HIV/AIDS in Africa: Difference between revisions

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HIV/AIDS is a major public health concern and cause of death in many parts of Africa. Although the continent is home to about 15.2 percent of the world's population,^[1] Sub-Saharan Africa alone accounted for an estimated 69 percent of all people living with HIV^[2] and 70 percent of all AIDS deaths in 2011.^[3]

Countries in North Africa and the Horn of Africa have significantly lower prevalence rates, as their populations typically engage in fewer high-risk cultural patterns that have been implicated in the virus's spread.^[4]^[5] Southern Africa is the worst affected region on the continent. As of 2011, HIV has infected at least 10 percent of the population in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe.^[6] In response, a number of initiatives have been launched to educate the public on HIV/AIDS, such as the Abstinence, be faithful, use a condom campaign.

Overview

In an article entitled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote:

HIV and AIDS has caused immense human suffering in the continent. The most obvious effect of this crisis has been illness and death, but the impact ... has ... not been confined to the health sector; households, schools, workplaces and economies have also been badly affected. ... In sub-Saharan Africa, people with HIV-related diseases occupy more than half of all hospital beds. ... [L]arge numbers of healthcare professionals are being directly affected.... Botswana, for example, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005. ... The toll of HIV and AIDS on households can be very severe. ... [I]t is often the poorest sectors of society that are most vulnerable.... In many cases, ... AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. ... Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor. ... The ... epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. ... It was calculated in 2006 that by 2020, Malawi's agricultural workforce will be 14% smaller than it would have been without HIV and AIDS. In other countries ... the reduction is likely to be over 20%. ... Almost invariably, the burden of coping rests with women. Upon a family member becoming ill, the role of women as carers, income-earners and housekeepers is stepped up. They are often forced to step into roles outside their homes as well. ... Older people are also heavily affected by the epidemic; many have to care for their sick children and are often left to look after orphaned grandchildren. ... Due to the amount of time spent caring for dependents, older people may become isolated from their peers as they no longer have the time to dedicate to their social networks that need to be fostered to prevent isolation and loneliness. ... It is hard to overemphasise the trauma and hardship that children ... are forced to bear. ... As parents and family members become ill, children take on more responsibility to earn an income, produce food, and care for family members. ... [M]ore children have been orphaned by AIDS in Africa than anywhere else. Many children are now raised by their extended families and some are even left on their own in child-headed households. ... HIV and AIDS are having a devastating effect on the already inadequate supply of teachers in African countries.... The illness or death of teachers is especially devastating in rural areas where schools depend heavily on one or two teachers. ... The impact of HIV and AIDS in Tanzania for example means that in 2006 it was estimated that around 45,000 additional teachers were needed to make up for those who had died or left work because of HIV and AIDS. ... AIDS damages businesses by squeezing productivity, adding costs, diverting productive resources, and depleting skills. Company costs for health-care, funeral benefits and pension fund commitments are likely to rise as the number of people taking early retirement or dying increases. Also, as the impact of the epidemic on households grows more severe, market demand for products and services can fall. ... In many countries of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. In the worst affected countries, average life expectancy has fallen by twenty years because of the epidemic. ... The biggest increase in deaths ... has been among adults aged between 20 and 49 years. This group now accounts for 60% of all deaths in sub-Saharan Africa.... AIDS is hitting adults in their most economically productive years and removing the very people who could be responding to the crisis. ... As access to treatment is slowly expanded throughout the continent, millions of lives are being extended and hope is being given to people who previously had none. Unfortunately though, the majority of people in need of treatment are still not receiving it, and campaigns to prevent new infections (which must remain the central focus of the fight against AIDS) are lacking in many areas.^[7]

Regional comparisons of HIV in 2011
World region	Adult HIV prevalence (ages 15–49)^[3]	Persons living with HIV^[3]	AIDS deaths^[3]	New HIV infections^[2]
Worldwide	0.8%	34,000,000	1,700,000	2,500,000
Sub-Saharan Africa	4.9%	23,500,000	1,200,000	1,800,000
South and Southeast Asia	0.3%	4,000,000	250,000	280,000
Eastern Europe and Central Asia	1.0%	1,400,000	92,000	140,000
East Asia	0.1%	830,000	59,000	89,000
Latin America	0.4%	1,400,000	54,000	83,000
Middle East and North Africa	0.2%	300,000	23,000	37,000
North America	0.6%	1,400,000	21,000	51,000
Caribbean	1.0%	230,000	10,000	13,000
Western and Central Europe	0.2%	900,000	7,000	30,000
Oceania	0.3%	53,000	1,300	2,900

Origins of HIV/AIDS in Africa

The earliest known cases of human HIV infection have been linked to western equatorial Africa, probably in southeast Cameroon where groups of the central common chimpanzee live. "Phylogenetic analyses ... revealed that all HIV-1 strains known to infect humans, including HIV-1 groups M, N, and O, were closely related to just one of these SIVcpz lineages: that found in P. t. troglodytes [the central common chimpanzee]." The disease is linked to the preparation of freshly killed chimpanzees for human consumption.^[8]^[9]

Current hypotheses also include that, once the virus jumped from chimpanzees or other apes to humans, the colonial medical practices of the 20th century helped HIV become established in human populations by 1930.^[10]

Researchers believe HIV was gradually spread by river travel. All the rivers in Cameroon run into the Sangha River, which joins the Congo River running past Kinshasa in the Democratic Republic of the Congo. 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,^[9] including people in Kishasa whose tissue samples from 1959 and 1960 have been preserved and studied retrospectively.^[11] The first epidemic of HIV/AIDS is believed to have occurred in Kinshasa in the 1970s, signalled by a surge in opportunistic infections such as cryptococcal meningitis, Kaposi's sarcoma, tuberculosis, and pneumonia.^[12]^[13]

History

Although many governments in Sub-Saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.

One of the strongest and most effectives solutions has been the introduction of the ABC method of AIDS. This stands for Abstinence, Be faithful, and Condom use. This method promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut.

