AIDS in Africa - SUB-SAHARAN AFRICA'S BIGGEST KILLER

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Last reviewed: 03-12-2008

SUB-SAHARAN AFRICA'S BIGGEST KILLER

AIDS is now the leading cause of death in sub-Saharan Africa and the main threat to the region's development, according to the World Bank. Sub-Saharan Africa is home to two-thirds of people with HIV, even though it is home to only 12 percent of the world's population.

The majority of people infected are women (60 percent), and most are not aware of their status, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

AIDS was first identified in Uganda in 1981. Since then more than 22 million Africans have died and the virus has spread across much of the continent, according to the World Bank.

Southern Africa is the worst-affected region.

South Africa has the world's highest caseload and seven other countries in the region have more than 15 percent incidence.

Swaziland has one of the highest infection rates - in 2007 it was 26.1 percent - and AIDS has devastated the country's agriculture. King Mswati III has been strongly criticised for taking numerous wives and for ending a ban on sex for girls under 18, introduced in 2001 to try and curb the AIDS epidemic.

But not all African countries are equally affected. Many have infection rates of less than 2 percent. 

Impact on the region

 AIDS has had a dramatic effect not only on families and communities, but also on national economies and overall health statistics.

Across sub-Saharan Africa, the size of the labour force will be 10 to 30 percent smaller by 2020 than it would have been without HIV/AIDS, according to the U.N. Development Programme (UNDP).

Families have lost their breadwinners and farming has been severely affected. In some parts of sub-Saharan Africa AIDS orphans have had to take over the farming. This means they are less likely to go to school and it also affects crop production and the food security of entire regions.

In the most affected countries, the pandemic has eroded the economic and social gains of the past 30 years, says the World Bank.

UNAIDS says HIV prevalence in southern Africa as a whole is levelling off but at very high levels. This means the number of new infections is equal to the number dying of AIDS.

Some AIDS campaigners claim even a drop in figures may not necessarily be good news. The Treatment Action Campaign, South Africa's powerful AIDS lobby group, says a fall in infection rates may be because people are dying of AIDS instead of receiving life-saving anti-retroviral treatment.

The provision of treatment is a major issue and has remained erratic.

Botswana has rapidly increased its treatment coverage to over 75 percent in 2007, as has Namibia. Another four countries have achieved over 50 percent coverage. Elsewhere, however, the majority of people who need anti-retroviral drugs cannot access them.

Overall 2.1 million people are on ART - nearly double the number in June 2006 but still far from the total needed. And new infections outpace access to treatment - for every person put on therapy, another two or three are newly infected, says the World Bank. 

South Africa

South Africa has the largest number of people with HIV/AIDS - 5.7 million.

But the South African government has been widely criticised for dragging its feet over the epidemic, which kills almost 1,000 people a day.

Fifteen years ago the infection rate was similar to that of Brazil. Brazil's has now dropped to just 0.6 percent, compared with South Africa's at 18.1 percent.

For many years the government rejected a public anti-retroviral (ARV) treatment programme, partly on cost grounds.

It dropped its official objections in 2003 and now has one of the world's largest ARV programmes, even though it reaches just 27 percent of those in need, UNAIDS said in 2008.

In late 2006, South Africa unveiled a draft five-year HIV battle plan.

It calls for South Africa to halve new infections by 2011 and deliver treatment and support to 80 percent of HIV-positive children, adults and their families. It will also aim to boost AIDS education and access to testing and counselling.

The new plan was developed after South Africa came in for angry ridicule at the 2006 global AIDS conference in Toronto - an embarrassment which many analysts said may have finally persuaded the government to change its tack.

International scientists said that the health minister, Manto Tshabalala-Msimang, should be dismissed for advocating traditional medicines - including garlic and beetroot - rather than anti-retrovirals to fight HIV.

And the U.N. special envoy on AIDS denounced South Africa for negligence in dealing with the epidemic and for propounding "lunatic" theories.

President Thabo Mbeki, who previously enraged activists by questioning the link between HIV and AIDS, has dropped out of the public debate.

The new approach is being led by Deputy President Phumzile Mlambo-Ngcuka, who has been named head of South Africa's National AIDS Council.

Another factor causing concern in South Africa is the emergence of a new strain of tuberculosis among AIDS patients in the KwaZulu-Natal region which is highly resistant to most antibiotics.

