HIV/AIDS in Africa
HIV/AIDS originated in the early 20th century and remains a significant public health challenge, particularly in Africa. Although Africa constitutes about 17% of the world's population,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> it bears a disproportionate burden of the epidemic. In 2023, around 25.6 million people in sub-Saharan Africa were living with HIV, accounting for over two-thirds of the global total.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The majority of new infections and AIDS-related deaths occur in Eastern and Southern Africa, which house approximately 55% of the global HIV-positive population.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
In Southern Africa, the epidemic is particularly severe. Countries including Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe have adult prevalence rates exceeding 10%.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> This has significantly affected life expectancy, with reductions of up to 20 years in the most impacted areas.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> North Africa, West Africa, and the Horn of Africa report significantly lower prevalence rates, attributed to differing cultural practices and reduced engagement in high-risk behaviors.<ref>Template:Cite book</ref> Efforts to combat the epidemic have focused on multiple strategies, including the widespread distribution of antiretroviral therapy (ART), which has substantially improved the quality of life and reduced mortality for those living with HIV.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Between 2010 and 2020, AIDS-related deaths declined by 43% in sub-Saharan Africa due to increased access to ART and prevention of mother-to-child transmission programs.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Challenges persist, including stigma, insufficient healthcare infrastructure, and funding constraints.
Key regional and international organizations, such as UNAIDS, the World Health Organization (WHO), and the African Union, continue to coordinate responses, aiming to achieve the United Nations Sustainable Development Goal of ending the HIV epidemic by 2030.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Initiatives such as the PEPFAR program and the Global Fund have been instrumental in scaling up ART distribution and prevention campaigns.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Despite progress, gender inequalities exacerbate the epidemic's impact, with young women in sub-Saharan Africa experiencing HIV infection rates three times higher than their male counterparts.<ref>Template:Cite journal</ref> Addressing socio-economic factors and enhancing HIV/AIDS education among at-risk populations remain vital components of comprehensive intervention strategies.
Overview
In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote:
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HIV ... has caused immense human suffering in the continent. The most obvious effect ... 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. ...
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. ...
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. ... [I]n Tanzania[,] for example[,] ... 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....
AIDS damages businesses by squeezing productivity, adding costs, diverting productive resources, and depleting skills. ... 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. ... 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 ... are lacking in many areas.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>{{#if:|
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| World region | citation | CitationClass=web
}}</ref>!! Persons living | ||
|---|---|---|---|---|
| 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 |
Regional prevalence
In contrast to Arab North Africa and the Horn of Africa, traditional cultures and religions in Sub-Saharan Africa have generally exhibited a more liberal attitude to female out-of-marriage sexual activity. The latter includes practices such as multiple sexual partners and unprotected sex, high-risk cultural patterns that have been implicated in the much greater spread of HIV in the subcontinent.<ref name="RCTHIV"/>
North Africa
| Country | Adult prevalence ages 15–49, 2021 |
citation | CitationClass=web
}}</ref>!! AIDS deaths, 2021<ref name="UNAIDS 2011" />!! New HIV infections, 2021<ref name="UNAIDS 2012" /> | |
|---|---|---|---|---|
| Algeria | <0.1%<ref name="UNAIDS 2011"/> | 21,000 | <500 | 2000 |
| Egypt | <0.1%<ref name="UNAIDS 2011"/> | 30,000 | <1000 | not available |
| Libya | 0.2%<ref name="UNAIDS 2011"/> | 8,300 | <200 | <500 |
| Morocco | <0.1%<ref name="UNAIDS 2011"/> | 23,000 | <500 | <1000 |
| Sudan | 0.1%<ref name="UNAIDS 2012"/> | 41,000 | 1,900 | 3,100 |
| Tunisia | <0.1%<ref name="UNAIDS 2011"/> | 5,400 | <500 | <500 |
Horn of Africa
As with North Africa, the HIV infection rates in the Horn of Africa are quite low. This has been attributed to the Muslim nature of many of the local communities and adherence to Muslim norms regarding sexuality.<ref name="RCTHIV"/>
Ethiopia's HIV prevalence rate decreased from 3.6 percent in 2001 to 1.4 percent in 2011.<ref name="UNAIDS 2012"/> The number of new infections per year decreased from 130,000 in 2001, to 24,000 in 2011.<ref name="UNAIDS 2012"/>
| Country | Adult prevalence ages 15–49, 2011<ref name="UNAIDS 2011"/> |
Adult prevalence ages 15–49, 2001<ref name="UNAIDS 2012"/> |
Number of people living with HIV, 2011<ref name="UNAIDS 2011"/> |
Number of people living with HIV, 2001<ref name="UNAIDS 2012"/> |
AIDS deaths, 2011<ref name="UNAIDS 2011"/> | AIDS deaths, 2001<ref name="UNAIDS 2012"/> | New HIV infections, 2011<ref name="UNAIDS 2012"/> | New HIV infections, 2001<ref name="UNAIDS 2012"/> |
|---|---|---|---|---|---|---|---|---|
| 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 |
Central Africa
In 2010, HIV infection rates in central Africa were moderate to high.<ref name="UNAIDS 2010"/>
| Country | Adult prevalence ages 15–49, 2011 |
Adult prevalence ages 15–49, 2001<ref name="UNAIDS 2012"/> |
Number of people living with HIV, 2011 |
Number of people living with HIV, 2001<ref name="UNAIDS 2012"/> |
AIDS deaths, 2011 | AIDS deaths, 2001<ref name="UNAIDS 2012"/> | New HIV infections, 2011<ref name="UNAIDS 2012"/> | New HIV infections, 2001<ref name="UNAIDS 2012"/> |
|---|---|---|---|---|---|---|---|---|
| Angola | 2.1%<ref name="UNAIDS 2011"/> | 1.7% | 230,000<ref name="UNAIDS 2011"/> | 130,000 | 12,000<ref name="UNAIDS 2011"/> | 8,200 | 23,000 | 20,000 |
| Cameroon | 4.6%<ref name="UNAIDS 2011"/> | 5.1% | 550,000<ref name="UNAIDS 2011"/> | 450,000 | 34,000<ref name="UNAIDS 2011"/> | 28,000 | 43,000 | 57,000 |
| Central African Republic | 4.6%<ref name="UNAIDS 2011"/> | 8.1% | 130,000<ref name="UNAIDS 2011"/> | 170,000 | 10,000<ref name="UNAIDS 2011"/> | 16,000 | 8,200 | 15,000 |
| Chad | 3.1%<ref name="UNAIDS 2011"/> | 3.7% | 210,000<ref name="UNAIDS 2011"/> | 170,000 | 12,000<ref name="UNAIDS 2011"/> | 13,000 | not available | not available |
| Congo | 3.3%<ref name="UNAIDS 2011"/> | 3.8% | 83,000<ref name="UNAIDS 2011"/> | 74,000 | 4,600<ref name="UNAIDS 2011"/> | 6,900 | 7,900 | 7,200 |
| Democratic Republic of the Congo | 1.2–1.6%<ref name="UNAIDS 2010"/> | not available | 430,000–560,000<ref name="UNAIDS 2010"/> | not available | 26,000–40,000 (2009)<ref name="UNAIDS 2010"/> | not available | not available | not available |
| Equatorial Guinea | 4.7%<ref name="UNAIDS 2011"/> | 2.5% | 20,000<ref name="UNAIDS 2011"/> | 7,900 | <1,000<ref name="UNAIDS 2011"/> | <500 | not available | not available |
| Gabon | 5.0%<ref name="UNAIDS 2011"/> | 5.2% | 46,000<ref name="UNAIDS 2011"/> | 35,000 | 2,500<ref name="UNAIDS 2011"/> | 2,100 | 3,000 | 4,900 |
| São Tomé and Príncipe | 1.0%<ref name="UNAIDS 2011"/> | 0.9% | <1,000<ref name="UNAIDS 2011"/> | <1,000 | <100<ref name="UNAIDS 2011"/> | <100 | not available | not available |
Eastern Africa
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HIV infection rates in eastern Africa are moderate to high.