Strong prevention programs are the cornerstone of effective national responses to AIDS, and the required changes in the health sector have presented huge challenges.

The global response to HIV and AIDS has improved considerably in recent years. Funding comes from many sources, the largest of which are the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US initiative known as PEPFAR^{[citation needed]}.

Causes and spread

Behavioral factors

High-risk behavioral patterns have been cited as being 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.^[4]^[5]

Economic factors

Lack of money is an obvious challenge, although a great deal of aid is distributed throughout developing countries with high HIV/AIDS rates. For African countries with advanced medical facilities, patents on many drugs have hindered the ability to make low cost alternatives.^[14]

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.^[15] Emergencies can also lead to greater exposure to HIV infection through new patterns of sex work. In Mozambique, an influx of humanitarian workers and transporters, such as truck drivers, attracted sex workers from outside the area.^[15] Similarly, in the Turkana District of northern Kenya, 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.^[15]

Health industry

When family members get sick with HIV or other sicknesses, family members often end up selling most of their belongings in order to provide health care for the individual. Medical facilities in many African countries are lacking. Many health care workers are also not available, in part due to lack of training by governments and in part due to the wooing of these workers by foreign medical organisations where there is a need for medical professionals.^[16] This is done largely through immigration laws that encourage recruitment in professional fields (special skill categories) like doctors and nurses in countries like Australia, Canada, and the U.S.

Brain drain

The African health care industry has been hard hit by a brain drain. Many qualified doctors, nurses, and other health care professionals have emigrated to other countries, creating low morale for developing countries. For example, in Malawi, the University of Malawi graduates medical doctors that end up working abroad. This is illustrated when at a certain point, there were more Malawian doctors in Manchester than in the entire country of Malawi.^[17]^[18] According to Dr. Ken Sagoe, of the Ghana Health Service, 604 out of 871 medical officers who trained in the country between the years of 1993-2002 now practice overseas. Zimbabwe also having 1,200 doctors trained in the 1990s with only 360 remaining today and Zambie with only 50 out of 600 doctors trained doctors still there remaining during the last 40 years.^[19]

Medical factors

Female genital mutilation

Female genital mutilation is statistically associated with an increased incidence of HIV infection in the Kenyan girls who underwent the procedure.^[20]

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.^[21]^[22] The distrust of modern medicine is sometimes linked to theories of a "Western Plot"^[23] of mass sterilization or population reduction, perhaps a consequence of several high profile incidents involving western medical practitioners.^[24]

Tuberculosis

Much of the deadliness of the epidemic in sub-Saharan Africa is caused by a deadly synergy between HIV and tuberculosis.^[25] An estimated 874,000 people in sub-Saharan Africa were living with both HIV and tuberculosis in 2011,^[3] with 330,000 in South Africa, 83,000 in Mozambique, 50,000 in Nigeria, 47,000 in Kenya, and 46,000 in Zimbabwe.^[26] In terms of cases per 100,000 population, Swaziland's rate of 1,010 was by far the highest in 2011.^[26]

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.^[3]

Pharmaceutical industry

African countries are also still fighting against what they perceive as unfair practices in the international pharmaceutical industry.^[27] Medical experimentation occurs in Africa on many medications, but once approved, access to the drug is difficult.^[27] Drug companies must make a return on the money they invest on research and work to obtain patents on their intellectual capital investments which restrict generic alternatives production. Patents on medications have prevented access to medications as well as the growth in research for more affordable alternatives. These pharmaceuticals insist that drugs should be purchased through them.^{[citation needed]} South African scientists in a combined effort with American scientists from Gilead recently came up with an AIDS gel that is 40% effective in women as announced in a study conducted at the University of KwaZulu-Natal in Durban, South Africa. This is a groundbreaking drug and will soon be made available to Africans and people abroad.^{[citation needed]} The South African government has indicated its willingness to make it widely available.^{[citation needed]} The FDA in the US is in the process of reviewing the drug for approval for US use.^[28]^[29] The AIDS/HIV epidemic has led to the rise in unethical medical Experimentation in Africa.^[27] Since the epidemic is widespread, African governments relax their laws in order to get research conducted in their countries which they would otherwise not afford.^[27] However, global organizations such as the Clinton Foundation, are working to reduce the cost of HIV/AIDS medications in Africa and elsewhere. For example, Inder Singh oversaw a program which reduced the cost of pediatric HIV/AIDS drugs by 80 to 92% by working with manufacturers to reduce production and distribution costs.^[30] 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.^[31] The scientific community considers the evidence that HIV causes AIDS to be conclusive and rejects AIDS-denialist claims as pseudoscience based on conspiracy theories, faulty reasoning, cherry picking, and misrepresentation of mainly outdated scientific data. Despite its lack of scientific acceptance, AIDS denialism has had a significant political impact, especially in South Africa under the former presidency of Thabo Mbeki.^{[citation needed]}

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^[32] and the Catholic Church's ban on condoms in 2009^{[citation needed]} as well as the renewed banning of condoms in Catholic schools in 2013.^{[citation needed]}

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 15–24 year old pregnant women attending antenatal clinics is sometimes used as an approximation. The test done to measure prevalence is a serosurvey in which blood is tested for the presence of HIV.

Health units that conduct serosurveys rarely operate in remote rural communities, and the data collected also does not measure people who seek alternate healthcare. Extrapolating national data from antenatal surveys relies on assumptions which may not hold across all regions and at different stages in an epidemic.

Recent national population or household-based surveys collecting data from both sexes, pregnant and non-pregnant women, and rural and urban areas, have adjusted the recorded national prevalence levels for several countries in Africa and elsewhere^{[citation needed]}. These, too, are not perfect: people may not participate in household surveys because they fear they may be HIV positive and do not want to know their test results. Household surveys also exclude migrant labourers, who are a high risk group.

Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries.

