans have rejected the use of
   condoms because of concerns that the intentions of those who urge their
   usage is to limit the growth of the African population.

   In the 35 African nations with the highest prevalence, average life
   expectancy is 48.3 years—6.5 years less than it would be without the
   disease. For the eleven countries in Africa with prevalence rates above
   13%, life expectancy is 47.7 years—11.0 years less than would be
   expected without HIV/AIDS.

   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.

   Health spending in Africa has historically been inadequate, leaving a
   legacy of poor health care capacity in many regions. This situation was
   often compounded after independence by the distorted spending
   priorities of the many military regimes across the continent. 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 a huge
   challenge.

   Without the kind of nutrition, health care and medicines (such as
   anti-retrovirals) that are available in developed countries, large
   numbers of people in these countries will begin to develop full-blown
   AIDS. They will not only be unable to work, but will also require
   significant medical care. It is forecast that this will likely cause a
   collapse of economies and societies in the region. In some heavily
   infected areas, the epidemic has left behind many orphans being cared
   for by elderly grandparents. UNAIDS, WHO and UNDP have already
   documented decreasing life expectancies and lowering of GNP in many
   African countries with prevalence rates of 10% or more.

   Many governments in sub-Saharan Africa denied that there was a problem
   for years, and are only now starting to work towards solutions. Lack of
   money is the core reason why most AIDS deaths occur in Third World
   countries. All areas of HIV prevention are underfunded when compared to
   even conservative estimates of the problems.
   Changes in life expectancy in several African countries. Botswana has
   been particularly badly hit [1], whilst public education projects
   campaigns have had a positive effect in Uganda [2]. (Source: World Bank
   World Development Indicators, 2004).
   Enlarge
   Changes in life expectancy in several African countries. Botswana has
   been particularly badly hit , whilst public education projects
   campaigns have had a positive effect in Uganda . (Source: World Bank
   World Development Indicators, 2004).

   A minority of scientists claim that as many as 40% of HIV infections in
   African adults may be associated with injections . However this theory
   is rejected by most experts, including those at the World Health
   Organisation, who assert that the vast majority of infections result
   from heterosexual transmission. .

Measuring the epidemic

   It should be borne in mind that national prevalence levels present a
   delayed representation of the epidemic as they account for the HIV
   infections of many years previously. That is, prevalence includes
   everyone in the country living with HIV and AIDS. Incidence, in
   contrast, measures the number of new infections, usually over the
   previous year. Unfortunately, there is no practicable and reliable way
   to assess incidence in sub-Saharan Africa. The closest approximation
   has been found to be prevalence in 15–24 year old pregnant women
   attending antenatal clinics, these measurements are known as
   serosurveys.

   However, some doubt has been cast on such reporting of HIV cases by
   health units, which rarely operate in remote rural communities and do
   not account for people who may decide, for example, to die at home or
   seek traditional healthcare. New national population or household-based
   surveys are increasingly being used to address the shortfalls in
   serosurveys. These collect data from both sexes, non-pregnant women and
   from the more remote areas, resulting in a more refined overall picture
   when combined with antenatal data. These measurements have adjusted the
   recorded national prevalence levels for several countries in Africa and
   elsewhere.

   Both serosurveys and national surveys have their disadvantages. People
   may not participate in household surveys because they fear they may be
   HIV positive or because they are absent from home, excluding the high
   risk group of travelling labourers. Extrapolating national data from
   antenatal surveys relies on a set of key assumptions which may not hold
   across all regions and at different stages in an epidemic.

   Occasionally, observers have gone so far as to suggest there may be
   significant disparities between official figures and actual HIV
   prevalence in some countries, such as Uganda. The Ugandan government
   vigorously maintains, however, that the figures are accurate.

Access to treatment

          "Treatment is technically feasible in every part of the world.
          Even the lack of infrastructure is not an excuse—I don't know a
          single place in the world where the real reason AIDS treatment
          is unavailable is that the health infrastructure has exhausted
          its capacity to deliver it. It's not knowledge that's the
          barrier. It's political will." Peter Piot, Executive Director of
          UNAIDS

   New anti-retroviral drugs (ARVs) can slow down and even reverse the
   progression of HIV infection, delaying the onset of AIDS by twenty
   years or more. Because of their high cost, however, only 7% of the 6
   million people in developing countries who need of ARV treatment have
   access to medication.

