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How many people in Africa are infected with HIV?
Approximately 95 percent of all AIDS orphans in the world live in sub-Saharan AfricaSub-Saharan Africa is the region of the world that is most affected by HIV & AIDS. An estimated 25.8 million people were living with HIV at the end of 2005 and approximately 3.1 million new infections occurred during that year. In just the past year the epidemic has claimed the lives of an estimated 2.4 million people in this region. More than twelve million children have been orphaned by AIDS.
The extent of the epidemic is only now becoming clear in many African countries, as increasing numbers of people with HIV are now becoming ill. In the absence of massively expanded prevention, treatment and care efforts, the AIDS death toll on the continent is expected to continue rising before peaking around the end of the decade. This means that the worst of the epidemic's impact on these societies will be felt in the course of the next ten years and beyond. Its social and economic consequences are already being felt widely not only in health but in education, industry, agriculture, transport, human resources and the economy in general.
How are different countries in Africa affected?
Large variations exist between individual countries. In some African countries, the epidemic is still growing despite its severity. Others face a growing danger of explosive growth. The sharp rise in HIV prevalence among pregnant women in Cameroon (more than doubling to over 11% among those aged 20-24 between 1998 and 2000) shows how suddenly the epidemic can surge.
National HIV prevalence rates vary greatly between countries. In Somalia and Gambia the prevalence is under 2% of the adult population, whereas in South Africa and Zambia around 20% of the adult population is infected.
In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 24%. These countries are Botswana (37.3%), Lesotho (28.9%), Swaziland (38.8%) and Zimbabwe (24.6%).
West Africa is relatively less affected by HIV infection, but the prevalence rates in some countries are creeping up. In west and central Africa HIV prevalence is estimated to exceed 5% in several countries including Cameroon (6.9%), Central African Republic (13.5%), Côte d'Ivoire (7.0%) and Nigeria (5.4%).
Until recently the national prevalence rate has remained relatively low in Nigeria, the most populous country in sub-Saharan Africa. The rate has grown slowly from 1.9% in 1993 to 5.4% in 2003. But some states in Nigeria are already experiencing HIV prevalence rates as high as those now found in Cameroon. Already around 3.6 million Nigerians are estimated to be living with HIV.
HIV infection in Eastern Africa varies between adult prevalence rates of 2.7% in Eritrea to 8.8% in Tanzania. In Uganda the countrywide prevalence among the adult population is 4.1%.
See our sub-Saharan statistics page for more national data.
Trends in the epidemic
The prevalence of HIV infections among a country's adult population - that is, the percentage of the adult population living with HIV - is a measure of the overall state of the epidemic in a country. But the prevalence gives a less clear picture of recent trends in the epidemic, because it does not distinguish between people who acquired the virus very recently and those who were infected a decade or more ago.
Regular measurement of HIV prevalence amongst groups of young people can give an indication of the HIV incidence amongst them, that is, the number of new infections occurring. The steadily dropping HIV prevalence over the last few years, among 15-19 year olds in Uganda, provide a more accurate picture of the trend in the epidemic in Uganda, and in this instance the effectiveness of prevention efforts among young people.
What is the effect of these levels of infections?
Over and above the personal suffering that accompanies HIV infection wherever it strikes, HIV in sub-Saharan Africa threatens to devastate whole communities, rolling back decades of progress towards a healthier and more prosperous future.
Sub-Saharan Africa faces a triple challenge of colossal proportions:
bringing health care, support and solidarity to a growing population of people with HIV-related illness,
reducing the annual toll of new infections by enabling individuals to protect themselves and others,
coping with the cumulative impact of over 17 million AIDS deaths on orphans and other survivors, on communities, and on national development.
What is the impact of HIV & AIDS on Africa?
HIV & AIDS have a widespread impact on many parts of society.
In many countries of Sub-Saharan Africa, AIDS is erasing decades of progress made in extending life expectancy. Millions of adults are dying young or in early middle age. Average life expectancy in Sub-Saharan Africa is now 47 years, when it could have been 62 without AIDS.
Children orphaned by AIDS in EthiopiaThe toll of HIV/AIDS on households can be very severe. Many families are losing their income earners and the families of those that die have to find money to pay for their funerals. Many of those dying have surviving partners who are themselves infected and in need of care. They leave behind children grieving and struggling to survive without a parent's care. HIV/AIDS strips the family assets further impoverishing the poor. In many cases, the presence of AIDS means that the household eventually dissolves, as the parents die and children are sent to relatives for care and upbringing.