Kenya
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In 2008, Kenya had the third largest number of individuals in Sub-Saharan Africa living with HIV.<ref name="UNAIDSKEN">Template:Cite news</ref> Kenya had the highest prevalence rate of any country outside of Southern Africa.<ref name="UNAIDSKEN"/> Kenya's HIV infection rate dropped from around 14 percent in the mid-1990s to 5 percent in 2006.<ref name="UNAIDS 2010"/> It rose again to 6.2 percent by 2011.<ref name="UNAIDSKEN"/> The number of newly infected people per year decreased by almost 30 percent, from 140,000 in 2001 to 100,000 in 2011.<ref name="UNAIDS 2012"/>
In 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.<ref name="UNAIDSKEN"/>
Christian men and women had a higher infection rate than their Muslim counterparts.<ref name="UNAIDSKEN"/> This discrepancy was especially visible among women, with Muslim women having a rate of 2.8 percent versus 8.4 percent among Protestant women and 8 percent among Catholic women.<ref name="UNAIDSKEN"/> HIV detection was more common among the wealthiest than among the poorest, at 7.2 percent versus 4.6 percent.<ref name="UNAIDSKEN"/>
Historically, HIV had been more prevalent in urban than rural areas, although the gap is closing rapidly.<ref name="UNAIDSKEN"/> In 2013, men in rural areas were more likely to be HIV-infected, at 4.5 percent, than those in urban areas, at 3.7 percent.<ref name="UNAIDSKEN"/>
Tanzania
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Between 2004 and 2008, the HIV incidence rate in Tanzania for people aged 15–44 slowed to 3.37 per 1,000 person-years. The rate was 4.42 for women, and 2.36 for men.<ref>Template:Cite journal</ref> The number of newly infected people per year increased slightly, from 140,000 in 2001 to 150,000 in 2011.<ref name="UNAIDS 2012"/> There were significantly fewer HIV infections in Zanzibar, which in 2011 had a prevalence rate of 1.0 percent compared to 5.3 percent in mainland Tanzania.<ref name="Survey">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 Template:Webarchive</ref>
Uganda
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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.<ref name="UNAIDS 2010"/><ref name="RCTHIV"/> This has been attributed to changing local behavioral patterns, with more respondents reporting greater use of contraceptives<ref>Template:Cite journal</ref> and a two-year delay in first sexual activity, as well as fewer people reporting casual sexual encounters and multiple partners.<ref name="RCTHIV"/>
The number of newly infected people per year increased by over 50 percent, from 99,000 in 2001 to 150,000 in 2011.<ref name="UNAIDS 2012"/> More than 40 percent of new infections are among married couples, indicating widespread and increasing infidelity.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> This increase has caused alarm. The director of the Centre for Disease Control – Uganda, Wuhib Tadesse, said in 2011 that,
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"For every person started on antiretroviral therapy, there are three new HIV infections[,] and this is unsustainable. We are very concerned. Complacence could be part of the problem. Young people nowadays no longer see people dying; they see people on ARVs but getting children. We need to re-examine our strategies.... Leaders at all levels are spending [more] time in workshops than in the communities to sensitive the people[,] and this must stop."<ref>{{#invoke:citation/CS1|citation
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| Country | Adult prevalence ages 15–49, 2011 |
Adult prevalence ages 15–49, 2001<ref name="UNAIDS 2012"/> |
Number of people living with HIV, 2011<ref name="UNAIDS 2011"/> |
Number of people living with HIV, 2001<ref name="UNAIDS 2012"/> |
AIDS deaths, 2011<ref name="UNAIDS 2011"/> | AIDS deaths, 2001<ref name="UNAIDS 2012"/> | New HIV infections, 2011<ref name="UNAIDS 2012"/> | New HIV infections, 2001<ref name="UNAIDS 2012"/> |
|---|---|---|---|---|---|---|---|---|
| Burundi | 1.3%<ref name="UNAIDS 2011"/> | 3.5% | 80,000 | 130,000 | 5,800 | 13,000 | 3,000 | 6,900 |
| Comoros | 0.1%<ref name="UNAIDS 2011"/> | <0.1% | <500 | <100 | <100 | <100 | not available | not available |
| Kenya | 6.2%<ref name="UNAIDS 2011"/> | 8.5% | 1,600,000 | 1,600,000 | 62,000 | 130,000 | 100,000 | 140,000 |
| Madagascar | 0.3%<ref name="UNAIDS 2011"/> | 0.3% | 34,000 | 22,000 | 2,600 | 1,500 | not available | not available |
| Mauritius | 1.0%<ref name="UNAIDS 2011"/> | 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 |
| Réunion | not available | not available | not available | not available | not available | not available | not available | not available |
| Rwanda | 2.9%<ref name="UNAIDS 2011"/> | 4.1% | 210,000 | 220,000 | 6,400 | 21,000 | 10,000 | 19,000 |
| Seychelles | not available<ref name="UNAIDS 2011"/> | not available | not available | not available | not available | not available | not available | not available |
| South Sudan | 3.1%<ref name="UNAIDS 2011"/> | not available | 150,000 | not available | 11,000 | not available | not available | not available |
| Tanzania | 5.1%<ref name="Survey"/> | 7.2% | 1,600,000 | 1,400,000 | 84,000 | 130,000 | 150,000 | 140,000 |
| Uganda | 7.2%<ref name="UNAIDS 2011"/> | 6.9% | 1,400,000 | 990,000 | 62,000 | 100,000 | 150,000 | 99,000 |
Western Africa
Western Africa has moderate levels of infection of both HIV-1 and HIV-2. The onset of the HIV epidemic in the region began in 1985, with reported cases in Senegal,<ref name=":2">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Benin,<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> and Nigeria.<ref>Template:Cite book</ref> These were followed in 1986 by Côte d'Ivoire.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The first identification of HIV-2 occurred in Senegal by microbiologist Souleymane Mboup and his collaborators.<ref name=":2" />
HIV prevalence in western Africa is lowest in Senegal and highest in Nigeria, which has the second largest number of people living with HIV in Africa after South Africa. Nigeria's infection rate, of the number of patients relative to the entire population, is much lower, at 3.7 percent, compared to South Africa's 17.3 percent.Template:Citation needed
In Niger in 2011, the national HIV prevalence rate for ages 15–49 was 0.8 percent. For sex workers, it was 36 percent.<ref name="UNAIDS 2012"/>
| Country | Adult prevalence ages 15–49, 2011<ref name="UNAIDS 2011"/> |
Adult prevalence ages 15–49, 2001<ref name="UNAIDS 2012"/> |
Number of people living with HIV, 2011<ref name="UNAIDS 2011"/> |
Number of people living with HIV, 2001<ref name="UNAIDS 2012"/> |
