HIV/AIDS in Africa: Difference between revisions
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[[Image:AidsEducationUganda.jpg|thumb|right|350px|AIDS education at a school in [[Uganda]].]] |
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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 10% of the world's population, Africa is estimated to have more than 60% of the AIDS infected population. |
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! <small>World region</small> !! <small>Adult HIV prevalence<br>(ages 15–49)</small> !! <small>Total HIV<br>cases (0–49)</small> !! <small>AIDS deaths<br>in 2004</small> |
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| Sub-Saharan Africa || 7.4% || 25.4m || 2.3m |
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| North America || 0.6% || 1.0m || 16,000 |
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| Western Europe || 0.3% || 570,000 || 16,000 |
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| <small>Regional comparisons of HIV (Source: [http://www.unaids.org/en/geographical+area/by+region.asp UNAIDS])</small> |
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==General overview== |
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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 most successful national response to date, in the whole world; and has witnessed consistent national declines since the mid-1990s. However, several agencies have cautioned against viewing the stablised 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 amongst high risk groups. |
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[[Image:UNAIDS 2004 HIVAfrica85-03.png|thumb|500px|left|The number of African people infected with HIV has exploded since the mid-1980s.]] |
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In the thirty-five African nations with the highest degree of 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 percent, life expectancy is 47.7 years—11.0 years less than would be expected without HIV/AIDS. |
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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. Which of these will eventually transpire depends largely on the international response to the crisis. |
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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 regime]]s across the continent. The health care systems inherited from [[colonialism|colonial powers]] were oriented toward curative treatment rather than preventative programmes. Strong prevention programmes are the cornerstone of effective national responses to AIDS and the required changes in the health sector have presented a huge challenge. |
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Without the kind of nutrition, health care and medicines, such as [[anti-retrovirals]] (ARV's) that are readily 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, further increasing the suffering and hardship faced. 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. |
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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. There is a need for large amounts of money in all of the areas of prevention of the disease: education, health-care, employment, and treatment. |
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[[Image:Aids in africa graph.gif|right|350px|thumb|Changes in life expectancy in several African countries. Botswana has been particularly badly hit [http://news.bbc.co.uk/1/hi/world/africa/4057421.stm], whilst public education projects campaigns have had a positive effect in Uganda [http://news.bbc.co.uk/2/hi/africa/3673327.stm]. (Source: [[World Bank]] ''World Development Indicators,'' 2004).]] |
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An expanding body of evidence challenges the conventional hypothesis that sexual transmission is responsible for more than 90% of adult HIV infections in Africa. Differences in epidemic trajectories across Africa do not correspond to differences in sexual behavior. Studies among African couples find low rates of heterosexual transmission, as in developed countries. Many studies report HIV infections in African adults with no sexual exposure to HIV and in children with HIV-negative mothers. Unexplained high rates of HIV incidence have been observed in African women during antenatal and postpartum periods. Many studies show 20%–40% of HIV infections in African adults associated with injections (though direction of causation is unknown). These and other findings that challenge the conventional hypothesis point to the possibility that HIV transmission through unsafe medical care may be an important factor in Africa's HIV epidemic. [http://www.africaaction.org/docs02/hiv0210t.htm] |
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==Measuring the epidemic== |
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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 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 clinic]]s, these measurements are known as [[serosurvey]]s. |
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However, some doubt has been cast on the 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. |
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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. |
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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. |
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==Access to treatment== |
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:''"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."'' <small>Peter Piot, Executive Director of UNAIDS</small> |
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New [[anti-retroviral drugs]] (ARVs) can slow down and even reverse the progression of the HIV virus, delaying the onset of AIDS by twenty years or more. Because of their high cost, however, only 7 percent of the 6 million people in developing countries who are urgently in need of ARV treatment are able to access them. |
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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. |
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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 cannot afford to continue purchasing the drugs. There is no available cure for HIV and no prospect of one being developed for a significant time to come. Once ARV treatment has started, it must be continued for the rest of the patient's life. |
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The cost of ARV treatment has fallen dramatically in recent years. In Europe, treatment can cost between $10,000 and $15,000 per person per year (pppy). In some African countries ARVs are available for under $140 pppy. The key factor in the expense of ARVs is their [[patent|patent status]], allowing drug companies to profit from their research and further incentivise future development. However, some international aid organisations such as [[Voluntary Services Overseas|VSO]], [[Oxfam]] and [[Médecins Sans Frontières]] have questioned whether the revenues generated by ARVs really tally with research costs. |
