HIV / AIDS IN AFRICA 2002 - Update

Africa is at the epicenter of a global health crisis driven by HIV/AIDS. As we enter the third decade of the HIV/AIDS pandemic, more Africa nations are at last starting to show the political will and commitment to tackling the HIV/AIDS epidemic that has been absent for long in most of Sub Saharan Africa (SSA). There are hopeful signs that it is not yet too late.

There were nearly 3.5 million new HIV infections in Africa by the end of 2002, and the number of people living with AIDS was 28.5 million people. There were also 11 million children orphaned by AIDS.

Senegal and Uganda are still the only two SSA countries that have successfully controlled HIV/AIDS through vigourous and sustained prevention campaigns, by successfully mobilizing all sectors of society in the fight against HIV/AIDS. Uganda in particular managed to control a rampant out of control epidemic, which shows that it can be done.

Figure 1

The failures in past years of other SSA countries to address HIV/AIDS is unfortunately now being evidenced by increasing HIV prevalence rates and precipitous declines in life expectancy. According to UNAIDS life expectancy in Sub Saharan Africa now stands at 47 years, where it would have been 62 years without AIDS. The UNAIDS 2002 Global HIV/AIDS report also shows that contrary to many researchers and epidemiologists thinking, the levels of HIV/AIDS especially in Southern Africa rather than leveling off are increasing ever more. Even more alarmingly, some epidemics seem to show no sign that the upper level of the threshold in the numbers of infected has been reached yet.

A report by the National Intelligence Council analsying the HIV/AIDS epidemic, concluded that the situation could get much worse. They came to these conclusions based on data in Nigeria and Ethiopia. Together the two countries make up almost a third of the people in sub- Saharan Africa, with a combined population of 200 million. Both Nigeria and Ethiopia are past the 5% prevalence rate among adults, the point at which the epidemic in several other African countries entered the “explosive phase.”

The Effect on food security

The AIDS epidemic is also having a profound effect on food security. Already in 2002, 13% of the total population of SSA, mainly in Southern Africa are facing the real prospect of famine. [ECOSOC]. Though environmental and economic factors have played a role, it is clear that the AIDS epidemic is having an effect. At the World Food Summit in Rome in June 2002, delegates were told it was no coincidence that six of the countries in Southern Africa experiencing the worst food shortages in a decade, had particularly high HIV prevalence levels. According to UNAIDS, HIV/AIDS and hunger were a "dual tragedy" threatening sub-Saharan Africa, and endangering the lives of millions. HIV/AIDS by undermining three of the main indicators of economic growth: physical, human and social capital was also hindering development. 

The impact of the AIDS epidemic in rural areas is now beginning to be felt.  According to the Food and Agriculture Organisation (FAO), HIV/AIDS has killed around 7 million agricultural workers since 1985 in the 25 hardest-hit countries in Africa, and food consumption has dropped by 40 percent in homes afflicted by HIV/AIDS. As a result farming skills have been lost, agricultural extension services have declined, rural livelihoods have disintegrated, productive capacity to work the land has dropped and household earnings are shrinking while the cost of caring for the ill skyrockets. The impact of HIV/AIDS on agricultural production and food availability would be felt in terms of quantity and quality of food.  In Zimbabwe, it is estimated communal agricultural output has decreased 50 percent in a five-year period, largely due to HIV/AIDS.

Regional Outlooks

Southern Africa

Despite hopeful signs that the epidemic in Southern Africa was showing signs of leveling off, the new UNAIDS Global report has dispelled any notion that the pandemic is reaching or likely to reach natural limits in the near future. Seven of the worst affected countries are in Southern Africa. According to UNAIDS  researchers have consistently underestimated the scale and levels the epidemic can reach.

Researchers had been hopeful that the epidemic would reach some natural level beyond which it could not grow, but new figures indicate this is not the case.  Previous models had indicated that a person’s risk level remained constant over time, but it now seems that people can move from low level risk to high level risk categories as their socio-economic and life style conditions change.