AIDS deaths, 2011<ref name="UNAIDS 2011"/> | AIDS deaths, 2001<ref name="UNAIDS 2012"/> | New HIV infections, 2011<ref name="UNAIDS 2012"/> | New HIV infections, 2001<ref name="UNAIDS 2012"/> |
|---|---|---|---|---|---|---|---|---|
| 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<ref group="Note" name="auto">The WHO records the following deaths by country due to HIV/AIDS is 2006 as follows:
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}}</ref> || 18,000 || 13,000 || 28,000 | ||
| Guinea | 1.4% | 1.5% | 85,000 | 72,000 | 4,000<ref group=Note name="auto"/> | 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<ref group=Note name="auto"/> | 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<ref group=Note name="auto"/> | 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<ref group=Note name="auto"/> | 8,100 | 9,500 | 17,000 |
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. Currently, Eswatini and Lesotho have the highest and second highest HIV prevalence rates in the world, respectively.<ref name="UNAIDS 2011" /> Of the nine southern African countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe), four are estimated to have an infection rate of over 15 percent.Template:Citation needed
In Botswana, the number of newly infected people per year declined by 67 percent, from 27,000 in 2001 to 9,000 in 2011. In Malawi, the decrease was 54 percent, from 100,000 in 2001 to 46,000 in 2011. All but two of the other countries in this region have recorded major decreases (Namibia, 62 percent; Zambia, 54 percent; Zimbabwe, 47 percent; South Africa, 38 percent; Eswatini, 32 percent). The number has remained virtually the same in Lesotho and Mozambique.<ref name="UNAIDS 2012"/>
Zimbabwe's first reported case of HIV was in 1985.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
There are widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners.<ref>The Political Economy of AIDS in Africa, edited by Nana K. Poku and Alan W. Whiteside, Ashgate Publishing, Ltd., 2004, page 235</ref> Men's sexual networks, in particular, tend to be quite extensive,<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> a fact that is tacitly accepted or even encouraged by many communities.<ref name=":1">Template:Cite journal</ref> Along with having multiple sexual partners, unemployment and population displacements resulting from drought and conflict have contributed to the spread of HIV/AIDS.<ref name=":1" />
A study in 2000 found that local men refuse to use condoms during intercourse with girls or women performing sex work. The girls and women are in desperate need of money and do not have a choice. This leads to multiple sex partners, which increases the likelihood of their infection with HIV/AIDS.<ref>Template:Cite journal</ref>
A 2008 study in Botswana, Namibia, and Eswatini, found that intimate partner violence, extreme poverty, education, and partner income disparity explained almost all of the differences in HIV status among adults aged 15–29 years. Among young women with any one of these factors, the HIV rate increased from 7.7 percent with no factors, to 17.1 percent. Approximately 26 percent of young women with any two factors were HIV positive, with 36 percent of those with any three factors and 39.3 percent of those with all four factors being HIV-positive.<ref>Template:Cite journal</ref>
| Country | Adult prevalence ages 15–49, 2011<ref name="UNAIDS 2011"/> |
Adult prevalence ages 15–49, 2001<ref name="UNAIDS 2012"/> |
Number of people living with HIV, 2011<ref name="UNAIDS 2011"/> |
Number of people living with HIV, 2001<ref name="UNAIDS 2012"/> |
AIDS deaths, 2011<ref name="UNAIDS 2011"/> | AIDS deaths, 2001<ref name="UNAIDS 2012"/> | New HIV infections, 2011<ref name="UNAIDS 2012"/> | New HIV infections, 2001<ref name="UNAIDS 2012"/> |
|---|---|---|---|---|---|---|---|---|
| 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<ref group=Note name="auto"/> | 15,000 | 26,000 | 26,000 |
| Malawi | 10.0% | 13.8% | 910,000 | 860,000 | 44,000<ref group=Note name="auto"/> | 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<ref group=Note name="auto"/> | 8,600 | 8,800 | 23,000 |
| South Africa | 17.3% | 15.9% | 5,600,000 | 4,400,000 | 270,000<ref group=Note name="auto"/> | 210,000 | 380,000 | 610,000 |
| Eswatini | 26.0% | 22.2% | 190,000 | 120,000 | 6,800<ref group=Note name="auto"/> | 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 |
Eswatini
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In 2011, the HIV prevalence rate in Eswatini was the highest in the world, at 26.0 percent of citizens aged 15–49.<ref name="UNAIDS 2011"/> The United Nations Development Program wrote in 2005,
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The immense scale of AIDS-related illness and deaths is weakening governance capacities for service delivery, with serious consequences on food security, economic growth[,] and human development. AIDS undermines the capacities of individuals, families, communities[,] and the state to fulfill their roles and responsibilities in society. If current trends are not reversed, the longer-term survival of Swaziland as a country will be seriously threatened.<ref>{{#invoke:citation/CS1|citation
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In 2009, the HIV epidemic in Eswatini reduced its life expectancy at birth to 49 years for men, and 51 years for women.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Life expectancy at birth in 1990 was 59 for men and 62 for women.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
In 2011, Eswatini's crude death rate of 19.51 per 1,000 people per year was the third highest in the world, behind only Lesotho and Sierra Leone.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> HIV/AIDS in 2002 caused 64 percent of all deaths in Eswatini.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Origins of HIV/AIDS in Africa
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The earliest known cases of human HIV infection were in western equatorial Africa, probably in southeastern 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 SIV cpz lineages: that found in P. t. troglodytes [Pan troglodytes troglodytes i.e. the central chimpanzee]." It is suspected that the disease jumped to humans from butchering of chimpanzees for human consumption.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="Hunt">Template:Cite news</ref>
Current hypotheses also include that, once the virus jumped from chimpanzees or other apes to humans, medical practices of the early 20th century helped HIV become established in human populations by 1930.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The virus likely moved from primates to humans when hunters came into contact with the blood of infected primates. The hunters then became infected with HIV and passed on the disease to other humans through bodily fluid contamination. This theory is known as the "Bushmeat theory".<ref>Template:Cite journal</ref>
