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Africa: New HIV/AIDS Report
Africa: New HIV/AIDS Report
Date distributed (ymd): 980714
Document reposted by APIC
Issue Areas: +economy/development+ +gender/women+
This posting contains excerpts from the executive summary of the latest
report on the global HIV/AIDS epidemic, which is at its most intense on
the African continent. It also contains an introductory note and links
to selected other sources.
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Introductory Background Note
In 1997, an estimated 2.3 million people worldwide died of AIDS, approximately
the same number as of malaria. As the report below indicates, the HIV/AIDS
epidemic is continuing to escalate, particularly in Africa. The 12th World
AIDS Conference, held in Geneva from Jun 28 through July 3, was headlined
"Bridging the Gap" to focus attention on the growing gap between
efforts to address the epidemic in rich countries and the rest of the world.
But much news coverage of the conference gave little indication of the
intended shift in focus, and recent U.S. coverage of the HIV/AIDS crisis
in African-American communities gave little attention to the international
Even the conference's own web site (http://www.aids98.ch -- no longer available 7/2000)
contains only limited information on the headline theme, although it did
note that the opening ceremony was disrupted by ACT-UP members with a banner
reading "AIDS: The World is Burning." Koua Desire N'Dah, an activist
from Cote d'Ivoire, noted that "the majority who are sick have no
access to treatment -- not even the simplest and cheapest medications are
available." Despite talk six months ago for additional funding for
treatment in the South and the formation of an African solidarity fund,
"today, the money still isn't there."
A few press stories (located by a search in http://www.dejanews.com
on "HIV/AIDS Geneva Africa") nevertheless reported on themes
stressed by conference officials and delegates. The gap, UNAIDS Executive
Director Peter Piot said, shows up not only in treatment, but also in transmission
rates, knowledge and prevention. Claire Mulanga, of the Society for Women
and AIDS in Africa, told journalists that the spread of the disease in
Africa was closely linked to the vulnerable position of women in society.
Others noted that transmission of the disease from pregnant women to new-born
babies, as well as general vulnerability to the disease and related conditions,
were directly related to poverty and to the lack of adequate medical services
The next World AIDS Conference will be held in Durban, South Africa,
and co-sponsored by the South African government (see its web site, which
went on-line in June, at http://www.aids2000.com).
For the June 1998 report from the Joint UN Programme on HIV/AIDS, see
the UNAIDS web site (http://www.unaids.org).
The report is available in both HTML and PDF (Adobe) format, but graphs
and Epidemiological Fact Sheets by Country are available only in the Adobe
PDF format. The Adobe program is free for downloading.
Report on the global HIV/AIDS epidemic
The evolving picture region by region
(excerpts -- full version available at http://www.unaids.org)
Sub-Saharan Africa: the epidemic shifts south
Over two-thirds of all the people now living with HIV in the world -
nearly 21 million men, women and children - live in Africa south of the
Sahara desert, and fully 83% of the world's AIDS deaths have been in this
region. Since the very start of the epidemic, HIV in sub-Saharan Africa
has mostly spread through sex between men and women. As shown in the annexed
tables, this means that women are more heavily affected in Africa than
in other regions, where the virus initially spread most quickly among men
by male-to-male sex or drug injecting. Four out of five HIV-positive women
in the world live in Africa.
An even higher proportion of the children living with HIV in the world
are in Africa - an estimated 87%. There are a number of reasons for this.
First, more women of childbearing age are HIV-infected in Africa than elsewhere.
Secondly, African women have more children on average than those in other
continents, so one infected woman may pass the virus on to a higher than
average number of children. Thirdly, nearly all children in Africa are
breastfed. Breastfeeding is thought to account for between a third and
half of all HIV transmission from mother to child. Finally, new drugs which
help reduce transmission from mother to child before and around childbirth
are far less readily available in developing countries, including those
in Africa, than in the industrialized world.
By the early 1980s, HIV was found in a geographic band stretching from
West Africa across to the Indian Ocean. The countries north of the Sahara
and those in the southern cone of the continent remained apparently untouched.
By 1987, the epidemic became more concentrated in the original areas, and
began gradually to colonize the south. A decade later, in 1997, HIV had
been recorded all over the continent.
In general, West Africa has seen its rates of infection stabilize at
much lower levels than East and southern Africa, as the tables in the annex
show. However, some of the most populous countries in West Africa are exceptions
to this rule. In Cote d'Ivoire, West Africa's third most populous nation,
1 adult in 10 is already believed to be living with HIV. Nigeria has an
estimated adult prevalence of 4.1% - relatively low by the standards of
the continent, but with 118 million inhabitants (a fifth of the population
of sub-Saharan Africa) this translates into 2.2 million infections. And
there is no evidence that infection levels have stabilized. Clearly, if
HIV prevalence in Nigeria were to approach the 20% rates all too commonly
seen in southern African countries, the burden would be devastating.
Today, the most severe HIV epidemics in the world are to be found in
the southern countries of Africa. The virus there is still spreading rapidly,
despite already high levels of infection. Figure 2 illustrates the recent
growth in infection rates in the general population in South Africa. High-prevalence
and relatively low-prevalence areas show the same pattern - a sharp rise
in just four years. Some 2.9 million South Africans are thought to be living
with HIV at the beginning of 1998, over 700 000 of them infected in 1997
Other countries in southern Africa face even higher rates of infection.