   Access to drugs is increasingly recognised as a key component to
   comprehensive AIDS strategies. ARVs play a central role in prevention
   as well as treatment. People are more likely to come forward for
   testing if there is some hope of receiving treatment and are more
   likely to adopt lower risk behaviours to avoid infecting others. ARVs
   also reduce the amount of HIV in the blood, thus reducing the risk of
   further transmission. Slowing the onset of AIDS allows people to
   continue leading a relatively normal life, fully contributing to the
   social and economic life of their country.

   The use of ARVs must be continuous in order to prevent the number of
   drug-resistant strains of HIV from spreading. In areas where drug
   therapy is expensive, such resistant strains have been observed as
   people have interrupted their treatment at times when they were unable
   to afford medication. Patients who start HIV treatment generally have
   to continue taking medications for the rest of their lives, although
   many HIV positive individuals undergo periods (commonly referred to as
   drug holidays) where they do not take ARV drugs.

   In Western societies, ARV treatment is very expensive, costing between
   $10,000 and $15,000 per person per year (pppy). The key factor in the
   expense of ARVs is their patent status, which allow drug companies to
   recoup research costs and turn a profit, enabling the development of
   new drugs. However, some international aid organisations such as VSO,
   Oxfam and Médecins Sans Frontières have questioned whether the revenues
   generated by ARVs really tally with research costs.

   In contrast, in some African countries, ARVs are available for under
   $140 per person per year (pppy). They are supplied by drug
   manufacturers in India, South Africa, Brazil, Thailand, and China,who
   have manufactured generic copies of patented ARV drugs. Fees are not
   paid to the patent holders and the drugs can consequently be
   distributed at prices agreeable to the governments and people of
   developing countries. The reduction in cost has come about from a
   combination of generic production and 'price offers', voluntary
   donations by companies. Patent holders began to reduce their prices
   when faced with competition from politically savvy generic firms.

   Another component of the cost of HIV therapy is the need for regular
   testing of viral load and CD4 cell count in order to prevent drug
   resistance. This, however, requires expensive laboratory equipment and
   good logistics, whose cost per patient in African countries are greater
   than those for the ARVs, making the total cost of the therapy
   approximately $800 when done according to Western standards.

   Consequently, ARV treatment is still relatively expensive for most
   Africans; for those living below the poverty threshold of a $2 / day
   income, it is still inaccessible, leaving free treatment as the only
   option for many.

   The World Health Organisation's 3 by 5 initiative aims to provide three
   million people with ARV treatment by the end of 2005. International aid
   organisations have lobbied for an expansion of generic production in
   developing countries, for immediate short term and stable, predictable
   long term financing of the 3 by 5 initiative.

   The DREAM (short for "Drug Resources Enhancement against Aids and
   Malnutrition", which used to be "Drug Resource Enhancement against AIDS
   in Mozambique") promoted by the Community of Sant'Egidio has proven to
   be an efficient means of giving access to free ARV treatment with
   generic HAART drugs to the poor on a large scale: So far, 5,000 people
   are receiving ARV treatment, especially in Mozambique, but the program
   is being built up also in other countries: Malawi, Guinea, Tanzania and
   others. Despite being free, the program aims at excellence in
   treatment, providing the best existent range of drugs ( HAART) and
   regular blood testing according to European standards. It is linked
   with a nutrition program as well as guidance and sanitary education by
   volunteers (other HIV patients taking part in the program), which
   encourages new patients to comply and come to the appointments. The
   compliance rate is very high (94%).
   National infection rates for HIV. No data is available for white
   coloured areas.
   Enlarge
   National infection rates for HIV. No data is available for white
   coloured areas.

Regional analysis

East-central Africa

   In this article, East and central Africa consists of Uganda, Kenya,
   Tanzania, Democratic Republic of Congo, the Congo Republic, Gabon,
   Equatorial Guinea, the Central African Republic, Rwanda, Burundi and
   Ethiopia and Eritrea on the Horn of Africa. 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 Total HIV Deaths 2003
   Tanzania 8.8%             1,500,000 160,000
   Kenya    6.7%             1,100,000 150,000
   Congo    4.9%             80,000    9,700
   Ethiopia 4.4%*            1,400,000 120,000
   Congo DR 4.2%             1,000,000 100,000
   Uganda   4.1%             450,000   78,000
   Eritrea  2.7%             55,000    6,300
                 HIV in East-central Africa (Source: UNAIDS)

   *A 2005 survey by the Central Statistical Agency of Ethiopia showed
   that Adult (ages 15-49) prevalence was only 1.4%, with prevalence among
   women at 1.9% and among men at 0.9%.