HIV made the leap from rural isolation to rapid urban transmission as a result of urbanization that occurred during the 20th century. There are many reasons why there is such a high prevalence of AIDS in Africa. One of the most formative explanations is the poverty that dramatically impacts the daily lives of Africans. The book, Ethics and AIDS in Africa: A Challenge to Our Thinking, describes how "Poverty has accompanying side-effects, such as prostitution (i.e. the need to sell sex for survival), poor living conditions, education, health and health care, that are major contributing factors to the current spread of HIV/AIDS."<ref name="Van Niekerk A. 2005">A., Van Niekerk A., and Loretta M. Kopelman. Ethics & AIDS in Africa: The Challenge to Our Thinking. Walnut Creek, CA: Left Coast, 2005.</ref>
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,<ref name="Hunt"/> including people in Kinshasa whose tissue samples from 1959 and 1960 have been preserved and studied retrospectively.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The first epidemic of HIV/AIDS is believed to have occurred in Kinshasa in the 1970s, signaled by a surge in opportunistic infections such as cryptococcal meningitis, Kaposi's sarcoma, tuberculosis, and pneumonia.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite journal</ref>
History
Acquired immunodeficiency syndrome (AIDS) is a fatal disease caused by the slow-acting human immunodeficiency virus (HIV). The virus multiplies in the body until it causes immune system damage, leading to diseases of the AIDS syndrome. HIV emerged in Africa in the 1960s and spread to the United States and Europe the following decade.<ref name=":0"/>
In the 1980s it spread across the globe until it became a pandemic. Some areas of the world were already significantly impacted by AIDS, while in others the epidemic was just beginning. The virus is transmitted by bodily fluid contact including the exchange of sexual fluids, by blood, from mother to child in the womb, and during delivery or breastfeeding. AIDS first was identified in the United States and France in 1981, principally among homosexual men. In 1982 and 1983, heterosexual Africans also were diagnosed.<ref name=":0">Template:Cite book</ref>
In the late 1980s, international development agencies regarded AIDS control as a technical medical problem rather than one involving all areas of economic and social life. Because public health authorities perceived AIDS to be an urban phenomenon associated with prostitution, they believed that the majority of Africans who lived in "traditional" rural areas would be spared. They believed that the heterosexual epidemic could be contained by focusing prevention efforts on persuading the so-called core transmitters—people such as sex workers and truck drivers, known to have multiple sex partners—to use condoms. These factors hindered prevention campaigns in many countries for more than a decade.<ref name=":0" />
Although many governments in Sub-Saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
AIDS was at first considered a disease of gay men and people suffering from drug addiction, but in Africa it took off among the general population. As a result, those involved in the fight against HIV began to emphasize aspects such as preventing transmission from mother to child, or the relationship between HIV and poverty, inequality of the sexes, and so on, rather than emphasizing the need to prevent transmission by unsafe sexual practices or drug injection. This change in emphasis resulted in more funding, but was not effective in preventing a drastic rise in HIV prevalence.<ref name=HIV_Today>Template:Cite journal, pp. iv-v.</ref>
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 President's Emergency Plan for AIDS Relief.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
The number of HIV positive people in Africa receiving anti-retroviral treatment rose from 1 million to 7.1 million between 2005 and 2012, an 805% increase. Almost 1 million of those patients were treated in 2012.<ref name="UNAIDS Special Report">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> The number of HIV positive people in South Africa who received such treatment in 2011 was 75.2 percent higher than the number in 2009.<ref name="UNAIDS 2012"/>
The number of AIDS-related deaths in 2011 in both Africa as a whole and Sub-Saharan Africa alone was 32 percent less than in 2005.<ref name="UNAIDS Special Report"/><ref name="UNAIDS 2012"/> The number of new HIV infections in Africa in 2011 was 33 percent less than in 2001, with a "24% reduction in new infections among children from 2009 to 2011".<ref name="UNAIDS Special Report"/> In Sub-Saharan Africa, new HIV positive cases over the same period declined by 25%.<ref name="UNAIDS 2012"/> According to UNAIDS, these successes have resulted from "strong leadership and shared responsibility in Africa and among the global community", including the work of Leopold Zekeng, who served as the organization's Country Director in Sierra Leone, Liberia, Ghana, Tanzania, and currently, Nigeria.<ref name="UNAIDS Press Release">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Prevention of HIV infections
Public education initiatives
Numerous public education initiatives have been launched to curb the spread of HIV in Africa.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
The role of stigma
{{ safesubst:#invoke:Unsubst||date=__DATE__ |$B= Template:AmboxTemplate:DMCA }} Many activists have drawn attention to stigmatization of those testing as HIV positive. This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and prejudices brought on by a cultures beliefs.<ref name="biomedcentral.com|access-date=2015-04-25">Template:Cite journal</ref> "When HIV/AIDS became a global disease, Some African leaders played ostrich and said that it was a gay disease found only in the West and Africans did not have to worry because there were no gays and lesbians in Africa".<ref>Template:Cite book</ref>
Africans were unaware of the already huge epidemic that was infesting their communities. The belief that only homosexuals could contract the diseases was later debunked as the number of heterosexual couples living with HIV increased. Unfortunately there were other rumors being spread by elders in Cameroon. These "elders speculated that HIV/AIDS was a sexually transmitted disease passed on from Fulani women only to non-Fulani men who had sexual contact with them. They also claimed if a man was infected as a result of having sexual contact with a Fulani woman, only a Fulani healer could treat him".<ref>Template:Cite book</ref>