In all affected countries, the HIV/AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic matures, the demand for care for those living with HIV rises, as does the toll amongst health workers. Health-care services face different levels of strain, depending on the number of people who seek services, the nature of their need, and the capacity to deliver that care.
How schools and other educational institutions are able to cope is a major factor in how well societies will eventually recover from the HIV/AIDS epidemic. A decline in school enrolment is one of the most visible effects of the HIV/AIDS epidemic on education in Africa.
HIV/AIDS dramatically affects labour, setting back economic activity and social progress. The vast majority of people living with HIV/AIDS in Africa are between the ages of 15 and 49 - in the prime of their working lives. Employers, schools, factories and hospitals have to train other staff to replace those at the workplace who become too ill to work.
Through its impacts on the labour force, households and enterprises, HIV/AIDS can act as a significant brake on economic growth and development. HIV/AIDS is already having a major affect on Africa's economic development, and in turn, this affects Africa's ability to cope with the epidemic.
See our African impact page for more information.
HIV prevention in Africa
A continuing rise in the number of HIV infected people is not inevitable. There is growing evidence that prevention efforts can be effective, and this includes initiatives in some of the most heavily affected countries.
In some countries there has been early and sustained prevention efforts. For example in Senegal there was effective prevention, which is still reflected in the relatively low adult prevalence rate of 0.8%. Also, Uganda shows that a widespread epidemic can be brought under control.
However, much of the progress is still occurring in localised settings. One new study in Zambia has shown success in prevention efforts. The study reported that urban men and women are less sexually active, that fewer had multiple partners and that condoms were used more consistently. This is in line with findings that HIV prevalence has declined significantly among 15-29 year-old urban women (down to 24.1% in 1999 from 28.3% in 1996), as well as amongst rural women aged 15-24 (down from 16.1% to 12.2% in the same period). Although these rates are still unacceptably high, this drop has prompted a hope that, if Zambia continues this response, it could become the second African country (after Uganda) to reverse a devastating epidemic. However, many hurdles still separate the country from such a milestone. For example, condom use amongst rural men remains very low (reported as 15% in 2001 compared to 68% for urban men when they last had sex with a casual or paid partner).
A murual in Durban, South Africa designed to increase awareness about HIV/AIDS in AfricaIn South Africa, for pregnant women under 20, HIV prevalence rates fell to 15.4% in 2001 (down from 21% in 1998). This suggests that awareness campaigns and prevention programmes are now starting to work. But a major challenge now is to sustain and build on such uncertain success, not least because HIV infection levels continue to rise among older pregnant women.
In Côte d'Ivoire the prevalence amongst female sex workers fell from 89% to 32% in the period 1991 to 1998. Partly explaining this positive development is the fact that the number of workers who said they had used condoms in their most recent working day, increased from 20% in 1992 to 78% in 1998. Sustained prevention efforts, built around local initiatives, have been central to this shift.
Overall a massive expansion in prevention efforts is needed, and although there is not one proven way to prevent new infections, the major components of a successful prevention programme are now known.
Provision of condoms
It was reported in 2001, that the overall provision of condoms to sub-Saharan Africa is only 4.6 per man per year. So another 1.9 billion condoms need to be provided if all countries are to have the same amount as the highest six countries in Africa. Botswana, South Africa, Zimbabwe, Togo, Congo and Kenya are supplied with about 17 condoms per man aged 15 to 59 years. It would cost an estimated $47.5 million (£34m) a year to fill the 1.9 billion condom gap excluding service delivery costs and production. Relative to the enormity of the HIV/AIDS pandemic in Africa, providing condoms is cheap and cost effective.1
However, condoms are not without their drawbacks, especially in the context of a stable partnership where pregnancy is desired, or where it may be difficult for one partner to suddenly suggest using condoms. For many individuals and couples in Africa, where HIV prevalence rates are high, finding out their infection status could expand their range of HIV prevention options.
Provision of Voluntary Counselling & Testing (VCT)
The provision of voluntary HIV counselling and testing (VCT) is an important part of any national prevention program. It is widely recognised that knowledge of their HIV infection can help a person to stay healthy for longer as well as preventing new infections. VCT also provides benefit for those who test negative. For those people who learn that they are negative, it may result in a change of behaviour. The provision of VCT has become easier, cheaper and more effective as a result of the availability of rapid HIV testing and therefore could and indeed needs to be made much more widely available in many sub-Saharan African countries.