A minority of scientists claim that as many as 40% of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity.^[33] The World Health Organization states that about 2.5% of HIV infections in sub-Saharan Africa are caused by unsafe medical injection practices and the "overwhelming majority" by unprotected sex.^[34]

Regional prevalence

According to the World Health Organization (WHO), it is the "directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends."^[35] Under the WHO's regional scheme, the African Regional office includes much of Africa. It is headquartered in Brazzaville, Congo.^[36] Most of North Africa and the Horn of Africa fall under the Eastern Mediterranean Regional office, with its headquarters in Cairo, Egypt.^[37]

By contrast with the predominantly Muslim areas in North Africa and the Horn region, traditional cultures and religions in much of Sub-Saharan Africa have generally exhibited a more liberal attitude vis-a-vis female out-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.^[5]

North Africa

The HIV prevalence rates in North Africa are among the lowest in the world. This is primarily attributed to the salient role of Islam in the region's societies, which has kept infection rates at a negligible level through the faith's strong influence on local mores, values, and government policies. Extra-marital sexual relations are also fervently discouraged in the area's predominantly Muslim communities.^[5]

Uniquely among countries in this region, Morocco's HIV prevalence rate has increased from less than 0.1 percent in 2001 to 0.2 percent in 2011.^[3]

Country	Adult prevalence ages 15-49, 2011	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011^[6]	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011^[6]	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Algeria	0.1%^[6]	<0.1%	13,000-28,000	not available	<1,000-1,500	<200-<500	not available	not available
Egypt	<0.1%^[6]	<0.1%	9,500	9,100	<1,000	<500	not available	not available
Libya	not available^[6]	not available	not available	not available	not available	not available	not available	not available
Morocco	0.2%^[6]	<0.1%	32,000	12,000	1,600	<1,000	not available	not available
Sudan	0.4%^[3]	0.5%	not available	not available	5,600	6,000	not available	not available
Tunisia	<0.1%^[6]	<0.1%	1,700	<1,000	<100	<100	not available	not available

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Algeria	1	360
Egypt	<0.1	43
Libya	3.4	220
Morocco	0.9	300
Sudan	8.2	2,800
Tunisia	0.6	66

Horn of Africa

As with North Africa, the HIV infection rates in the Horn of Africa are generally quite low. This has been attributed to the Muslim nature of many of the local communities and adherence to Islamic morals.^[5]

Ethiopia's HIV prevalence rate has decreased from 3.6 percent in 2001 to 1.4 percent in 2011.^[3] The number of new infections per year also has decreased from 130,000 in 2001 to 24,000 in 2011.^[3]

Country	Adult prevalence ages 15-49, 2011^[6]	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011^[6]	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011^[6]	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Djibouti	1.4%	2.7%	9,200	12,000	<1,000	1,000	<1,000	1,300
Eritrea	0.6%	1.1%	23,000	23,000	1,400	1,500	not available	not available
Ethiopia	1.4%	3.6%	790,000	1,300,000	54,000	100,000	24,000	130,000
Somalia	0.7%	0.8%	35,000	34,000	3,100	2,800	not available	not available

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Djibouti	not available	not available
Eritrea	8.2	440
Ethiopia	45	38,000
Somalia	not available	not available

Central Africa

HIV infection rates in Central Africa are generally moderate to high.^[4]

Country	Adult prevalence ages 15-49, 2011	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Angola	2.1%^[6]	1.7%	230,000^[6]	130,000	12,000^[6]	8,200	23,000	20,000
Cameroon	4.6%^[6]	5.1%	550,000^[6]	450,000	34,000^[6]	28,000	43,000	57,000
Central African Republic	4.6%^[6]	8.1%	130,000^[6]	170,000	10,000^[6]	16,000	8,200	15,000
Chad	3.1%^[6]	3.7%	210,000^[6]	170,000	12,000^[6]	13,000	not available	not available
Congo	3.3%^[6]	3.8%	83,000^[6]	74,000	4,600^[6]	6,900	7,900	7,200
Democratic Republic of the Congo	1.2%-1.6%^[4]	not available	430,000-560,000^[4]	not available	26,000-40,000 (2009)^[4]	not available	not available	not available
Equatorial Guinea	4.7%^[6]	2.5%	20,000^[6]	7,900	<1,000^[6]	<500	not available	not available
Gabon	5.0%^[6]	5.2%	46,000^[6]	35,000	2,500^[6]	2,100	3,000	4,900
Sao Tome and Principe	1.0%^[6]	0.9%	<1,000^[6]	<1,000	<100^[6]	<100	not available	not available

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Angola	43	8,500
Cameroon	93	19,000
Central African Republic	159	7,100
Chad	45	5,200
Congo	119	4,900
Democratic Republic of the Congo	49	34,000
Equatorial Guinea	52	370
Gabon	185	2,800
Sao Tome and Principe	9	15

East Africa

HIV infection rates in East Africa are generally moderate to high.

Uganda 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.^[4]^[5] This has been attributed to changing local behavioral patterns, with more respondents reporting greater use of contraceptives^{[citation needed]} and a two-year delay in first sexual activity as well as fewer people reporting casual sexual encounters and multiple partners.^[5] However, the number of newly infected people per year has increased by over 50 percent, from 99,000 in 2001 to 150,000 in 2011.^[3]

According to a 2008 report from the Joint United Nations Programme on HIV/AIDS, Kenya had the third largest number of individuals in Sub-Saharan Africa living with HIV.^[38] It also had the highest prevalence rate of any country outside of Southern Africa.^[38] Kenya's HIV infection rate dropped from around 14 percent in the mid-1990s to 5 percent in 2006,^[4] but rose again to 6.2 percent by 2011.^[38] The number of newly infected people per year, however, decreased by almost 30 percent, from 140,000 in 2001 to 100,000 in 2011.^[3] 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.^[38] Christian men and women also had a higher infection rate than their Muslim counterparts.^[38] This discrepancy was especially high 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.^[38] HIV was also more common among the most wealthy than among the poorest (7.2 percent versus 4.6 percent).^[38] Historically, HIV had been more prevalent among urban than rural areas, although the gap is closing rapidly.^[38] Men in rural areas are now more likely to be HIV-infected (at 4.5 per cent) than those in urban areas (at 3.7 per cent).^[38]