   Some areas of East Africa are beginning to show substantial declines in
   the prevelance of HIV infection. In the early 1990s, 13% of Ugandan
   residents were HIV positive; This has now fallen 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' of HIV
   prevention: a combination of abstinence (A), fidelity to your partner
   (Be faithful) and condom use (C). 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.

   Circumcision of the penis is believed to reduce the risk of HIV
   infection in males. This may have contributed to the relatively lower
   rates of infection in Congo, Ethiopia and Eritrea, where circumcision
   is widely practised, as compared to other countries in the region.

   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.

West Africa

   For the purposes of this discussion, Western Africa shall include the
   coastal countries of Mauritania, Senegal, The Gambia, Cape Verde,
   Guinea-Bissau, Guinea, Sierra Leone, Liberia, Côte d'Ivoire, Ghana,
   Togo, Benin, Nigeria and the landlocked states of Mali, Burkina Faso
   and Niger.

   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 Cote 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, Burkina Faso,
   Mali, Mauritania and highest in Burkina Faso, Côte d'Ivoire, and
   Nigeria. Nigeria has the second largest HIV prevalence 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%.

Southern Africa

   In the mid-1980s, HIV and AIDS were virtually unheard of in Southern
   Africa - it is now the worst-affected region in the world. There has
   been no sign of overall national decline in any of the eleven
   countries: Angola, Namibia, Zambia, Zimbabwe, Botswana, Malawi,
   Mozambique, South Africa, the two small states of Lesotho and Swaziland
   and the island of Madagascar. 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.

   Nearly every country in the region has a national HIV prevalence level
   of at least 10%. The only exception to this rule is Angola, with a rate
   of less than 5%. This is not the result of a successful national
   response to the threat of AIDS but of a long running civil war.

   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.

Impacts of the AIDS Epidemic

   Africa's HIV/AIDS epidemic has had important effects on society,
   economics and politics in the continent. The best introduction to this
   is by Tony Barnett and Alan Whiteside, "AIDS in the 21st Century:
   Disease and Globalization," (MacMillan Palgrave 2003). The economic
   impact of AIDS is noticed in slower economic growth, a distortion in
   spending, increased inflows of international assistance, and changing
   demographic structure of the population. There are also fears that a
   major long-term drop in adult life-expectancy will change the rationale
   for economic decision-making, contributing to lower savings and
   investment rates. However, most of these impacts remain theoretically
   possible rather than empirically observed. Economists in South Africa
   have developed the most sophisticated models for the impacts of the
   epidemic, and Nicoli Nattrass in "The Moral Economy of AIDS in South
   Africa" estimates that it is possible for the South African government
   to provide universal access to anti-retroviral therapy without
   overstretching the national budget. AIDS has intersected with drought,
   unemployment and other sources of stress to create what Alan Whiteside
   and Alex de Waal have called "new variant famine," characterized by the
   inability of poor, AIDS-affected households to cope with the demands of
   securing sufficient food during a time of food crisis.

   The social impact of HIV/AIDS is most evident in the continent's
   orphans crisis. Approximately 12 million children in sub-Saharan Africa
   are estimated to be orphaned by AIDS. These children are overwhelmingly
   cared for by relatives including especially grandmothers, but the
   capacity of the extended family to cope with this burden is stretched
   very thin and is, in places, collapsing. UNICEF and other international
   agencies consider a scaled-up response to Africa's orphan crisis a
   humanitarian priority. Practitioners and welfare specialists are
   sensitive to the need not to identify and isolate children orphaned by
   AIDS from other needy and vulnerable children, in part because of fear
   of stigmatizing them. Therefore, there is a search for effective social
   policies and programs that will provide necessary assistance and
   protection for all orphans and vulnerable children.

   The political impact of the epidemic has been little studied. There has
   been much concern that high levels of HIV among soldiers and political
   leaders could lead to a "hollowing out" or even collapse of essential
   state structures, and an escalation of conflict. Laurie Garrett of the
   Council on Foreign Affairs is most publicly associated with this
   position. However, it is also clear that the epidemic has coincided
   with the entrenchment of democracy in much of Africa, and that
   governments and armies have learned to cope with the effects of the
   epidemic.

Other causes of AIDS in Africa

   According to a Time magazine article called "Death Stalks a Continent,"
   some causes of AIDS are:
     * AIDS patients are afraid to admit their disease, for fear that they
       will be made social outcasts
     * The developed world is working, but it is not enough
     * Even though many people are educated, they still allow AIDS to
       spread sexually
     * Millions are not educated
     * Extreme lack of money

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