Figure 2

 

 

 

 

 

 

 

 

 

Source: Adapted from UNAIDS, “Report on the global HIV/AIDS Epidemic”

As Figure 2 shows the prevalence levels are reaching unimaginably high proportions. But as high as they prevalence rates are, they do not reflect the true picture. When measured in specific age groups, the prevalence rates are even higher as Figure 3 shows.

Figure 3

Signs of hope in South Africa

A newly released report from the Medical Research Council and MOH in South Africa offers same glimmer of in South Africa. HIV prevalence rates of pregnant women attending ANC has barely increased from 24.5% in 2000 to 24.8% in 2001. It is still too early to tell whether this trend will continue.

Figure 4

Source: National HIV And Syphilis Sero-Prevalence Survey Of Women Attending Public Antenatal Clinics In South Africa – 2000 & 2001

Perhaps the most heartening sign is the continued decline since 1998 of the HIV prevalence rates in the under 20 year age group. This has been taken as a sign that health education and prevention messages are getting through. A previous survey of teenagers showed that 70% were concerned about the risk of contracting HIV.

Figure 5

Source: National HIV And Syphilis Sero-Prevalence Survey Of Women Attending Public Antenatal Clinics In South Africa – 2000 & 2001

Overall the 20-29 year age group did not changed significantly in 2001 from 2000. However there was a sharp increase in the 35-39 year age group, the reasons for which are unclear. This shows there is no room for complacency, while the overall trend seems to be toward a more mature epidemic, the magnitude and scale is still overwhelming.

Eastern Africa

East African countries were the first to experience the intensity of the HIV/AIDS epidemic, where prevalence rates by 1992, in Uganda for example at its peak had reached HIV prevalence rates of almost 30% in areas figures that rival those in Southern Africa today. Uganda, Kenya and Tanzania in East Africa are now seen as countries with mature epidemics. Uganda and Tanzania have experienced continuous declines in adult HIV prevalence rates since 1997.

Worryingly Kenya has not, which may pose problems for the region. The HIV prevalence rate in Kenya appears to have been increasing, albeit slowly over the past few years. There are now 2.5 million people living with HIV/AIDS in Kenya and according to AIDS activists who have been demanding more action from the government, 700 people a day die form HIV/AIDS. Equally disturbing is the worrying attitudes amongst the youth, many of whom still remain ignorant of HIV/AIDS. The government acknowledges work needs to be done, but claims that condom use increased to 100 million in 2001 compared to 78 million in 1998.

HIV   Prevalence Rates in Adults (15-49) in East African Countries.
Country	1997	1999	2001
Kenya	11.64%	13.95%	15.0%
Uganda	9.42%	8.09%	7.91%
Tanzania	9.51%	8.30%	5.0%
Source: UNAIDS HIV/AIDS and STD Surveillance Data, 1997, 1999, 2001

Uganda- an epidemic in reverse, hope for Africa.

HIV prevalence has continued to decline in Uganda for the last 8 years. Uganda still remains the only African country to have controlled a raging HIV/AIDS epidemic. Through the use of sustained HIV/AIDS programmes, mobilization of all sectors of society, the country has brought HIV prevalence from almost 30% in 1992 to 5% by the end of 2001.

This achievement has been made almost entirely through local efforts, using community led programmes allied with government initiatives.  Uganda shows that well supported social and behavioral prevention programs work. It is through behavioural change to sexual attitudes that this success has been achieved, but the question has always remained just how great were these changes and how big a part did they play. Recent research published in the July edition of The Lancet Medical Journal supports this evidence.  A 10 year cohort study of 15 villages recorded a 40% reduction in HIV sero-prevalence rates in women attending antenatal clinics over a 6 year period.

 Despite this encouraging news, health officials still acknowledge there is work to be done. A prevalence of 5% is still extremely high corresponding to over half a million (510,000) people living with AIDS. Some believe that without the widespread use of antiretroviral therapy as part of prevention and eradication programmes it will be difficult to bring the rates down.