Between 2004 and 2008, the HIV incidence rate in Tanzania for ages 15-44 slowed to 3.37 per 1,000 person-years (4.42 for women and 2.36 for men).^[39] The number of newly infected people per year increased slightly, from 140,000 in 2001 to 150,000 in 2011.^[3] There were also significantly fewer HIV infections in Zanzibar, which in 2011 had a prevalence rate of 1.0 percent compared to a 5.3 percent in mainland Tanzania.^[40]

Country	Adult prevalence ages 15-49, 2011	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011^[6]	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011^[6]	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Burundi	1.3%^[6]	3.5%	80,000	130,000	5,800	13,000	3,000	6,900
Comoros	0.1%^[6]	<0.1%	<500	<100	<100	<100	not available	not available
Kenya	6.2%^[6]	8.5%	1,600,000	1,600,000	62,000	130,000	100,000	140,000
Madagascar	0.3%^[6]	0.3%	34,000	22,000	2,600	1,500	not available	not available
Mauritius	1.0%^[6]	0.9%	7,400	6,600	<1,000	<500	not available	not available
Mayotte	not available	not available	not available	not available	not available	not available	not available	not available
Reunion	not available	not available	not available	not available	not available	not available	not available	not available
Rwanda	2.9%^[6]	4.1%	210,000	220,000	6,400	21,000	10,000	19,000
Seychelles	not available^[6]	not available	not available	not available	not available	not available	not available	not available
South Sudan	3.1%^[6]	not available	150,000	not available	11,000	not available	not available	not available
Tanzania	5.1%^[40]	7.2%	1,600,000	1,400,000	84,000	130,000	150,000	140,000
Uganda	7.2%^[6]	6.9%	1,400,000	990,000	62,000	100,000	150,000	99,000

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Burundi	30	2,600
Comoros	1.4	11
Kenya	113	47,000
Madagascar	0.6	130
Mauritius	1.6	21
Mayotte	not available	not available
Reunion	not available	not available
Rwanda	27	2,900
Seychelles	5.8	<10
South Sudan	not available	not available
Tanzania	65	30,000
Uganda	102	35,000

West Africa

West Africa has generally moderate 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 Benin,^[41] Mali,^{[citation needed]} and Nigeria.^[42] These were followed by Burkina Faso,^{[citation needed]} Côte d'Ivoire,^[43] Ghana,^{[citation needed]} Liberia,^{[citation needed]} and Senegal^{[citation needed]} in 1986. The epidemic began in Niger, Sierra Leone, and Togo in 1987; in The Gambia, Guinea, and Guinea-Bissau in 1989; and in Cape Verde in 1990.^{[citation needed]}

HIV prevalence in West 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. 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).

The main driver of infection in the region is commercial sex.^{[citation needed]} In the Ghanaian capital of Accra, for example, 80 percent of HIV infections in young men had been acquired from women who sell sex.^{[citation needed]} 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.^[3]

Country	Adult prevalence ages 15-49, 2011^[6]	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011^[6]	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011^[6]	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Benin	1.2%	1.7%	64,000	66,000	2,800	6,400	4,900	5,300
Burkina Faso	1.1%	2.1%	120,000	150,000	6,800	15,000	7,100	13,000
Cape Verde	1.0%	1.0%	3,300	2,700	<200	<500	not available	not available
Côte d'Ivoire	3.0%	6.2%	360,000	560,000	23,000	50,000	not available	not available
Gambia	1.5%	0.8%	14,000	5,700	<1,000	<500	1,300	1,200
Ghana	1.5%	2.2%	230,000	250,000	15,000^{[Note 1]}	18,000	13,000	28,000
Guinea	1.4%	1.5%	85,000	72,000	4,000^{[Note 2]}	5,100	not available	not available
Guinea-Bissau	2.5%	1.4%	24,000	9,800	<1,000	<1,000	2,900	1,800
Liberia	1.0%	2.5%	25,000	39,000	2,300^{[Note 3]}	2,500	not available	not available
Mali	1.1%	1.6%	110,000	110,000	6,600	9,700	8,600	12,000
Mauritania	1.1%	0.6%	24,000	10,000	1,500	<1,000	not available	not available
Niger	0.8%	0.8%	65,000	45,000	4,000	3,200	6,400	6,200
Nigeria	3.7%	3.7%	3,400,000	2,500,000	210,000^{[Note 4]}	150,000	340,000	310,000
Senegal	0.7%	0.5%	53,000	24,000	1,600	1,400	not available	not available
Sierra Leone	1.6%	0.9%	49,000	21,000	2,600	<1,000	3,900	4,500
Togo	3.4%	4.1%	150,000	120,000	8,900^{[Note 5]}	8,100	9,500	17,000

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Benin	12	1,100
Burkina Faso	9.5	1,600
Cape Verde	19	97
Côte d'Ivoire	50	10,000
Gambia	45	800
Ghana	18	4,600
Guinea	47	4,800
Guinea-Bissau	99	1,500
Liberia	31	1,300
Mali	9.4	1,500
Mauritania	43	1,500
Niger	11	1,700
Nigeria	30	50,000
Senegal	14	1,700
Sierra Leone	64	3,800
Togo	16	1,000

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. Of the nine southern African countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe), four are estimated to have an infection rate of over 15 percent.

In Botswana, the number of newly infected people per year has decreased 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; Swaziland, 32 percent;). The number has remained virtually the same in Lesotho and Mozambique.^[3]

Zimbabwe's first reported case of HIV was in 1985.^[45]^[46]

Aside from polygynous relationships, which can be quite prevalent in parts of Africa,^{[citation needed]} there are also widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners.^[47] Men's sexual networks, in particular, tend to be quite extensive, a fact that is tacitly accepted by many communities.^{[citation needed]} Cultural or social norms often indicate that while women must remain faithful, men are able and even expected to philander irrespective of their marital status. Along with the occurrence of multiple sexual partners, unemployment and population displacements that have resulted from drought and conflict have contributed to the spread of HIV/AIDS.