HIV/AIDS-related care in Africa
A tiny fraction of the millions of Africans in need of antiretroviral treatment are receiving it. Many millions are not even receiving treatment for opportunistic infections. These figures reflect the world's continuing failure, despite the progress of recent years, to mount a response that matches the scale and severity of the global HIV/AIDS epidemic.
Treatment and care for HIV/AIDS consists of a number of different elements apart from antiretroviral drugs. These include voluntary counselling and testing (VCT), food and management of nutritional effects, follow-up counselling, protection from stigma and discrimination, treatment of STIs, and the prevention and treatment of opportunistic infections (OIs). All the things that need to be provided apart from antiretrovirals (ARVs) can, and indeed should be provided before ARVs are available. This does not exclude the provision of ARVs when they are available. Indeed, when antiretrovirals do become available the provision of antiretroviral therapy should be easier and quicker to implement because many of the things apart from drugs that are needed for successful ART are already in place.
The World Health Organisation (WHO) in its guidance for the use of ARVs in resource limited countries, has stated that for the successful use of antiretroviral drugs, there needs to be access to specific services and facilities, which include:
HIV counselling and testing and follow-up counselling services
Capacity to appropriately manage HIV related illness and opportunistic infections
A continuous supply of medicines for the treatment of opportunistic infections and other HIV related illnesses.
Little emphasis is being placed by many countries on the provision of these services, despite the fact that many countries are discussing the provision of ARVS for those living with HIV/AIDS.
Botswana has become the first African country to aim to provide antiretroviral therapy to its citizens on a national scale. It is believed by many that if any country in Africa is going to succeed in implementing such a comprehensive HIV/AIDS care and treatment programme, then it is Botswana. But its ambitious antiretroviral drug programme, MASA, has not yet been as successful as first hoped. Of the 300,000 HIV-infected people, 110,000 were estimated to meet the criteria to qualify for treatment. The government aimed to enrol 19,000 people in the first year, but only 3,500 were actually enrolled. By June 2004, this had risen to around 18,000.
This disappointing outcome has highlighted a number of issues related to providing antiretroviral therapy. These include the education and training of health care workers and the strength of the infrastructure. If other countries with fewer resources by head of population are to follow the example of Botswana, there are still many lessons to be learned. A considerable emphasis needs to be placed not only on the availability of antiretroviral drugs, but the availability of health care professionals and an adequate infrastructure.
See our resource-poor treatment and care page for more information.
What need to be done to make a difference in Africa?
A mural in Durban, designed to increase awareness about HIV/AIDS in AfricaAdditional money is needed to combat the epidemic in Africa. It was estimated in 2000, that US$ 1.5 billion a year would make it possible to achieve higher levels of implementation of successful prevention programmes for the whole of Sub Saharan Africa. These prevention programmes would cover sexual, mother-to-child and blood transfusion related HIV transmission. In the area of care for orphans and for people living with HIV or AIDS, costs depend very much on what kind of care is being provided. It is estimated that, with at least US$ 1.5 billion a year, countries in sub-Saharan Africa could provide some people with symptom and pain relief (palliative care), could treat and prevent opportunistic infections and provide care for orphans. Making a start on providing antiretroviral therapy would add several billion dollars annually to the bill.
In April 2001, the U.N. Secretary General, Kofi Annan, called for action what is now known as the Global Fund to fight AIDS, Tuberculosis and Malaria. When the Global Fund was started, it was hoped that it would be an effective mechanism to attract and manage resources to deal with international health issues. In 2001, the UN Secretary General quoted an estimate of $7-10 billion being required annually to tackle the HIV/AIDS epidemic in low and middle income countries worldwide.
In its first year, in two rounds of programme proposals and approvals, the Global Fund has awarded $1.5 billion, of which Africa is being given 62%. Of the overall total 56% is being given for HIV/AIDS related purposes. The Global Fund has unfortunately not raised as much money as it was first hoped. Also, the administrative processing of the funds has been slow and has delaying the actual distribution of the money. By the beginning of June 2003 only 9 African countries had actually received money from the fund for HIV/AIDS, and the total distributed for projects in Africa was only $5,8 million.