West and Central Africa

There is growing evidence of a rapid rise and spread of HIV/AIDS in West and Central African countries.  The long time held view that the relatively low rates that have been stable for 5-8 years would continue to stay that way has proved a fallacy. This complacent attitude was assisted by the fact that though the national HIV/AIDS rates were higher than the threshold 5% at which an epidemic takes off, they had not increased significantly.  West Africa has been home to the less virulent form of HIV known as HIV-2, and though the origin if HIV has yet to be proved, many scientists believe it originated somewhere in West Africa. But the rates of HIV have been increasingly steadily over the past few years as the more lethal HIV-1 has taken hold. Because HIV prevalence rates have been low compared to the other parts of SSA, many West and Central African governments have been slow to initiate national HIV/AIDS programs.

Cameroon  - Trouble on the horizon.

HIV has been increasing steadily in Cameroon. Disturbingly the highest rates are now being found in young people. HIV prevalency rates in pregnant women attending antenatal clinics show that in the 15-19 year old age group they were 11.5% and 12.2 % in the 20-24 year age group. The HIV rates were equally high in both rural and urban areas.

Figure 6

 

 

 

 

 

 

 

Past experience has shown that the HIV rates in young people are a factor in driving the epidemic, and the data may indicate that Cameroon is just at the beginning of a steep rise in incidence of new HIV infections.

Nigeria – the evolution of an epidemic

Nigeria has the largest population in all of Africa, over a 120 million people, and by the end of 2001 already had 3.5 million people infected with HIV/AIDS. A report from the National Intelligence Council (NIC) in USA concluded that based on available evidence, increasing HIV incidence in Nigeria and Ethiopia could lead to a doubling of HIV/AIDS cases in Africa over the next 5 years.

HIV prevalence rates in Nigeria
1997	1999	2001
4%	5.1%	6%
Source: UNAIDS

According to UNAIDS some states in Nigeria are already experiencing, HIV prevalence rates similar to neighbouring Cameroon and many think the real rate is nearer 10%.

There is still hope

The experience of Uganda shows that an HIV/AIDS epidemic can be brought under controlled and turned around using sustained prevention campaigns. Recent research from Uganda underscores just how effective that can be. The news from Zambia, Senegal and South Africa is also encouraging.

In Zambia the HIV rates in the 15-29 year old age group decreased significantly, for urban women; 28.3% (1996) to 24.5% (1999) and for rural women 16.1%  (1996) to 12.2%. (1999). Senegal has managed to maintain HIV prevalence rates to below 2%, even as those of its neighbours are rising. South Africa has the dubious distinction of being the country with the highest number of people infected with HIV, 5 million at the end of 2001, but the decline in HIV prevalence among young people for the third year in a row is a very hopeful sign.

However there are still many hurdles, for instance a new report by UNAIDS shows that condom use is still very low in many parts of Africa. Still more troubling is the fact that it appears the level and knowledge amongst the youth is still very low. It is clear that sustained prevention campaigns centered around local and community activities can be very effective in producing real results in blunting the epidemic. There needs to be greater political will and leadership in making sure such efforts are made, if Africa is to succeed in defeating the epidemic.

Sources

1.       Mulaiteye S.M et al. (2002). Declining HIV-1 Incidence and associated prevalence over 10 years in a rural population in South western Uganda: a cohort study. Lancet Medical Journal. Vol 360: 9326. July

2.       Ssemakula J. (2002) AIDS crisis will get worse in Sub-Saharan Africa. Medilinks. June

3.       Ssemakula J. (2002) KENYA: Anti-AIDS groups demand urgency to match crisis.Medilinks May

4.       Ssemakula J. (2001) KENYA: AIDS group suggests worrying attitudes among youth. Medilinks. December

5.       Ssemakula J. (2002) HIV/AIDS leveling off in South Africa? Medilinks June

6.       Ssemakula J. (2002) HIV/AIDS in  Africa - update? Medilinks June

7.       UNAIDS. (2002) Report on the Global HIV/AIDS epidemic. UNAIDS June