A 2008 study in Botswana, Namibia, and Swaziland found that these disadvantages have an additive effect on HIV status. The authors found that four factors (intimate partner violence, extreme poverty, education, and partner income disparity) explained almost all of the difference in HIV status between 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. Some 26 percent of young women with any two factors were HIV positive; 36 percent of those with any three factors and 39.3 percent of those with all four factors were HIV-positive.^[48]

Most HIV infections found in southern Africa are HIV-1,^{[citation needed]} the world's most common HIV infection, which predominates everywhere except west Africa, home to HIV-2.

Country	Adult prevalence ages 15-49, 2011^[6]	Adult prevalence ages 15-49, 2001^[3]	Number of people living with HIV, 2011^[6]	Number of people living with HIV, 2001^[3]	AIDS deaths, 2011^[6]	AIDS deaths, 2001^[3]	New HIV infections, 2011^[3]	New HIV infections, 2001^[3]
Botswana	23.4%	27.0%	300,000	270,000	4,200	18,000	9,000	27,000
Lesotho	23.3%	23.4%	320,000	250,000	14,000^{[Note 6]}	15,000	26,000	26,000
Malawi	10.0%	13.8%	910,000	860,000	44,000^{[Note 7]}	63,000	46,000	100,000
Mozambique	11.3%	9.7%	1,400,000	850,000	74,000	46,000	130,000	140,000
Namibia	13.4%	15.5%	190,000	160,000	5,200^{[Note 8]}	8,600	8,800	23,000
South Africa	17.3%	15.9%	5,600,000	4,400,000	270,000^{[Note 9]}	210,000	380,000	610,000
Swaziland	26.0%	22.2%	190,000	120,000	6,800^{[Note 10]}	6,700	13,000	19,000
Zambia	12.5%	14.4%	970,000	860,000	31,000	72,000	51,000	110,000
Zimbabwe	14.9%	25.0%	1,200,000	1,800,000	58,000	150,000	74,000	140,000

Country	Concurrent HIV/Tuberculosis infections, 2011 (cases per 100,000 population)^[26]	Concurrent HIV/Tuberculosis infections, 2011 (cases)^[26]
Botswana	292	5,900
Lesotho	481	11,000
Malawi	114	18,000
Mozambique	347	83,000
Namibia	359	8,400
South Africa	650	330,000
Swaziland	1,010	12,000
Zambia	285	38,000
Zimbabwe	360	46,000

Swaziland

The HIV infection rate in Swaziland is the highest in the world at 26.0 percent of persons aged 15-49 and at over 50 percent of adults in their 20s.^[49] This has stopped possible economic and social progress, and is at a point where it endangers the existence of its society as a whole. The United Nations Development Program has written that if the expansion continues unabated, the "longer term existence of Swaziland as a country will be seriously threatened".^[49]

Swaziland's HIV epidemic has reduced its life expectancy at birth to 49 for men and 51 for women as of 2009.^[50] Swaziland's crude death rate of 19.51 per 1,000 people per year (based on 2011 data) is the third highest in the world, behind only Lesotho and Sierra Leone.^[51] HIV/AIDS currently causes 61 percent of all deaths in the country. About 2 percent of Swaziland's total population dies of HIV/AIDS every year.^[52]

Prevention efforts

Numerous public initiatives have been launched to curb the spread of HIV in Africa, such as the Abstinence, be faithful, use a condom (ABC) campaign.

One of the greatest problems many African countries face, due to high prevalence rates, is "HIV fatigue", where populations are not interested in hearing more about a disease they hear about constantly. In order to address this, novel approaches are often required. In 1999, the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation provided major funding for the loveLife website, an online sexual health and relationship resource for teenagers.^[53] In 2011, the Botswana Ministry of Education introduced new HIV/AIDS educational technology in local schools. The TeachAIDS prevention software, developed at Stanford University, was distributed to every primary, secondary and tertiary educational institution in the country, reaching all learners from 6 to 24 years of age nationwide.^[54]

Notes

^ The number of AIDS deaths in Ghana in 2006 was 22,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Guinea in 2006 was 6,100. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Liberia in 2006 was 3,400. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Nigeria in 2006 was 220,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Togo in 2006 was 11,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Lesotho in 2006 was 22,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Malawi in 2006 was 75,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Namibia in 2006 was 12,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in South Africa in 2006 was 390,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006
^ The number of AIDS deaths in Swaziland in 2006 was 9,800. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