But more than money is needed to provide HIV/AIDS related prevention, care and treatment. In order to implement prevention, care and treatment programmes, a country's health, education, communications and other infrastructures have to be well enough developed in order to deliver these interventions. In some countries, these systems are already under strain and they are likely to crumble even further under the weight of AIDS. Money can also only be used wisely if there are sufficient people available. And the shortage of trained adults is already acute in some countries of sub-Saharan Africa. If antiretroviral drug programmes are to be implemented, the health infrastructure to do this must be in place and must be strong enough to support the programme.
African countries also, in many instances, need more commitment from their governments. There are promising signs that some governments are starting to respond and becoming more and more involved.
HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic in Africa. Fear of discrimination often prevents people from getting tested, seeking treatment for AIDS or from admitting their HIV status publicly. More HIV/AIDS related education is needed in Africa since no policy or law alone can combat HIV/AIDS related discrimination. The fear and prejudice that lies at the core of the HIV/AIDS discrimination needs to be tackled at both community and national levels.
Also, in many parts of Sub-Saharan Africa, as elsewhere in the world, the inequality between men and women, and economic deprivation helps to drive the epidemic. Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. In countries with generalised epidemics in Africa, up to 80% of women aged 15-24 have been shown to lack sufficient knowledge about HIV/AIDS. Women and girls may need to receive specific attention in any HIV prevention program.
These are some of the serious challenges that African countries and their partners in the global community will have to face if they are to make a real difference to the epidemic.
The way forward
To tackle HIV/AIDS in Africa is not an easy task. Many efforts are and will be needed. The long-term planning to slow the epidemic and reduce its impact needs be highlighted. One of the best ways to tackle HIV/AIDS is prevention. Those prevention efforts that work in Africa and individual countries need to be identified and sustained. This also means enabling the more-than 90% of Africans to protect themselves against infection. The other massive challenge is that of ensuring that the estimated 9% of African adults who are HIV-positive get the treatment and care they need.
More resources are needed in Africa for HIV/AIDS including money. However, if there are no resources to be used, innovative solutions need to be developed at lower cost. These efforts may be small but they will still play a role before sufficient resources are in place. Innovative and culturally specific approaches are needed to deal with any aspect of HIV/AIDS. They may not only be cheaper but more suitable for the people that they engage.
It is also likely to be many years until ARVs are widely available in Africa. Therefore, it is important everything that can be done and should be done to provide care and support for people living with HIV/AIDS before the arrival of antiretroviral drugs. For example, many of the common HIV-related opportunistic infections are fairly easy to prevent and treat. The prevention and treatment of opportunistic infections can result in significant gains in life expectancy and quality of life among people living with HIV. It is vitally important that all aspects and means of prevention, treatment and care are considered and used in Africa.
Useful links related to HIV/AIDS in Africa
The impact of HIV & AIDS in Africa www.avert.org/aidsimpact.htm
AIDS in Africa Q&A: the basics www.avert.org/aids-africa-questions-1.htm
AIDS in Africa Q&A: the issues www.avert.org/aids-africa-questions-2.htm
Getting HIV & AIDS antiretroviral drugs for Africa www.avert.org/aidsdrugsafrica.htm
Who is getting AIDS drugs? www.avert.org/aidstarget.htm
HIV & AIDS treatment and care in resource poor countries www.avert.org/hivcare.htm
HIV related opportunistic infections: prevention, treatment and care in resource poor countries www.avert.org/aidscare.htm
HIV & AIDS in Botswana www.avert.org/aidsbotswana.htm
HIV & AIDS in South Africa www.avert.org/aidssouthafrica.htm
HIV & AIDS in Uganda www.avert.org/aidsuganda.htm
HIV & AIDS in Zambia www.avert.org/aids-zambia.htm
HIV & AIDS in Nigeria www.avert.org/aids-nigeria.htm
AIDS orphans in Africa www.avert.org/aidsorphans.htm
Sub-Saharan Africa HIV & AIDS statistics www.avert.org/subaadults.htm
The sources included:
This page was edited and written by Jenni Fredriksson and Annabel Kanabus.
1 'British Medical Journal (2001) 'Not enough condoms are supplied to African men', Vol.323, 21 July
UNAIDS (2005) 'AIDS epidemic update', December
UNAIDS (2003) 'AIDS epidemic update', December
UNAIDS (2002) 'AIDS epidemic update', December
UNAIDS (2004) 'Report on the global HIV/AIDS epidemic 2004', July
UNAIDS (2002) 'Report on the global HIV/AIDS epidemic 2002', July
Last updated April 28, 2006
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UK
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How many people in Africa are infected with HIV?