TB is an airborne illness that is particularly deadly for those with immune systems weakened by HIV.

Women

Women make up two-thirds of new infections in the region.

As in other regions their vulnerability is increasing. UNAIDS says although the traditional ABC - Abstain, Be faithful, use a Condom - approach to prevention has saved many lives, it is not enough for women. Many are not in a position to abstain from sex, rely on fidelity, or negotiate condom use.

The Global Coalition on Women and AIDS says that in some of the worst-affected countries - South Africa, Zambia and Zimbabwe - young women aged 15 to 24 are at least five times more likely to be infected than young men.

And researchers in 2003 found that young married women in Kenya and Zambia are at a higher risk of HIV infection than their unmarried counterparts, according to the U.N. Development Fund for Women (UNIFEM).

Poor education about the virus and women's lack of power to ask husbands to use a condom are major factors in the soaring infection rates among women.

HIV infection rates can rise during humanitarian crises. Rape in areas such as Sudan's Darfur region and eastern Democratic Republic of Congo is used as a weapon of war.

Some women and girls in conflict zones may also be forced into sex work as displaced families lose their usual source of income.

Another AIDS-related factor affecting women in many parts of Africa is inheritance rights. Many women lose their land and home when their husband dies. If this happens when the widow has AIDS (often having been infected by her husband), she is essentially condemned to an early death. Her property is taken, which means she loses assets she could use for medical care and the shelter she needs for survival.

In a 2002 report on Kenya Human Rights Watch found that parts of western Kenya with the highest AIDS prevalence also commonly practised "wife inheritance" where a male relative of the dead husband adopts the widow as his wife - and "cleansing" rituals, which often involves unprotected sex to cleanse the widow of her dead husband's evil spirits.

What's the solution?
The African Union launched a campaign in April 2006 to prevent new infections through education, counselling, testing and condom distribution.

At the same time there has been a strong international focus on stepping up treatment programmes. In 2007, over 2.1 million people were receiving life-saving HIV drugs, according to UNAIDS. That's double the number of the previous year.

Peter Piot, head of UNAIDS, says one of the main obstacles to preventing the spread of AIDS in Africa is social stigma, although this is beginning to change as more HIV-positive Africans go public.

Research by academics in the U.K. and U.S. suggests that taking a preventative approach by prescribing a daily dose of the drug tenofovir could save up to 3.2 million people from becoming infected with HIV over the next ten years in sub-Saharan Africa alone - at a cost of $2 billion.

Uganda has been hailed by many for its approach to containing the virus. Uganda's infection rate peaked at 15 percent in the 1990s but by 2007 it had dropped to 5.4 percent.

Uganda has used the ABC approach. It quickly acknowledged the epidemic and began a public information campaign early on, the key message being "Zero Grazing" - avoid casual sex.

Much of the prevention work was done by grassroots organisations who educated people about HIV/AIDS by word of mouth, and helped break down the stigma associated with AIDS.

But behind all that was a strong political will to stop the epidemic, and openness about HIV. Successive governments mobilised the entire population in the fight against the virus.

In 2006, however, Human Rights Watch criticised the Ugandan government and evangelical Christian groups for promoting abstinence-only messages and for attacking the effectiveness of condoms. HRW said the effect was to raise infection levels.

There has also been some evidence that rates of HIV infection are now on the rise in Uganda's rural areas - but experts have been cautious in coming to any definite conclusions so far.

Zimbabwe's government also responded very early on to the virus. In 1987 it set up the National Aids Control Programme to lead the national response. In 1999 Zimbabwe became the first country in the world to introduce a 3 percent levy on taxable income in order to pay for preventative measures and treatment.

Zimbabwe has one of the worst infection rates in Africa, and is home to one million children who have lost at least one parent to the disease, according to UNICEF.

But the proportion of people living with HIV has dropped sharply from 25 percent in 2000 to 15.3 in 2007. Health experts attribute the fall to more condom use and programmes encouraging people to have fewer sexual partners.

But NGOs have been sceptical about the drop, questioning whether falling prevalence might be due to deaths from AIDS and the high numbers of people leaving the country as its ongoing economic crisis continues to bite.

Retrieved 26^th August 2010 from ‘AlertNet – Alerting humanitarians to emergencies’ http://www.alertnet.org/db/crisisprofiles/HIV_AFR.htm?v=in_detail

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