HIV/AIDS in Africa

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. Much of the deadliness of the epidemic in Sub-Saharan Africa has to do with a deadly synergy between HIV and Tuberculosis. [http://news.bbc.co.uk/2/hi/africa/7074298.stm 'Dual epidemic' threatens Africa, BBC News] ] In fact, Tuberculosis is the world's greatest infectious killer of women of reproductive age and the leading cause of death among people with HIV/AIDS. [Stop TB Partnership. [http://www.prnewswire.co.uk/cgi/news/release?id=95088 London tuberculosis rates now at Third World proportions.] "PR Newswire Europe Ltd." 4 December 2002. Retrieved on 3 October 2006.]

Some areas of East Africa are beginning to show substantial declines in the prevalence of HIV infection. In the early 1990s, 13% of Ugandan residents were HIV positive; This has now 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.

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, 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 HIV/AIDS 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 the long-running Angolan Civil War (1975-2002).

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. (Source: 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.

Spawning new epidemics in Africa and Abroad

Because HIV has destroyed the immune systems of at least a quarter of the population in some areas, far more people are not only developing Tuberculosis but spreading it to otherwise healthy neighbours.

See also

* ASSA AIDS Model a South African model of the pandemic
* Demographics of Africa
* HIV/AIDS in South Africa

References

* [http://www.unaids.org/wad2004/report.html UNAIDS Epidemic Update December 2004]
* [http://www.unaids.org/bangkok2004/report.html UNAIDS 2004 Report on the global AIDS epidemic]
* [http://www.peopleandplanet.org/stopaids/report.php Treating AIDS Now, Romilly Greenhill] , People & Planet, March 2004
* "Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic", Raymond A. Smith (ed), Penguin Books. ISBN 0-14-051486-4.
* Tony Barnett and Alan Whiteside, "AIDS in the 21st Century: Disease and Globalization," Palgrave Macmillan, 2003, ISBN 1-4039-0006-X
* John Iliffe, "The African AIDS Epidemic: A History," James Currey, 2006, ISBN 0-85255-890-2
* Nicoli Nattrass, "The Moral Economy of AIDS in South Africa," Cambridge University Press, 2003, ISBN 0-521-54864-0
* Alex de Waal, "AIDS and Power: Why there is no political crisis--yet," Zed Books, 2006, ISBN 1-84277-707-6
* Pieter Fourie, "The Political Management of HIV and AIDS in South Africa: One burden too many?" Palgrave Macmillan, 2006, ISBN 0-230-00667-1

Further reading

* [http://ifpri.catalog.cgiar.org/dbtw-wpd/exec/dbtwpub.dll?AC=GET_RECORD&XC=/dbtw-wpd/exec/dbtwpub.dll&BU=http%3A%2F%2Fifpri.catalog.cgiar.org%2Fpubsearch.htm&TN=IFPRIpubs&SN=AUTO30397&SE=502&RN=10&MR=20&TR=0&TX=1000&ES=1&CS=1&XP=&RF=Web+Cite+Checkbox&EF=&DF=more+info....&RL=0&EL=0&DL=0&NP=2&ID=&MF=&MQ=&TI=0&DT=&ST=0&IR=2421&NR=0&NB=0&SV=0&BG=&FG=000000&QS=pubsearch&OEX=ISO-8859-1&OEH=ISO-8859-1 Agriculture and HIV/AIDS : understanding the links between agriculture and health (brief) ] by Stuart Gillespie (2006) International Food Policy Research Institute
* [http://knowledge.allianz.com/en/globalissues/demographic_change/population_growth/aids_southern_africa.html "AIDS Turns Africa's Demographics Upside Down"] , Allianz Knowledge, October 18, 2007
* [http://knol.google.com/k/andrew-bell/religion-and-aids-in-africa/1gi7uxqqtt51h/2# Religion and AIDS in Africa: Islam as AIDS Prevention?] by Andrew Bell (2008)

External links

* [http://www.unaids.org/en/Regions_Countries/Regions/SubSaharanAfrica.asp Sub-Saharan Africa page] of United Nations UNAIDS Programme
* [http://www.fhssa.org/ Foundation for Hospices in Sub-Saharan Africa]
* [http://www.aidsportal.org/overlay_details.aspx?nex=19 Africa] at AIDSPortal
* [http://www.aidsandafrica.com/ AidsAndAfrica.com]
* [http://www.sierraleone.com/politics-development/1446-aids-sierra-leone.html AIDS in Sierra Leone]
* [http://research.uchicago.edu/highlights/item.php?id=211 Preventing HIV in Africa: Understanding Sexual Behavior Change] , video interview with Emily Oster

Charities and non-governmental organizations

* [http://www.santegidio.org/en/amicimondo/aids/index.htm Project to combat Aids in Mozambique] , Community of Sant'Egidio
* [http://www.soschildrensvillages.org.uk/aids-africa/ Aids Africa Children: HIV / AIDS Orphans] , SOS Children
* [http://www.doctorswithoutborders.org/news/hiv-aids/index.cfm/ HIV/AIDS information page] , Médecins Sans Frontières / Doctors Without Borders
* Seguku Women's Association (SeWA)