Approximately 95 percent of all AIDS orphans in the world live in sub-Saharan AfricaSub-Saharan Africa is the region of the world that is most affected by HIV & AIDS. An estimated 25.8 million people were living with HIV at the end of 2005 and approximately 3.1 million new infections occurred during that year. In just the past year the epidemic has claimed the lives of an estimated 2.4 million people in this region. More than twelve million children have been orphaned by AIDS.
The extent of the epidemic is only now becoming clear in many African countries, as increasing numbers of people with HIV are now becoming ill. In the absence of massively expanded prevention, treatment and care efforts, the AIDS death toll on the continent is expected to continue rising before peaking around the end of the decade. This means that the worst of the epidemic's impact on these societies will be felt in the course of the next ten years and beyond. Its social and economic consequences are already being felt widely not only in health but in education, industry, agriculture, transport, human resources and the economy in general.
How are different countries in Africa affected?
Large variations exist between individual countries. In some African countries, the epidemic is still growing despite its severity. Others face a growing danger of explosive growth. The sharp rise in HIV prevalence among pregnant women in Cameroon (more than doubling to over 11% among those aged 20-24 between 1998 and 2000) shows how suddenly the epidemic can surge.
National HIV prevalence rates vary greatly between countries. In Somalia and Gambia the prevalence is under 2% of the adult population, whereas in South Africa and Zambia around 20% of the adult population is infected.
In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 24%. These countries are Botswana (37.3%), Lesotho (28.9%), Swaziland (38.8%) and Zimbabwe (24.6%).
West Africa is relatively less affected by HIV infection, but the prevalence rates in some countries are creeping up. In west and central Africa HIV prevalence is estimated to exceed 5% in several countries including Cameroon (6.9%), Central African Republic (13.5%), Côte d'Ivoire (7.0%) and Nigeria (5.4%).
Until recently the national prevalence rate has remained relatively low in Nigeria, the most populous country in sub-Saharan Africa. The rate has grown slowly from 1.9% in 1993 to 5.4% in 2003. But some states in Nigeria are already experiencing HIV prevalence rates as high as those now found in Cameroon. Already around 3.6 million Nigerians are estimated to be living with HIV.
HIV infection in Eastern Africa varies between adult prevalence rates of 2.7% in Eritrea to 8.8% in Tanzania. In Uganda the countrywide prevalence among the adult population is 4.1%.
See our sub-Saharan statistics page for more national data.
Trends in the epidemic
The prevalence of HIV infections among a country's adult population - that is, the percentage of the adult population living with HIV - is a measure of the overall state of the epidemic in a country. But the prevalence gives a less clear picture of recent trends in the epidemic, because it does not distinguish between people who acquired the virus very recently and those who were infected a decade or more ago.
Regular measurement of HIV prevalence amongst groups of young people can give an indication of the HIV incidence amongst them, that is, the number of new infections occurring. The steadily dropping HIV prevalence over the last few years, among 15-19 year olds in Uganda, provide a more accurate picture of the trend in the epidemic in Uganda, and in this instance the effectiveness of prevention efforts among young people.
What is the effect of these levels of infections?
Over and above the personal suffering that accompanies HIV infection wherever it strikes, HIV in sub-Saharan Africa threatens to devastate whole communities, rolling back decades of progress towards a healthier and more prosperous future.
Sub-Saharan Africa faces a triple challenge of colossal proportions:
bringing health care, support and solidarity to a growing population of people with HIV-related illness,
reducing the annual toll of new infections by enabling individuals to protect themselves and others,
coping with the cumulative impact of over 17 million AIDS deaths on orphans and other survivors, on communities, and on national development.
What is the impact of HIV & AIDS on Africa?
HIV & AIDS have a widespread impact on many parts of society.
In many countries of Sub-Saharan Africa, AIDS is erasing decades of progress made in extending life expectancy. Millions of adults are dying young or in early middle age. Average life expectancy in Sub-Saharan Africa is now 47 years, when it could have been 62 without AIDS.
Children orphaned by AIDS in EthiopiaThe toll of HIV/AIDS on households can be very severe. Many families are losing their income earners and the families of those that die have to find money to pay for their funerals. Many of those dying have surviving partners who are themselves infected and in need of care. They leave behind children grieving and struggling to survive without a parent's care. HIV/AIDS strips the family assets further impoverishing the poor. In many cases, the presence of AIDS means that the household eventually dissolves, as the parents die and children are sent to relatives for care and upbringing.