References

^ Current World Population, Nations Online, 2012
^ ^a ^b "Global Fact Sheet", Joint United Nations Programme on HIV and AIDS, 20 November 2012
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as "UNAIDS Report on the Global AIDS Epidemic 2012" (PDF). Retrieved 13 May 2013.
^ ^a ^b ^c ^d ^e ^f ^g ^h "UNAIDS Report on the Global AIDS Epidemic 2010" (PDF). Retrieved 2011-06-08.
^ ^a ^b ^c ^d ^e ^f ^g "Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan Africa" (PDF). Retrieved 2010-06-27.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az "Prevalence of HIV, total (% of population ages 15-49)".
^ "The Impact of HIV & AIDS in Africa", AVERT
^ "Tracing the Origin of the AIDS Pandemic", Physicians' Research Network, summary by Tim Horn, edited by Lucia Torian, September 2005
^ ^a ^b "Hunt for origin of HIV pandemic ends at chimpanzee colony in Cameroon", The Guardian, reported by Ian Sample, 25 May 2006
^ "Origin of AIDS Linked to Colonial Practices in Africa". NPR. Retrieved 2011-03-29.
^ "Letter: Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960", Nature, authored by Michael Worobey, Marlea Gemmel, Dirk E. Teuwen, Tamara Haselkorn, Kevin Kunstman, Michael Bunce, Jean-Jacques Muyembe, Jean-Marie M. Kabongo, Raphael M. Kalengay, Eric Van Marck, M. Thomas P. Gilbert, and Steven M. Wolinsky, 2 October 2008
^ "History of HIV & AIDS in Africa", AVERT
^ "The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis", American Journal of Tropical Medicine and Hygiene, authored by Jean-Francoise Molez, March 1998, pages 273-6
^ Susan Hunter, "Black Death: AIDS in Africa" , Palrave Macmillan 2003 chapter 2
^ ^a ^b ^c Samuels, Fiona (2009) HIV and emergencies: one size does not fit all, London: Overseas Development Institute
^ "African Migration and the Brain Drain — David Shinn". Sites.google.com. 2008-06-20. Retrieved 2011-03-29.
^ "Health systems in Malawi". Ruder Finn blog. Retrieved 2 November 2010.
^ Robert L Broadhead and Adamson S Muula (2002, August). Creating a medical school for Malawi: problems and achievements. BMJ. 2002 August 17; 325(7360): 384–387 - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123892/
^ Garrett, Laurie. 2007. The Challenge of Global Health. Foreign Affairs 86 (1):27
^ "Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania", Annals of Epidemiology, authored by Devon D. Brewer, John J. Petterat, John M. Roberts Jr., and Stuart Brody, 2007, 17:217–222
^ "Sterilizing vaccines or the politics of the womb: Retrospective study of a rumor in the Cameroon", Medical Anthropology Quarterly, authored by P. Feldman-Savelsberg, F. T. Ndonko, and B. Schmidt-Ehry, 2000, 14(2):159-179
^ "How vaccine safety can become political — the example of polio in Nigeria", Current Drug Safety, authored by C. J. Clements, P. Greenough, and D. Shull, 2006, 1(1):117-119
^ "Combating anti-vaccination rumors: Lessons learned from case studies in Africa", UNICEF, Nairobi
^ "Why Africa Fears Western Medicine", The New York Times, authored by Harriet A. Washington, 31 July 2007
^ "'Dual epidemic' threatens Africa". BBC News. 2 November 2007. Retrieved 2011-03-29.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Table A4.2, Annex 4: Global, regional and country-specific data for key indicators, Global Tuberculosis Report 2012, World Health Organization
^ ^a ^b ^c ^d Meier,Benjamin Mason: International Protection of Persons Undergoing Medical Experimentation: Protecting the Right of Informed Consent, Berkeley journal of international law [1085-5718] Meier yr:2002 vol:20 iss:3 pg:513 -554
^ "New Aids gel could protect women from HIV". South Africa — The Good News — Sagoodnews.co.za. 2010-07-20. Retrieved 2011-03-29.
^ Fox, Maggie (2010-10-27). "Groups moving forward to develop AIDS gel". Reuters. Retrieved 2011-03-29.
^ "Inder Singh, Executive Vice President for the Clinton Foundation, on Expanding Access to Health Care". Wharton Magazine. 2011-03-29. Retrieved 2011-08-10.
^ Mark Schoofs (2000-07-04). "Debating the Obvious — Page 1 - News — New York". Village Voice. Retrieved 2012-02-21.
^ Mark Schoofs (20 March 2013). "Kenya condom advert pulled after religious complaints". BBC. Retrieved 2013-03-21.
^ Africa: HIV/AIDS through Unsafe Medical Care. Africaaction.org. Retrieved on 2010-10-25.
^ WHO | Expert group stresses that unsafe sex is primary mode of transmission of HIV in Africa. Who.int (2003-03-14). Retrieved on 2010-10-25.
^ "About WHO". World Health Organization. Retrieved 14 May 2013.
^ "Regional Office for Africa". World Health Organization. Retrieved 13 May 2013.
^ "Regional Office for the Eastern Mediterranean". World Health Organization. Retrieved 13 May 2013.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Fortunate, Edith (20 May 2013). "Rich Kenyans hardest hit by HIV, says study". Daily Nation. Retrieved 19 May 2013.
^ "Estimates of HIV incidence from household-based prevalence surveys", AIDS, Timothy B. Halletta, et al., 2 January 2010, 24(1), pages 147–152
^ ^a ^b Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12, 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, TACAIDS, and the Ministry of Health and Social Welfare, with support provided by ICF International; data collected 16 December 2011 to 24 May 2012; report published in Dar es Salaam in March 2013
^ "HEALTH-BENIN: Growing Number of AIDS Orphans", Inter Press Service 28 August 2002
^ "Chapter 2: The Epidemiology of HIV/AIDS in Nigeria", contributed by Abdulsalami Nasidi and Tekena O. Harry, in the book "AIDS in Nigeria: A Nation on the Threshold", edited by Olusoji Adeyi, Phyllis J. Kanki, and Oluwole Odutolu, Harvard Center for Population and Development Studies, Harvard University Press, 2006
^ "Epidemological Fact Sheet on HIV/AIDS and sexually transmitted infections", UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000
^ The World Bank - Life expectancy at birth, total (years)
^ "AIDS in Africa During the Nineties Zimbabwe. A review and analysis of survey and research results", National AIDS Council, Ministry of Health and Child Welfare, The MEASURE Project, Centers for Disease Control and Prevention (CDC/Zimbabwe), Carolina Population Center, University of North Carolina at Chapel Hill, 2002, page 1
^ "HIV/AIDS: The Zimbabwean Situation and Trends", American Journal of Clinical Medicine Research, authored by Duri Kerina, Stray-Pedersen Babill, and F. Muller, 2013, 1(1), 15-22
^ Poku, N. K. and Whiteside, A. (2004) 'The Political Economy of AIDS in Africa', 235.
^ Andersson N, Cockcroft A. Choice disability and HIV status: evidence from a cross-sectional study in Botswana, Namibia and Swaziland. AIDS and Behavior 2012;16(1):189–191.
^ ^a ^b Country programme outline for Swaziland, 2006-2010. United Nations Development Program. http://www.undp.org.sz/index.php?option=com_docman&task=doc_download&gid=19&Itemid=67. Retrieved November 22, 2009.
^ Swaziland, World Health Organization
^ "Mortality and global health estimates: Age-standardized death rate by country", World Health Organization
^ Swaziland, Mortality Country Fact Sheet 2006. WHO. Retrieved November 22, 2009.
^ Mitchell, Claudia (2004). "'And what are you reading, Miss? Oh, it is only a website': The New Media and the Pedagogical Possibilities of Digital Culture as a South African'Teen Guide'to HIV/AIDS and STDs". Convergence: The International Journal of Research into New Media Technologies. 10 (1): 84. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
^ "UNICEF funds TeachAIDS work in Botswana". TeachAIDS. 2 June 2010. Retrieved 24 January 2011.