This communal belief is shared by many other African cultures who believe that HIV and AIDS originated from women. Because of this belief that men can only get HIV from women many "women are not free to speak of their HIV status to their partners for fear of violence".<ref name="biomedcentral.com|access-date=2015-04-25"/>
In general HIV carries a negative stigma in Sub-Saharan Africa. This stigma makes it very challenging for Sub-Saharan Africans to share that they have HIV, because they are afraid of being an outcast from their friends and family. In every Sub-Saharan community, HIV is seen as the bringer of death. The common belief is that once you have HIV you are destined to die. People seclude themselves based on these beliefs. They do not tell their family and live with guilt and fear because of HIV. In a 2014 survey "80.8% of participants would not sleep in the same room as someone who was HIV positive, while 94.5% would not talk to someone who was HIV positive".<ref name="biomedcentral.com|access-date=2015-04-25"/>
Social stigma plays a significant role in the state of HIV and AIDS infection in Africa. "In a normatively HIV/AIDS-stigmatizing Sub Saharan African communities, this suspicion of one's status by others is also applicable to individuals who are not HIV positive, but who may wish to utilize healthcare services for preventive purposes. This group of individuals under fear of suspicion may avoid being mistakenly identified as stigmatized by simply avoiding HARHS utilization." (151)<ref name="Van Niekerk A. 2005"/>
"At the individual level, persons living with HIV/AIDS in Sub-Saharan Africa likely want to conceal their stigmatized identities whenever possible in order to gain these rewards associated with having a 'normal' identity. The rewards of being considered normal' in the context of high-HIV-prevalence Sub-Saharan Africa are varied and great... such rewards for which there is empirical support in this context include perceived sexual freedom, avoidance of discrimination, avoidance of community or family rejection, avoidance of losing one's job or residence, and avoidance of losing one's sexual partners. Other potential rewards of being considered normal include avoidance of being associated with promiscuity or prostitution, avoidance of emotional, social and physical isolation and avoidance of being blamed for others' illness" (150).<ref name="Van Niekerk A. 2005"/>
Combination prevention programs
The Joint United Nations Program on HIV/AIDS defines combination prevention programs as:
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rights-based, evidence-informed, and community-owned programs that use a mix of biomedical, behavioral, and structural interventions, prioritized to meet the current HIV prevention needs of particular individuals and communities, so as to have the greatest sustained impact on reducing new infections. Well-designed programs are carefully tailored to national and local needs and conditions; focus resources on the mix of programmatic and policy actions required to address both immediate risks and underlying vulnerability; and are thoughtfully planned and managed to operate synergistically and consistently on multiple levels (e.g. individual, relationship, community, society) and over an adequate period of time. Using different prevention strategies in combination is not a new idea combination approaches have been used effectively to generate sharp, sustained reductions in new HIV infections in diverse settings. Combination prevention reflects common sense, yet it is striking how seldom the approach has been put into practice. Prevention efforts to date have overwhelmingly focused on reducing individual risk, with fewer efforts made to address societal factors that increase vulnerability to HIV. UNAIDS' combination prevention framework puts structural interventions—including programs to promote human rights, to remove punitive laws that block the AIDS response, and to combat gender inequality and HIV related stigma and discrimination—at the center of the HIV prevention agenda.<ref>"Combination HIV Prevention: Tailoring and Coordinating Biomedical, Behavioural and Structural Strategies to Reduce New HIV Infections", Joint United Nations Programme on HIV/AIDS, 2010, pages 8-10</ref>{{#if:|
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"It is the consensus in the HIV scientific community that abstinence, be faithful, use a condom [(ABC)] principles are vital guides for public health intervention, but are better bundled with biomedical prevention approaches; lone behavioral change approaches are not likely to stop the global pandemic."<ref>Template:Cite journal</ref> Uganda has replaced its ABC strategy with a combination prevention program because of an increase in the annual HIV infection rate. Most new infections were coming from people in long-term relationships who had multiple sexual partners.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Abstinence, be faithful, use a condom
The abstinence, be faithful, use a condom (ABC) strategy to prevent HIV infection promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut. The implementation of ABC differs among those who use it. For example, the President's Emergency Plan for AIDS Relief has focused more on abstinence and fidelity than condoms<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> while Uganda has had a more balanced approach to the three elements.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
The effectiveness of ABC is controversial. At the 16th International AIDS Conference in 2006, African countries gave the strategy mixed reviews. In Botswana,
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In Nigeria,
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In Kenya,
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In Ghana,
An estimated value of about 300,000 people(All ages) have been infected with the HIV virus. This is prevalent and highest in the Eastern Region of Ghana and lowest in the Northern Regions of the country. As part of national efforts to control the wide spread of the HIV virus, the ABC approach is a popular strategy employed for HIV prevention in the country. The virus is higher among women than among men in all age groups with estimates of 56 percent among females and 44 percent among male. Sexual transmission remains the major mode of HIV transmission in Ghana but other approaches such as Information Education and Communication (IEC) and Behavior Change Communication (BCC) are all been used for the course of the virus prevention.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Eswatini in 2010 announced that it was abandoning the ABC strategy because it was a dismal failure in preventing the spread of HIV. "If you look at the increase of HIV in the country while we've been applying the ABC concept all these years, then it is evident that ABC is not the answer," said Dr. Derek von Wissell, Director of the National Emergency Response Council on HIV/AIDS.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Prevention efforts