In all affected countries, the HIV/AIDS epidemic is bringing additional pressure to bear on the health sector. As the epidemic matures, the demand for care for those living with HIV rises, as does the toll amongst health workers. Health-care services face different levels of strain, depending on the number of people who seek services, the nature of their need, and the capacity to deliver that care.
How schools and other educational institutions are able to cope is a major factor in how well societies will eventually recover from the HIV/AIDS epidemic. A decline in school enrolment is one of the most visible effects of the HIV/AIDS epidemic on education in Africa.
HIV/AIDS dramatically affects labour, setting back economic activity and social progress. The vast majority of people living with HIV/AIDS in Africa are between the ages of 15 and 49 - in the prime of their working lives. Employers, schools, factories and hospitals have to train other staff to replace those at the workplace who become too ill to work.
Through its impacts on the labour force, households and enterprises, HIV/AIDS can act as a significant brake on economic growth and development. HIV/AIDS is already having a major affect on Africa's economic development, and in turn, this affects Africa's ability to cope with the epidemic.
See our African impact page for more information.
HIV prevention in Africa
A continuing rise in the number of HIV infected people is not inevitable. There is growing evidence that prevention efforts can be effective, and this includes initiatives in some of the most heavily affected countries.
In some countries there has been early and sustained prevention efforts. For example in Senegal there was effective prevention, which is still reflected in the relatively low adult prevalence rate of 0.8%. Also, Uganda shows that a widespread epidemic can be brought under control.
However, much of the progress is still occurring in localised settings. One new study in Zambia has shown success in prevention efforts. The study reported that urban men and women are less sexually active, that fewer had multiple partners and that condoms were used more consistently. This is in line with findings that HIV prevalence has declined significantly among 15-29 year-old urban women (down to 24.1% in 1999 from 28.3% in 1996), as well as amongst rural women aged 15-24 (down from 16.1% to 12.2% in the same period). Although these rates are still unacceptably high, this drop has prompted a hope that, if Zambia continues this response, it could become the second African country (after Uganda) to reverse a devastating epidemic. However, many hurdles still separate the country from such a milestone. For example, condom use amongst rural men remains very low (reported as 15% in 2001 compared to 68% for urban men when they last had sex with a casual or paid partner).
A murual in Durban, South Africa designed to increase awareness about HIV/AIDS in AfricaIn South Africa, for pregnant women under 20, HIV prevalence rates fell to 15.4% in 2001 (down from 21% in 1998). This suggests that awareness campaigns and prevention programmes are now starting to work. But a major challenge now is to sustain and build on such uncertain success, not least because HIV infection levels continue to rise among older pregnant women.
In Côte d'Ivoire the prevalence amongst female sex workers fell from 89% to 32% in the period 1991 to 1998. Partly explaining this positive development is the fact that the number of workers who said they had used condoms in their most recent working day, increased from 20% in 1992 to 78% in 1998. Sustained prevention efforts, built around local initiatives, have been central to this shift.
Overall a massive expansion in prevention efforts is needed, and although there is not one proven way to prevent new infections, the major components of a successful prevention programme are now known.
Provision of condoms
It was reported in 2001, that the overall provision of condoms to sub-Saharan Africa is only 4.6 per man per year. So another 1.9 billion condoms need to be provided if all countries are to have the same amount as the highest six countries in Africa. Botswana, South Africa, Zimbabwe, Togo, Congo and Kenya are supplied with about 17 condoms per man aged 15 to 59 years. It would cost an estimated $47.5 million (£34m) a year to fill the 1.9 billion condom gap excluding service delivery costs and production. Relative to the enormity of the HIV/AIDS pandemic in Africa, providing condoms is cheap and cost effective.1
However, condoms are not without their drawbacks, especially in the context of a stable partnership where pregnancy is desired, or where it may be difficult for one partner to suddenly suggest using condoms. For many individuals and couples in Africa, where HIV prevalence rates are high, finding out their infection status could expand their range of HIV prevention options.
Provision of Voluntary Counselling & Testing (VCT)
The provision of voluntary HIV counselling and testing (VCT) is an important part of any national prevention program. It is widely recognised that knowledge of their HIV infection can help a person to stay healthy for longer as well as preventing new infections. VCT also provides benefit for those who test negative. For those people who learn that they are negative, it may result in a change of behaviour. The provision of VCT has become easier, cheaper and more effective as a result of the availability of rapid HIV testing and therefore could and indeed needs to be made much more widely available in many sub-Saharan African countries.