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)

[44] The number of AIDS deaths in Ghana in 2006 was 22,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[45] The number of AIDS deaths in Guinea in 2006 was 6,100. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[46] The number of AIDS deaths in Liberia in 2006 was 3,400. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[47] The number of AIDS deaths in Nigeria in 2006 was 220,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[48] The number of AIDS deaths in Togo in 2006 was 11,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[54] The number of AIDS deaths in Lesotho in 2006 was 22,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[55] The number of AIDS deaths in Malawi in 2006 was 75,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[56] The number of AIDS deaths in Namibia in 2006 was 12,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[57] The number of AIDS deaths in South Africa in 2006 was 390,000. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[58] The number of AIDS deaths in Swaziland in 2006 was 9,800. Data on the size of the HIV/AIDS epidemic: Number of deaths due to AIDS by country, World Health Organization, 2006

[1] Current World Population, Nations Online, 2012

[2012_Facts-2] "Global Fact Sheet", Joint United Nations Programme on HIV and AIDS, 20 November 2012

[UNAIDS_2012-3] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as "UNAIDS Report on the Global AIDS Epidemic 2012" (PDF). Retrieved 13 May 2013.

[UNAIDS_2010-4] ^ ^a ^b ^c ^d ^e ^f ^g ^h "UNAIDS Report on the Global AIDS Epidemic 2010" (PDF). Retrieved 2011-06-08.

[RCTHIV-5] ^ ^a ^b ^c ^d ^e ^f ^g "Religious and cultural traits in HIV/AIDS epidemics in sub-Saharan Africa" (PDF). Retrieved 2010-06-27.

[UNAIDS_2011-6] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ ^o ^p ^q ^r ^s ^t ^u ^v ^w ^x ^y ^z ^aa ^ab ^ac ^ad ^ae ^af ^ag ^ah ^ai ^aj ^ak ^al ^am ^an ^ao ^ap ^aq ^ar ^as ^at ^au ^av ^aw ^ax ^ay ^az "Prevalence of HIV, total (% of population ages 15-49)".

[7] "The Impact of HIV & AIDS in Africa", AVERT

[8] "Tracing the Origin of the AIDS Pandemic", Physicians' Research Network, summary by Tim Horn, edited by Lucia Torian, September 2005

[Hunt-9] "Hunt for origin of HIV pandemic ends at chimpanzee colony in Cameroon", The Guardian, reported by Ian Sample, 25 May 2006

[10] "Origin of AIDS Linked to Colonial Practices in Africa". NPR. Retrieved 2011-03-29.

[11] "Letter: Direct evidence of extensive diversity of HIV-1 in Kinshasa by 1960", Nature, authored by Michael Worobey, Marlea Gemmel, Dirk E. Teuwen, Tamara Haselkorn, Kevin Kunstman, Michael Bunce, Jean-Jacques Muyembe, Jean-Marie M. Kabongo, Raphael M. Kalengay, Eric Van Marck, M. Thomas P. Gilbert, and Steven M. Wolinsky, 2 October 2008

[12] "History of HIV & AIDS in Africa", AVERT

[13] "The historical question of acquired immunodeficiency syndrome in the 1960s in the Congo River basin area in relation to cryptococcal meningitis", American Journal of Tropical Medicine and Hygiene, authored by Jean-Francoise Molez, March 1998, pages 273-6

[ReferenceA-14] Susan Hunter, "Black Death: AIDS in Africa" , Palrave Macmillan 2003 chapter 2

[ODIhiv-15] Samuels, Fiona (2009) HIV and emergencies: one size does not fit all, London: Overseas Development Institute

[16] "African Migration and the Brain Drain — David Shinn". Sites.google.com. 2008-06-20. Retrieved 2011-03-29.

[17] "Health systems in Malawi". Ruder Finn blog. Retrieved 2 November 2010.

[18] Robert L Broadhead and Adamson S Muula (2002, August). Creating a medical school for Malawi: problems and achievements. BMJ. 2002 August 17; 325(7360): 384–387 - http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1123892/

[19] Garrett, Laurie. 2007. The Challenge of Global Health. Foreign Affairs 86 (1):27

[20] "Male and Female Circumcision Associated With Prevalent HIV Infection in Virgins and Adolescents in Kenya, Lesotho, and Tanzania", Annals of Epidemiology, authored by Devon D. Brewer, John J. Petterat, John M. Roberts Jr., and Stuart Brody, 2007, 17:217–222

[21] "Sterilizing vaccines or the politics of the womb: Retrospective study of a rumor in the Cameroon", Medical Anthropology Quarterly, authored by P. Feldman-Savelsberg, F. T. Ndonko, and B. Schmidt-Ehry, 2000, 14(2):159-179

[22] "How vaccine safety can become political — the example of polio in Nigeria", Current Drug Safety, authored by C. J. Clements, P. Greenough, and D. Shull, 2006, 1(1):117-119

[23] "Combating anti-vaccination rumors: Lessons learned from case studies in Africa", UNICEF, Nairobi

[24] "Why Africa Fears Western Medicine", The New York Times, authored by Harriet A. Washington, 31 July 2007

[DUAL-25] "'Dual epidemic' threatens Africa". BBC News. 2 November 2007. Retrieved 2011-03-29.