In 1999, the Henry J. Kaiser Family Foundation and the Bill and Melinda Gates Foundation provided major funding for the Love Life website, an online sexual health and relationship resource for teenagers.<ref>Template:Cite journal</ref>
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.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
African Union's efforts
AIDS Watch Africa
During the Abuja African Union Summit on HIV/AIDS in April 2001, the heads of state and heads of government of Botswana, Ethiopia, Kenya, Mali, Nigeria, Rwanda, South Africa, and Uganda established the AIDS Watch Africa (AWA) advocacy platform. The initiative was formed to "accelerate efforts by Heads of State and Government to implement their commitments for the fight against HIV/AIDS, and to mobilize the required national and international resources."<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> In January 2012, AWA was revitalized to include all of Africa and its objectives were broadened to include malaria and tuberculosis.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa
In 2012, the African Union adopted a Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria Response in Africa.<ref name="UNAIDS Press Release"/> This Roadmap outlines a set of African-developed strategies to strengthen shared responsibility and international cooperation for achieving sustainable AIDS solutions in Africa by 2015. The solutions are organized around three strategic pillars: diversified financing; access to medicines; and enhanced health governance. The Roadmap defines goals, results and roles and responsibilities to hold stakeholders accountable for the realization of these solutions between 2012 and 2015.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Preventing HIV transmission from pregnant women to children
The Joint United Nations Program on HIV/AIDS reported that the following sixteen African nations in 2012 "ensure[d] that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child": Botswana, Eswatini, Gabon, Gambia, Ghana, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Tanzania, Zambia and Zimbabwe.<ref name="UNAIDS Press Release"/><ref name="UNAIDS 2012"/>
Causes and spread
Behavioral factors
High-risk behavioral patterns are largely responsible for the significantly greater spread of HIV/AIDS in Sub-Saharan Africa than in other parts of the world. Chief among these are the traditionally liberal attitudes espoused by many communities inhabiting the subcontinent toward multiple sexual partners and pre-marital and outside marriage sexual activity.<ref name="UNAIDS 2010">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref name="RCTHIV">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> HIV transmission is most likely in the first few weeks after infection, and is therefore increased when people have more than one sexual partner in the same time period.<ref name=HIV_Today/>
In most of the developed world outside Africa, this means HIV transmission is high among prostitutes and other people who may have more than one sexual partner concurrently. Within the cultures of sub-Saharan Africa, it is relatively common for both men and women to be carrying on sexual relations with more than one person, which promotes HIV transmission.<ref name=HIV_Today/> This practice is known as concurrency, which Helen Epstein describes in her book, The Invisible Cure: Africa, the West, and the Fight against AIDS, in which her research into the sexual mores of Uganda revealed the high frequency with which men and women engage in concurrent sexual relationships.<ref>Epstein, Helen. The Invisible Cure: Africa, the West, and the Fight against AIDS. New York: Farrar, Straus, and Giroux, 2007.</ref>
In sub-Saharan Africa AIDS is the leading killer. A large reason for the high transmission rates is because of the lack of education provided to youth. When infected, most children die within one year because of the lack of treatment.<ref>Template:Cite book</ref>
All demographic populations in Sub-Saharan Africa have been infected with HIV, from men to women, and from pregnant women to children. Rather than having more of a specific group infected, male or female, the ratio of men and women infected with HIV are quite similar. With the HIV infection, 77% of men, women, and children, develop AIDS, and die in Sub-Saharan Africa. In addition, "more than 90% of AIDS orphans and children [were] infected with HIV".<ref>Template:Cite journal</ref>
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.<ref name="ReferenceA">Susan Hunter, "Black Death: AIDS in Africa", Palrave Macmillan 2003 chapter 2</ref>
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.<ref name="ODIhiv">Samuels, Fiona (2009) HIV and emergencies: one size does not fit all Template:Webarchive, London: Overseas Development Institute</ref> 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.<ref name="ODIhiv"/> 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.<ref name="ODIhiv"/>
Health industry
Sub-Saharan "Africans have always appreciated the importance of health care because good health is seen as necessary for the continuation and growth of their lineage".<ref name="Intercultural Press">Template:Cite book</ref> Without proper health the culture will not be able to thrive and grow. Unfortunately, "health services in many countries are swamped by the need to care for increasing numbers of infected and sick people. Ameliorative drugs are too expensive for most victims, except for a very small number who are affluent".<ref name="Intercultural Press"/> The greatest number of sick people with the fewest doctors, Sub-Saharan Africa "has 11 percent of the world's population but carries 24 percent of the global disease burden. With less than 1 percent of global health expenditure and only 3 percent of the world's health workers".Template:Citation needed