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Drug manufacturers in [[South Africa]] and also in [[India]], [[Brazil]], [[Thailand]] and [[China]] 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 affordable 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 generic firms. |
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The [[World Health Organisation]] '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, immediate short term and stable, predictable long term financing of the 3 by 5 initiative. |
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The [[DREAM]] (short for "Drug Resources Enhancement against Aids and Malnutrition", formerly "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 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. See: [http://www.santegidio.org/en/amicimondo/aids/programma.htm] |
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[[Image:Africa HIV-AIDS 300px.png|thumb|right|294px|National infection rates for HIV. No data is available for white coloured areas.]] |
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==Regional analysis== |
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===East-central Africa=== |
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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. |
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! Country !! Adult prevalence !! Total HIV !! Deaths 2003 |
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| [[Uganda]] || 4.1% || 450,000 || 78,000 |
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| [[Kenya]] || 6.7% || 1,100,000 || 150,000 |
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| [[Tanzania]] || 8.8% || 1,500,000 || 160,000 |
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| [[Republic of the Congo|Congo]] || 4.9% || 80,000 || 9,700 |
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| [[Democratic Republic of the Congo|Congo DR]] || 4.2% || 1,000,000 || 100,000 |
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| [[Ethiopia]] || 4.4% || 1,400,000 || 120,000 |
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| [[Eritrea]] || 2.7% || 55,000 || 6,300 |
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| <small>HIV in East-central Africa (Source: [http://www.unaids.org/en/geographical+area/by+region/sub-saharan+africa.asp UNAIDS])</small> |
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Some areas of East Africa are beginning to show substantial declines in the prevelance of HIV infection. In the early 1990s, 13 percent of [[Uganda]]n residents were HIV positive; This has now fallen to 4.1 percent by the end of 2003. Evidence may suggest that the tide may also be turning in [[Kenya]]: prevalence fell from 13.6 percent in 1997–1998 to 9.4 percent 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. |
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Most governments in the region established AIDS education programmes in the mid-1980s in partnership with the [[World Health Organization]] and international [[Non-governmental organization|NGO]]s. 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 percent 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. |
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[[circumcision|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. |
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There are no non-human [[Vector (biology)|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 percent were observed in this group in the late 1980s in [[Uganda]], [[Kenya]] and [[Tanzania]]. |
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===West Africa=== |
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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]]. |
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The region has 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 Lione, Togo and Niger in 1987; Mauritiana in 1988; The Gambia, Guinea-Bissau, and Guinea in 1989; and finally Cape Verde in 1990. |
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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]]. |
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The main driver of infection in the region is [[prostitution|commercial sex]]. In the [[Ghana|Ghanaian]] capital [[Accra]], for example, 80 percent of HIV infections in young men had been acquired from women who sell sex. In [[Niger]], the adult national HIV prevalence was 1 percent in 2003, yet surveys of sex workers in different regions found a HIV infection rate of between 9 and 38 percent. |
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===Southern Africa=== |
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In the mid-1980s, HIV and AIDS were virtually unheard of in Southern Africa - it is now the Worst affected sub-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]]. Almost 30 percent of the global number of people living with HIV live in an area where only 2 percent of the world's population reside. |
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Nearly every country in the region has a national HIV prevalence level of at least 10 percent. The only exception to this rule is [[Angola]], with a rate of less than 5 percent. Tragically, this is not the result of a successful national response to the threat of AIDS but of a long running civil war. |
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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. |
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==References== |
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*[http://www.unaids.org/wad2004/report.html UNAIDS Epidemic Update December 2004] |
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*[http://www.unaids.org/bangkok2004/report.html UNAIDS 2004 Report on the global AIDS epidemic] |
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*[http://www.peopleandplanet.org/stopaids/report.php Treating AIDS Now, Romily Greenhill], [[People & Planet]], March 2004 |
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*[http://www.amazon.com/exec/obidos/ASIN/0140514864/qid=1114549923/sr=2-1/ref=pd_bbs_b_2_1/102-0242111-9829747 Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith (ed), Penguin Books] |
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==External links== |
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*[http://www.unaids.org/ The United Nations UNAIDS Programme - www.unaids.org] |
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*[http://www.unaids.org/EN/Geographical+Area/By+Region/sub-saharan+africa.asp UNAIDS Sub-Saharan Africa page] |
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*[http://www.aidsandafrica.com/ www.AidsAndAfrica.com] |
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*[http://www.santegidio.org/en/amicimondo/aids/index.htm] |
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{{AIDS}} |
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[[Category:HIV/AIDS]] |
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[[Category:Development]] |
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[[Category:Africa]] |
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[[nl:Aids in Afrika]] |
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Revision as of 17:47, 27 August 2005
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