HIV/AIDS-related care in Africa
A tiny fraction of the millions of Africans in need of antiretroviral treatment are receiving it. Many millions are not even receiving treatment for opportunistic infections. These figures reflect the world's continuing failure, despite the progress of recent years, to mount a response that matches the scale and severity of the global HIV/AIDS epidemic.
Treatment and care for HIV/AIDS consists of a number of different elements apart from antiretroviral drugs. These include voluntary counselling and testing (VCT), food and management of nutritional effects, follow-up counselling, protection from stigma and discrimination, treatment of STIs, and the prevention and treatment of opportunistic infections (OIs). All the things that need to be provided apart from antiretrovirals (ARVs) can, and indeed should be provided before ARVs are available. This does not exclude the provision of ARVs when they are available. Indeed, when antiretrovirals do become available the provision of antiretroviral therapy should be easier and quicker to implement because many of the things apart from drugs that are needed for successful ART are already in place.
The World Health Organisation (WHO) in its guidance for the use of ARVs in resource limited countries, has stated that for the successful use of antiretroviral drugs, there needs to be access to specific services and facilities, which include:
HIV counselling and testing and follow-up counselling services
Capacity to appropriately manage HIV related illness and opportunistic infections
A continuous supply of medicines for the treatment of opportunistic infections and other HIV related illnesses.
Little emphasis is being placed by many countries on the provision of these services, despite the fact that many countries are discussing the provision of ARVS for those living with HIV/AIDS.
Botswana has become the first African country to aim to provide antiretroviral therapy to its citizens on a national scale. It is believed by many that if any country in Africa is going to succeed in implementing such a comprehensive HIV/AIDS care and treatment programme, then it is Botswana. But its ambitious antiretroviral drug programme, MASA, has not yet been as successful as first hoped. Of the 300,000 HIV-infected people, 110,000 were estimated to meet the criteria to qualify for treatment. The government aimed to enrol 19,000 people in the first year, but only 3,500 were actually enrolled. By June 2004, this had risen to around 18,000.
This disappointing outcome has highlighted a number of issues related to providing antiretroviral therapy. These include the education and training of health care workers and the strength of the infrastructure. If other countries with fewer resources by head of population are to follow the example of Botswana, there are still many lessons to be learned. A considerable emphasis needs to be placed not only on the availability of antiretroviral drugs, but the availability of health care professionals and an adequate infrastructure.
See our resource-poor treatment and care page for more information.
What need to be done to make a difference in Africa?
A mural in Durban, designed to increase awareness about HIV/AIDS in AfricaAdditional money is needed to combat the epidemic in Africa. It was estimated in 2000, that US$ 1.5 billion a year would make it possible to achieve higher levels of implementation of successful prevention programmes for the whole of Sub Saharan Africa. These prevention programmes would cover sexual, mother-to-child and blood transfusion related HIV transmission. In the area of care for orphans and for people living with HIV or AIDS, costs depend very much on what kind of care is being provided. It is estimated that, with at least US$ 1.5 billion a year, countries in sub-Saharan Africa could provide some people with symptom and pain relief (palliative care), could treat and prevent opportunistic infections and provide care for orphans. Making a start on providing antiretroviral therapy would add several billion dollars annually to the bill.
In April 2001, the U.N. Secretary General, Kofi Annan, called for action what is now known as the Global Fund to fight AIDS, Tuberculosis and Malaria. When the Global Fund was started, it was hoped that it would be an effective mechanism to attract and manage resources to deal with international health issues. In 2001, the UN Secretary General quoted an estimate of $7-10 billion being required annually to tackle the HIV/AIDS epidemic in low and middle income countries worldwide.
In its first year, in two rounds of programme proposals and approvals, the Global Fund has awarded $1.5 billion, of which Africa is being given 62%. Of the overall total 56% is being given for HIV/AIDS related purposes. The Global Fund has unfortunately not raised as much money as it was first hoped. Also, the administrative processing of the funds has been slow and has delaying the actual distribution of the money. By the beginning of June 2003 only 9 African countries had actually received money from the fund for HIV/AIDS, and the total distributed for projects in Africa was only $5,8 million.