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When family members get sick with HIV or other sicknesses, family members often end up selling most of their belongings in order to provide health care for the individual. Medical facilities in many African countries are lacking. Many health care workers are also not available, in part due to lack of training by governments and in part due to the wooing of these workers by foreign medical organizations where there is a need for medical professionals.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Notably, Dr. Leopold Zekeng, a Cameroonian virologist and UNAIDS country director, has emphasized the importance of building local research infrastructure and public health capacity to reduce overreliance on external aid and improve treatment access across West and Central Africa. Template:Cite book
Many individuals who get a medical degree end up leaving Sub-Saharan Africa to work abroad "either to escape instability or to practice where they have better working conditions and a higher salary".<ref name="Health">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Many low income communities are very far away from a hospital and they cannot afford to bus there or pay for medical attention once they arrive. "Healthcare in Africa differs widely, depending on the country and also the region – those living in urban areas are more likely to receive better healthcare services than those in rural or remote regions".<ref name="Health"/>
It is very common to just wait out a sickness or seek help from a neighbor or relative. Currently antiretroviral therapy is the closest to a cure. Many hospitals lack enough antiretroviral drugs to treat everyone. This may be because most Sub-Saharan African countries invest "as little as 1-4 dollars per capita, [so] overseas aid is a major source of funding for healthcare".<ref name="Health"/>
Many overseas organizations are very hesitant to give antiretroviral drugs to Sub-Saharan Africa because they are expensive, which means that there is only so much they can give. Relying on other countries for help in general requires more paperwork and faith in another country very far away. Delivery of drugs and other aid takes many month and years to arrive in the hands of those that need help.<ref name=":3" />
Medical factors
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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.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> The distrust of modern medicine is sometimes linked to theories of a "Western Plot"<ref>"Combating anti-vaccination rumors: Lessons learned from case studies in Africa", UNICEF, Nairobi</ref> of mass sterilization or population reduction. Author Harriet A. Washington argues that this may be due to several high-profile incidents involving western medical practitioners.<ref>Template:Cite news</ref>
Pharmaceutical industry
Africans are still fighting against unethical human experimentation and other practices of unfair treatment by the pharmaceutical industry.<ref name="ReferenceB">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</ref> Medical experimentation occurs in Africa on many medications, but once approved, access to the drug is difficult.<ref name="ReferenceB"/>
South African scientists in a combined effort with American scientists from Gilead Sciences recently tested and found effective a tenofovir-based anti-retroviral vaginal gel that could be used as pre-exposure prophylaxis. Testing of this gel was conducted at the University of KwaZulu-Natal in Durban, South Africa.<ref>Template:Cite journal</ref> The FDA in the US is in the process of reviewing the drug for approval for US use.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref><ref>Template:Cite news</ref> The AIDS/HIV epidemic has led to the rise in unethical medical experimentation in Africa.<ref name="ReferenceB"/>
Since the epidemic is widespread, African governments sometimes relax their laws in order to get research conducted in their countries which they would otherwise not afford.<ref name="ReferenceB"/> Global organizations such as the Clinton Foundation, are working to reduce the cost of HIV/AIDS medications in Africa and elsewhere. For example, the philanthropist Inder Singh oversaw a program which reduced the cost of paediatric HIV/AIDS drugs by between 80 and 92 percent by working with manufacturers to reduce production and distribution costs.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> Manufacturers often cite distribution and production difficulties in developing markets, which create a substantial barrier to entry.<ref name=":3">Template:Cite journal</ref>
Political factors
Major African political leaders have denied the link between HIV and AIDS, favoring alternate theories.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> 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.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Subtype factor
Subtypes A and C are the most prevalent HIV subtypes in Africa, and subtype C is the most prominent in the world, accounting for about 50% of all HIV infections.<ref>Template:Cite journal</ref><ref>Template:Cite journal</ref> Despite this, the majority of HIV research has historically been focused on subtype B, which constitutes only 12% of infections, mostly in Europe.<ref name=":4">Template:Cite journal</ref> Due to this lack of research, it is currently unclear whether or not subtype C has evolved factors for increased viral transmission compared to other HIV subtypes.<ref name=":4" />
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.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Health care delivery
While there is currently no cure or vaccine for HIV/AIDS there are emerging treatments. It has been extensively discussed that antiretroviral drugs (ART) are crucial for preventing the acquiring of AIDS. AIDS is acquired at the final stage of the HIV virus, which can be completely averted. It is overwhelmingly possible to live with the virus and never acquire AIDS. The proper obedience to ART drugs can provide an infected person with a limitless future. ART drugs are key in preventing the diseases from progressing as well as ensuring the disease is well controlled, thus forbidding the disease from becoming resistant to the treatments.<ref>Template:Cite journal</ref>
In countries like Nigeria and the Central African Republic, less than 25% of the population has access to the ART drugs.<ref>Template:Cite journal</ref> Funds devoted to ART drug access were measured at $19.1 billion in 2013 in low and middle-income countries among the region, however the funds were short of the UNAIDS' previous resource needs estimates of $22–24 billion by 2015.<ref>Template:Cite journal</ref>
Measurement