[TB/HIV-26] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ ^j ^k ^l ^m ⁿ Table A4.2, Annex 4: Global, regional and country-specific data for key indicators, Global Tuberculosis Report 2012, World Health Organization

[ReferenceB-27] Meier,Benjamin Mason: International Protection of Persons Undergoing Medical Experimentation: Protecting the Right of Informed Consent, Berkeley journal of international law [1085-5718] Meier yr:2002 vol:20 iss:3 pg:513 -554

[28] "New Aids gel could protect women from HIV". South Africa — The Good News — Sagoodnews.co.za. 2010-07-20. Retrieved 2011-03-29.

[29] Fox, Maggie (2010-10-27). "Groups moving forward to develop AIDS gel". Reuters. Retrieved 2011-03-29.

[30] "Inder Singh, Executive Vice President for the Clinton Foundation, on Expanding Access to Health Care". Wharton Magazine. 2011-03-29. Retrieved 2011-08-10.

[31] Mark Schoofs (2000-07-04). "Debating the Obvious — Page 1 - News — New York". Village Voice. Retrieved 2012-02-21.

[32] Mark Schoofs (20 March 2013). "Kenya condom advert pulled after religious complaints". BBC. Retrieved 2013-03-21.

[33] Africa: HIV/AIDS through Unsafe Medical Care. Africaaction.org. Retrieved on 2010-10-25.

[34] WHO | Expert group stresses that unsafe sex is primary mode of transmission of HIV in Africa. Who.int (2003-03-14). Retrieved on 2010-10-25.

[WHO-35] "About WHO". World Health Organization. Retrieved 14 May 2013.

[AFRO-36] "Regional Office for Africa". World Health Organization. Retrieved 13 May 2013.

[EMRO-37] "Regional Office for the Eastern Mediterranean". World Health Organization. Retrieved 13 May 2013.

[UNAIDSKEN-38] ^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ Fortunate, Edith (20 May 2013). "Rich Kenyans hardest hit by HIV, says study". Daily Nation. Retrieved 19 May 2013.

[39] "Estimates of HIV incidence from household-based prevalence surveys", AIDS, Timothy B. Halletta, et al., 2 January 2010, 24(1), pages 147–152

[Survey-40] Tanzania HIV/AIDS and Malaria Indicator Survey 2011-12, 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, TACAIDS, and the Ministry of Health and Social Welfare, with support provided by ICF International; data collected 16 December 2011 to 24 May 2012; report published in Dar es Salaam in March 2013

[41] "HEALTH-BENIN: Growing Number of AIDS Orphans", Inter Press Service 28 August 2002

[42] "Chapter 2: The Epidemiology of HIV/AIDS in Nigeria", contributed by Abdulsalami Nasidi and Tekena O. Harry, in the book "AIDS in Nigeria: A Nation on the Threshold", edited by Olusoji Adeyi, Phyllis J. Kanki, and Oluwole Odutolu, Harvard Center for Population and Development Studies, Harvard University Press, 2006

[43] "Epidemological Fact Sheet on HIV/AIDS and sexually transmitted infections", UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000

[49] The World Bank - Life expectancy at birth, total (years)

[50] "AIDS in Africa During the Nineties Zimbabwe. A review and analysis of survey and research results", National AIDS Council, Ministry of Health and Child Welfare, The MEASURE Project, Centers for Disease Control and Prevention (CDC/Zimbabwe), Carolina Population Center, University of North Carolina at Chapel Hill, 2002, page 1

[51] "HIV/AIDS: The Zimbabwean Situation and Trends", American Journal of Clinical Medicine Research, authored by Duri Kerina, Stray-Pedersen Babill, and F. Muller, 2013, 1(1), 15-22

[52] Poku, N. K. and Whiteside, A. (2004) 'The Political Economy of AIDS in Africa', 235.

[53] Andersson N, Cockcroft A. Choice disability and HIV status: evidence from a cross-sectional study in Botswana, Namibia and Swaziland. AIDS and Behavior 2012;16(1):189–191.

[undp.org.sz-59] Country programme outline for Swaziland, 2006-2010. United Nations Development Program. http://www.undp.org.sz/index.php?option=com_docman&task=doc_download&gid=19&Itemid=67. Retrieved November 22, 2009.

[60] Swaziland, World Health Organization

[61] "Mortality and global health estimates: Age-standardized death rate by country", World Health Organization

[62] Swaziland, Mortality Country Fact Sheet 2006. WHO. Retrieved November 22, 2009.

[63] Mitchell, Claudia (2004). "'And what are you reading, Miss? Oh, it is only a website': The New Media and the Pedagogical Possibilities of Digital Culture as a South African'Teen Guide'to HIV/AIDS and STDs". Convergence: The International Journal of Research into New Media Technologies. 10 (1): 84. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)

[64] "UNICEF funds TeachAIDS work in Botswana". TeachAIDS. 2 June 2010. Retrieved 24 January 2011.

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v t e HIV/AIDS in Africa
Sovereign states	Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African Republic Chad Comoros Democratic Republic of the Congo Republic of the Congo Djibouti Egypt Equatorial Guinea Eritrea Eswatini Ethiopia Gabon The Gambia Ghana Guinea Guinea-Bissau Ivory Coast Kenya Lesotho Liberia Libya Madagascar Malawi Mali Mauritania Mauritius Morocco Mozambique Namibia Niger Nigeria Rwanda São Tomé and Príncipe Senegal Seychelles Sierra Leone Somalia South Africa South Sudan Sudan Tanzania Togo Tunisia Uganda Zambia Zimbabwe
States with limited recognition	Sahrawi Arab Democratic Republic Somaliland
Dependencies and other territories	Canary Islands / Ceuta / Melilla (Spain) Madeira (Portugal) Mayotte / Réunion (France) Saint Helena / Ascension Island / Tristan da Cunha (United Kingdom)