Hi Everyone,
The AIDS epidemic and Africa. How do we combat the situation. Issues to
think about.
"This report has been divided into 3 sets to satisfy the requirements for
list owner."
[Forwarded by Leela McCullough, Information Director for SatelLife.
Unfortunately, tables and figures in the report could not be
transmitted--Mod.]
Report on the global HIV/AIDS epidemic June 1998 (excerpted from the full
report by UNAIDS)
The evolving picture by region
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 C=F4te 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 alone.
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 1996.
Joe.
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