Prevalence measures include everyone living with HIV and AIDS, and present a delayed representation of the epidemic by aggregating the HIV infections of many years. Incidence, in contrast, measures the number of new infections, usually over the previous year. There is no practical, reliable way to assess incidence in Sub-Saharan Africa. Prevalence in 15- to 24-year-old pregnant women attending antenatal clinics is sometimes used as an approximation. The test done to measure prevalence is a sero survey in which blood is tested for the presence of HIV.Template:Citation needed
Health units that conduct sero surveys rarely operate in remote rural communities, and the data collected also does not measure people who seek alternate healthcare. Extrapolating national data from antenatal surveys relies on assumptions which may not hold across all regions and at different stages in an epidemic.Template:Citation needed
Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries.Template:Citation needed
A minority of scientists claim that as many as 40 percent of HIV infections in African adults may be caused by unsafe medical practices rather than by sexual activity.<ref>Africa: HIV/AIDS through Unsafe Medical Care Template:Webarchive. Africaaction.org. Retrieved on 25 October 2010.</ref> The World Health Organization states that about 2.5 percent of HIV infections in Sub-Saharan Africa are caused by unsafe medical injection practices and the "overwhelming majority" by unprotected sex.<ref>{{#invoke:citation/CS1|citation |CitationClass=web }}</ref>
Tuberculosis coinfections
Much of the deadliness of the epidemic in Sub-Saharan Africa is caused by a deadly synergy between HIV and tuberculosis, termed a "co-epidemic".<ref name="DUAL">Template:Cite news</ref> The two diseases have been "inextricably bound together" since the beginning of the HIV epidemic.<ref name="Friedman">{{#invoke:citation/CS1|citation |CitationClass=web }}</ref> "Tuberculosis and HIV co-infections are associated with special diagnostic and therapeutic challenges and constitute an immense burden on healthcare systems of heavily infected countries like Ethiopia."<ref>Template:Cite journal</ref>
In many countries without adequate resources, the tuberculosis case rate has increased five to ten-fold since the identification of HIV.<ref name="Friedman"/> Without proper treatment, an estimated 90 percent of persons living with HIV die within months after contracting tuberculosis.<ref name="DUAL"/> The initiation of highly active antiretroviral therapy in persons coinfected with tuberculosis can cause an immune reconstitution inflammatory syndrome with a worsening, in some cases severe worsening, of tuberculosis infection and symptoms.<ref>Template:Cite journal</ref>
An estimated 874,000 people in Sub-Saharan Africa were living with both HIV and tuberculosis in 2011,<ref name="UNAIDS 2012"/> with 330,000 in South Africa, 83,000 in Mozambique, 50,000 in Nigeria, 47,000 in Kenya, and 46,000 in Zimbabwe.<ref name="TB/HIV"/> In terms of cases per 100,000 population, Eswatini's rate of 1,010 per 100,000, or approximately 1%, was by far the highest in 2011.<ref name="TB/HIV"/>
In the following 20 African countries, the cases-per-100,000 coinfection rate increased at least 20 percent between 2000 and 2011: Algeria, Angola, Chad, Comoros, Republic of the Congo, Democratic Republic of the Congo, Equatorial Guinea, The Gambia, Lesotho, Liberia, Mauritania, Mauritius, Morocco, Mozambique, Senegal, Sierra Leone, South Africa, Eswatini, Togo, and Tunisia.Template:Citation needed
Since 2004, 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.<ref name="UNAIDS 2012"/>
| Country | citation | CitationClass=web
}}</ref> !! Concurrent | ||
|---|---|---|---|---|
| North Africa | ||||
| Algeria | 1 | 360 | 0.3 | 100 |
| Egypt | <0.1 | 43 | <0.1 | 56 |
| Libya | 3.4 | 220 | not available | not available |
| Morocco | 0.9 | 300 | 0.4 | 110 |
| Sudan | 8.2 | 2,800 | 9.3 | 3,200 |
| Tunisia | 0.6 | 66 | 0.6 | 53 |
| Horn of Africa | ||||
| Djibouti | 63 | 570 | 86 | 730 |
| Eritrea | 8.2 | 440 | 20 | 750 |
| Ethiopia | 45 | 38,000 | 141 | 93,000 |
| Somalia | 22 | 2,100 | 27 | 2,000 |
| Central Africa | ||||
| Angola | 43 | 8,500 | 44 | 6,100 |
| Cameroon | 93 | 19,000 | 130 | 20,000 |
| Central African Republic | 159 | 7,100 | 591 | 22,000 |
| Chad | 45 | 5,200 | 51 | 4,200 |
| Congo | 119 | 4,900 | 126 | 3,900 |
| Democratic Republic of the Congo | 49 | 34,000 | 57 | 28,000 |
| Equatorial Guinea | 52 | 370 | 47 | 250 |
| Gabon | 185 | 2,800 | 203 | 2,500 |
| São Tomé and Príncipe | 9 | 15 | 9.7 | 14 |
| Eastern Africa | ||||
| Burundi | 30 | 2,600 | 121 | 7,700 |
| Comoros | 1.4 | 11 | 0 | <10 |
| Kenya | 113 | 47,000 | 149 | 47,000 |
| Madagascar | 0.6 | 130 | 0.8 | 120 |
| Mauritius | 1.6 | 21 | 1.1 | 13 |
| Mayotte | not available | not available | not available | not available |
| Réunion | not available | not available | not available | not available |
| Rwanda | 27 | 2,900 | 141 | 11,000 |
| Seychelles | 5.8 | <10 | not available | not available |
| South Sudan | not available | not available | not available | not available |
| Tanzania | 65 | 30,000 | 106 | 36,000 |
| Uganda | 102 | 35,000 | 244 | 59,000 |
| Western Africa | ||||
| Benin | 12 | 1,100 | 20 | 1,300 |
| Burkina Faso | 9.5 | 1,600 | 22 | 2,700 |
| Cape Verde | 19 | 97 | 19 | 84 |
| Côte d'Ivoire | 50 | 10,000 | 155 | 26,000 |
| Gambia | 45 | 800 | 18 | 230 |
| Ghana | 18 | 4,600 | 47 | 9,000 |
| Guinea | 47 | 4,800 | 58 | 4,900 |
| Guinea-Bissau | 99 | 1,500 | 25 | 310 |
| Liberia | 31 | 1,300 | 33 | 940 |
| Mali | 9.4 | 1,500 | 16 | 1,800 |
| Mauritania | 43 | 1,500 | 21 | 550 |
| Niger | 11 | 1,700 | 18 | 2,000 |
| Nigeria | 30 | 50,000 | 42 | 52,000 |
| Senegal | 14 | 1,700 | 7.9 | 750 |
| Sierra Leone | 64 | 3,800 | 20 | 810 |
| Togo | 16 | 1,000 | 18 | 840 |
| Southern Africa | ||||
| Botswana | 292 | 5,900 | 611 | 11,000 |
| Lesotho | 481 | 11,000 | 425 | 8,300 |
| Malawi | 114 | 18,000 | 324 | 36,000 |
| Mozambique | 347 | 83,000 | 279 | 51,000 |
| Namibia | 359 | 8,400 | 787 | 15,000 |
| South Africa | 650 | 330,000 | 317 | 140,000 |
| Eswatini | 1,010 | 12,000 | 607 | 6,500 |
| Zambia | 285 | 38,000 | 493 | 50,000 |
| Zimbabwe | 360 | 46,000 | 666 | 83,000 |
Works
See also
- Demographics of Africa
- The Global Fund to Fight AIDS, Tuberculosis and Malaria
- HIV/AIDS in Malawi
- President's Emergency Plan for AIDS Relief, PEPFAR program
- South African model of the pandemic
- Syphilis in sub-Saharan Africa
- United Nations Special Envoy for HIV/AIDS in Africa
- Leopold Zekeng
International
- HIV/AIDS in Asia
- HIV/AIDS in Australia
- HIV/AIDS in Europe
- HIV/AIDS in North America
- HIV/AIDS in South America
Notes
References
Further reading
External links
- AIDS: Voices From Africa Template:Webarchive - slideshow by Life magazine
- AIDS at UNFPA
- Visualization tool for HIV/AIDS prevalence in sub-Saharan Africa from 2000 to 2017
Template:AIDS Template:Africa in topic Template:Africa topics