In Botswana, the proportion of the adult population living with HIV has
doubled over the last five years, with 43% of pregnant women testing HIV-positive
in 1997 in the major urban centre of Francistown. In Zimbabwe, one in four
adults in 1997 were thought to be infected. In Harare, 32% of pregnant
women were already infected in 1995. In Beit Bridge, a major commercial
farming centre, HIV prevalence in pregnant women shot up from 32% in 1995
to 59% in 1996. Although infection levels in Zimbabwe's cities were slightly
higher than in rural areas, the difference was not great. In one town near
the South African border with a large population of migrant workers, 7
out of 10 women attending antenatal clinics tested HIV-positive in 1995.
The first country in Africa to respond actively to a massive national
HIV/AIDS burden was Uganda. The government engaged religious and traditional
leaders and other sectors of society in a vigorous debate that helped forge
consensus around the need to attack the problem of HIV. Active prevention
programmes, focused on delaying sexual relations and negotiating safe behaviour,
were brought into schools. Community groups were set up to counsel people
and families living with the virus. The efforts of the government and people
of Uganda seem to be paying off. At both rural and urban surveillance sites
infection rates are falling. The improvement has been particularly marked
in the younger age groups. This is in line with behaviour studies showing
that young people nowadays are adopting safer sexual behaviour - later
sexual initiation, fewer partners, more condom use - than was common a
decade ago. First signs of falling infection rates in young people are
also being seen in neighbouring Tanzania, in areas with active prevention
programmes. In women aged 15-24 in the urban area of Bukoba, prevalence
fell from 28% in 1987 to 11% in 1993. In the surrounding rural area, prevalence
among women in the same age group fell from almost 10% in 1987 to 3% in
The industrialized world: AIDS is falling
In general, HIV infection rates appear to be dropping in Western Europe,
with new infections concentrated among drug injectors in the southern countries
of the continent, particularly Greece and Portugal. It is estimated that
30000 Western Europeans were newly infected with HIV in 1997. Antiretroviral
drugs given to women during pregnancy and the availability of safe alternatives
to breastfeeding (see page 49) kept mother-to-child transmission low; it
is estimated that fewer than 500 children under the age of 15 were infected
with HIV in 1997.
North America estimated it had around 44000 new HIV infections in 1997,
close to half of them among injecting drug users. As in Western Europe,
transmission from mother to child was rare, with fewer than 500 new cases.
Generally, industrialized countries concentrate on following AIDS cases
rather than tracking HIV. And as HIV infections continue to rise in the
developing world, AIDS cases in many industrialized countries are falling
In Western Europe, new AIDS cases (corrected for delays in reporting)
fell from 23 954 in 1995 to 14 874 in 1997 - a 38% drop. The fall in AIDS
cases is due in part to prevention measures taken since the late 1980s
by gay communities, and to a sustained rise in the proportion of young
people using condoms, which led to a drop in the number of people infected
with HIV. Because of the long lag time between HIV infection and symptomatic
AIDS, the behaviour change of the late 1980s is only now being reflected
in fewer new cases of AIDS. But the downturn is probably due most of all
to new antiretroviral drug therapies which postpone the development of
AIDS and prolong the life of people living with HIV (see page 46).
In the United States, AIDS case reports indicate that the first-ever
annual decrease in new cases - 6% - occurred in 1996, and an even larger
reduction was expected in 1997. The biggest improvement - a drop of 11%
- was in homosexual men. In some disadvantaged sections of society, however,
AIDS continues to rise. Among African-Americans, new AIDS cases rose by
19% among heterosexual men and 12% among heterosexual women in 1996. In
the Hispanic community, there were 13% more cases among men and 5% more
among women than a year earlier. This is partly because these communities
may find it hard to access the expensive new drugs that could stave off
the onset of AIDS. It is partly, too, because prevention efforts in minority
communities, where transmission is often through heterosexual intercourse
and drug injecting, have been less successful than in the predominantly
well-educated and well-organized gay community.
North Africa and the Middle East: the great unknown
Less is known about HIV infection rates in North Africa or the Middle
East than in other parts of the world. Some countries, particularly those
with large populations of immigrant workers, carry out mass screening for
the virus, but none estimates infections at more than 1 adult in 100. Just
over 200 000 people are estimated to be living with HIV in these countries,
under 1% of the world total.
Risk behaviour does, however, exist. At least one country in the region
has started a programme to reduce risky drug-injecting practices. The generally
conservative social and political attitudes in the Middle East and North
Africa often make it difficult for governments to address risk behaviour
directly. However, in some countries in the region, governments have created
elbow room for community and nongovernmental organizations to help sex
workers and others whose behaviour puts them at risk to protect themselves
This material is being reposted for wider distribution by the Africa
Policy Information Center (APIC), the educational affiliate of the Washington
Office on Africa. APIC's primary objective is to widen the policy debate
in the United States around African issues and the U.S. role in Africa,
by concentrating on providing accessible policy-relevant information and
analysis usable by a wide range of groups individuals.