But more than money is needed to provide HIV/AIDS related prevention, care and treatment. In order to implement prevention, care and treatment programmes, a country's health, education, communications and other infrastructures have to be well enough developed in order to deliver these interventions. In some countries, these systems are already under strain and they are likely to crumble even further under the weight of AIDS. Money can also only be used wisely if there are sufficient people available. And the shortage of trained adults is already acute in some countries of sub-Saharan Africa. If antiretroviral drug programmes are to be implemented, the health infrastructure to do this must be in place and must be strong enough to support the programme.
African countries also, in many instances, need more commitment from their governments. There are promising signs that some governments are starting to respond and becoming more and more involved.
HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic in Africa. Fear of discrimination often prevents people from getting tested, seeking treatment for AIDS or from admitting their HIV status publicly. More HIV/AIDS related education is needed in Africa since no policy or law alone can combat HIV/AIDS related discrimination. The fear and prejudice that lies at the core of the HIV/AIDS discrimination needs to be tackled at both community and national levels.
Also, in many parts of Sub-Saharan Africa, as elsewhere in the world, the inequality between men and women, and economic deprivation helps to drive the epidemic. Women and girls are commonly discriminated against in terms of access to education, employment, credit, health care, land and inheritance. In countries with generalised epidemics in Africa, up to 80% of women aged 15-24 have been shown to lack sufficient knowledge about HIV/AIDS. Women and girls may need to receive specific attention in any HIV prevention program.
These are some of the serious challenges that African countries and their partners in the global community will have to face if they are to make a real difference to the epidemic.
The way forward
To tackle HIV/AIDS in Africa is not an easy task. Many efforts are and will be needed. The long-term planning to slow the epidemic and reduce its impact needs be highlighted. One of the best ways to tackle HIV/AIDS is prevention. Those prevention efforts that work in Africa and individual countries need to be identified and sustained. This also means enabling the more-than 90% of Africans to protect themselves against infection. The other massive challenge is that of ensuring that the estimated 9% of African adults who are HIV-positive get the treatment and care they need.
More resources are needed in Africa for HIV/AIDS including money. However, if there are no resources to be used, innovative solutions need to be developed at lower cost. These efforts may be small but they will still play a role before sufficient resources are in place. Innovative and culturally specific approaches are needed to deal with any aspect of HIV/AIDS. They may not only be cheaper but more suitable for the people that they engage.
It is also likely to be many years until ARVs are widely available in Africa. Therefore, it is important everything that can be done and should be done to provide care and support for people living with HIV/AIDS before the arrival of antiretroviral drugs. For example, many of the common HIV-related opportunistic infections are fairly easy to prevent and treat. The prevention and treatment of opportunistic infections can result in significant gains in life expectancy and quality of life among people living with HIV. It is vitally important that all aspects and means of prevention, treatment and care are considered and used in Africa.
Useful links related to HIV/AIDS in Africa
The impact of HIV & AIDS in Africa www.avert.org/aidsimpact.htm
AIDS in Africa Q&A: the basics www.avert.org/aids-africa-questions-1.htm
AIDS in Africa Q&A: the issues www.avert.org/aids-africa-questions-2.htm
Getting HIV & AIDS antiretroviral drugs for Africa www.avert.org/aidsdrugsafrica.htm
Who is getting AIDS drugs? www.avert.org/aidstarget.htm
HIV & AIDS treatment and care in resource poor countries www.avert.org/hivcare.htm
HIV related opportunistic infections: prevention, treatment and care in resource poor countries www.avert.org/aidscare.htm
HIV & AIDS in Botswana www.avert.org/aidsbotswana.htm
HIV & AIDS in South Africa www.avert.org/aidssouthafrica.htm
HIV & AIDS in Uganda www.avert.org/aidsuganda.htm
HIV & AIDS in Zambia www.avert.org/aids-zambia.htm
HIV & AIDS in Nigeria www.avert.org/aids-nigeria.htm
AIDS orphans in Africa www.avert.org/aidsorphans.htm
Sub-Saharan Africa HIV & AIDS statistics www.avert.org/subaadults.htm
The sources included:
This page was edited and written by Jenni Fredriksson and Annabel Kanabus.
1 'British Medical Journal (2001) 'Not enough condoms are supplied to African men', Vol.323, 21 July
UNAIDS (2005) 'AIDS epidemic update', December
UNAIDS (2003) 'AIDS epidemic update', December
UNAIDS (2002) 'AIDS epidemic update', December
UNAIDS (2004) 'Report on the global HIV/AIDS epidemic 2004', July
UNAIDS (2002) 'Report on the global HIV/AIDS epidemic 2002', July
Last updated April 28, 2006
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