HIV/AIDS in Africa

In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote: ==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. Kenya had the highest prevalence rate of any country outside of Southern Africa. The number of newly infected people per year increased slightly, from 140,000 in 2001 to 150,000 in 2011. Uganda 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. and a two-year delay in first sexual activity, as well as fewer people reporting casual sexual encounters and multiple partners. This increase has caused alarm. The director of the Centre for Disease Control – Uganda, Wuhib Tadesse, said in 2011 that, 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, Benin, and Nigeria. These were followed in 1986 by Côte d'Ivoire. The first identification of HIV-2 occurred in Senegal by microbiologist Souleymane Mboup and his collaborators. 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. There are widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners. Men's sexual networks, in particular, tend to be quite extensive, a fact that is tacitly accepted or even encouraged by many communities. Along with having multiple sexual partners, unemployment and population displacements resulting from drought and conflict have contributed to the spread of HIV/AIDS. 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. Eswatini In 2011, the HIV prevalence rate in Eswatini was the highest in the world, at 26.0 percent of citizens aged 15–49. Life expectancy at birth in 1990 was 59 for men and 62 for women. 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. HIV/AIDS in 2002 caused 64 percent of all deaths in Eswatini. ==Origins of HIV/AIDS in Africa ==

, 2002 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. 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. 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". 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." 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, 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. ==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. 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. 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. 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. 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. 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. ==Prevention of HIV infections==

, Tanzania Public education initiatives Numerous public education initiatives have been launched to curb the spread of HIV in Africa. The role of stigma 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. "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". 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". 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". 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. 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 while Uganda has had a more balanced approach to the three elements. The effectiveness of ABC is controversial. At the 16th International AIDS Conference in 2006, African countries gave the strategy mixed reviews. In Botswana, In Nigeria, In Kenya, 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. 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. 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. 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. 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." In January 2012, AWA was revitalized to include all of Africa and its objectives were broadened to include malaria and tuberculosis. 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. 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. ==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. 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. 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. 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". 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. 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. 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. 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". 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. 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". 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". The distrust of modern medicine is sometimes linked to theories of a "Western Plot" 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. Pharmaceutical industry Africans are still fighting against unethical human experimentation and other practices of unfair treatment by the pharmaceutical industry. Medical experimentation occurs in Africa on many medications, but once approved, access to the drug is difficult. The FDA in the US is in the process of reviewing the drug for approval for US use. The AIDS/HIV epidemic has led to the rise in unethical medical experimentation in Africa. 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. 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. Despite this, the majority of HIV research has historically been focused on subtype B, which constitutes only 12% of infections, mostly in Europe. 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. Climate change ==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. In countries like Nigeria and the Central African Republic, less than 25% of the population has access to the ART drugs. 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. ==Measurement==

gets an HIV test on the Desmond Tutu HIV Foundation's Tutu Tester, a mobile test unit. 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. 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. Thus, there may be significant disparities between official figures and actual HIV prevalence in some countries. 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. 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. ==Tuberculosis coinfections==

in South Africa 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". The two diseases have been "inextricably bound together" since the beginning of the HIV epidemic. "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." In many countries without adequate resources, the tuberculosis case rate has increased five to ten-fold since the identification of HIV. An estimated 874,000 people in Sub-Saharan Africa were living with both HIV and tuberculosis in 2011, with 330,000 in South Africa, 83,000 in Mozambique, 50,000 in Nigeria, 47,000 in Kenya, and 46,000 in Zimbabwe. 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. 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. 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. == Works ==

• 28: Stories of AIDS in Africa == See also ==