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Africa: AIDS Epidemic Update
AfricaFocus Bulletin
Jun 3, 2006 (060603)
(Reposted from sources cited below)
Editor's Note
"Sub-Saharan Africa remains the worst-affected region in the world.
... Overall, HIV prevalence in this region appears to be levelling
off, albeit at exceptionally high levels in southern Africa. Such
apparent 'stabilization' of the epidemic reflects situations where
the numbers of people being newly infected with HIV roughly match
the numbers of people dying of AIDS-related illnesses." - 2006
Report on the Global AIDS Epidemic
Despite some signs of progress, such as declining rates in AIDS
prevalence in Kenya and Zimbabwe, the report noted that only one of
five Africans needing antiretroviral treatment has access to
treatment. "Seven times more people have access to treatment" than
five years ago, UN Secretary General Kofi Annan told the General
Assembly on June 2. "But the epidemic continues to outpace us. Last
year, globally, there were more new infections than ever before,
and more people died than ever before."
UNAIDS estimates that some 2 million people died of AIDS in subSaharan
Africa in 2005, compared to approximately 1.9 million in
2003. The number of AIDS orphans increased from an estimated 10.2
million to an estimated 12 million and the number of people living
with HIV from an estimated 23.5 million to an estimated 24.5
million.
This AfricaFocus Bulletin contains excerpts from the section on
Africa in UNAIDS 2006 Report of the Global AIDS Epidemic. For the
full report visit the UNAIDS website (http://www.unaids.org).
Another Bulletin also sent out today contains reports on the civil
society critique of the official statement agreed by government
representatives yesterday.
For earlier AfricaFocus Bulletins on health issues, visit
http://www.africafocus.org/healthexp.php
++++++++++++++++++++++end editor's note+++++++++++++++++++++++
2006 Report on the Global AIDS Epidemic
Excerpts from Chapter 02 Overview of the Global AIDS Epidemic
An estimated 38.6 million [33.4 million--46.0 million] people
worldwide were living with HIV in 2005. An estimated 4.1 million
[3.4 million--6.2 million] became newly infected with HIV and an
estimated 2.8 million [2.4 million--3.3 million] lost their lives
to AIDS. Introduction
Overall globally, the HIV incidence rate (the annual number of new
HIV infections as a proportion of previously uninfected persons) is
believed to have peaked in the late 1990s and to have stabilized
subsequently, notwithstanding increasing incidence in a number
countries. In several countries, favourable trends in incidence are
related to changes in behaviour and prevention programmes. Changes
in incidence along with rising AIDS mortality have caused global
HIV prevalence (the proportion of people living with HIV) to level
off (see Figure 2.1). However, the numbers of people living with
HIV have continued to rise, due to population growth and, more
recently, the lifeprolonging effects of antiretroviral therapy.
In sub-Saharan Africa, the region with the largest burden of the
AIDS epidemic, data also indicate that the HIV incidence rate has
peaked in most countries. However, the epidemics in this region are
highly diverse and especially severe in southern Africa, where some
of the epidemics are still expanding.
New survey data underscore the disproportionate impact of the AIDS
epidemic on women, especially in sub- Saharan Africa where, on
average, three women are HIV-infected for every two men. Among
young people (15 24 years), that ratio widens considerably, to
three young women for every young man.
Among the notable new trends are the recent declines in national
HIV prevalence1 in two sub-Saharan African countries (Kenya and
Zimbabwe), urban areas of Burkina Faso and similarly in Haiti,
alongside indications of significant behavioural change including
increased condom use, fewer partners and delayed sexual debut. In
the rest of sub-Saharan Africa, the majority of epidemics appear to
be levelling off but at exceptionally high levels in most of
southern Africa.
...
Sub-Saharan Africa
Sub-Saharan Africa remains the worst-affected region in the world.
Across the region, rates of new HIV infections peaked in the late
1990s, and a few of its epidemics show recent declines, notably in
Kenya, Zimbabwe and in urban areas of Burkina Faso. Overall, HIV
prevalence in this region appears to be levelling off, albeit at
exceptionally high levels in southern Africa. Such apparent
'stabilization' of the epidemic reflects situations where the
numbers of people being newly infected with HIV roughly match the
numbers of people dying of AIDS-related illnesses.
A little more than one-tenth of the world's population live in
sub-Saharan Africa which is home to almost 64% of all people living
with HIV--24.5 million [21.6 million--27.4 million]. Two million
[1.5 million--3.0 million] of them are children younger than 15
years of age. Indeed, almost nine in ten children (younger than 15
years) living with HIV are in sub-Saharan Africa. An estimated 2.7
million [2.3 million--3.1 million] people in the region became
newly infected, while 2.0 million [1.7 million--2.3 million] adults
and children died of AIDS. There were some 12.0 million [10.6
million--13.6 million] orphans living in sub-Saharan Africa in
2005.
Three-quarters of all women (15 years and older) living with HIV
are in sub-Saharan Africa. In most of the region, women are
disproportionately affected by AIDS, compared with men expressions
of the often highly unequal social and socioeconomic status of
women and men. Women comprise an estimated 13.2 million [11.4
million-15.1 million] or 59% of adults living with HIV in Africa
south of the Sahara.
An estimated 930,000 [790,000-1.1 million] adults and children died
of AIDS in southern Africa in 2005-one-third of all AIDS deaths
globally. Access to antiretroviral therapy has increased more than
eight-fold since the end of 2003, with about 810,000 people on
treatment in December 2005. About one in six (17%) of the 4.7
million people in need of antiretroviral therapy in this region now
receive it. Progress is uneven, however, with coverage reaching or
exceeding 50% in only three countries (Botswana, Namibia and
Uganda) but remaining below 20% in most others. South Africa
accounts for one-quarter of all people receiving antiretroviral
therapy in sub-Saharan Africa (WHO/UNAIDS, 2006).
It bears reminding that there is no single, 'African' epidemic, and
that HIV prevalence varies significantly between and within
subregions and countries. Such general trends in HIV prevalence
therefore should not obscure the highly varied nature of the AIDS
epidemics underway throughout this region.
Southern Africa remains the global epicentre of the epidemic.
Almost one in three people infected with HIV globally live in this
subregion. About 43% (860,000 [560,000-1.4 million]) of all
children (under 15 years) living with HIV are in southern Africa,
as are approximately 52% (6.8 million [5.9 million-7.7 million]) of
all women (15 years and older) living with HIV.
Except in Angola, national HIV infection levels are exceptionally
high and show no signs of abating. (In Angola's case, isolation and
inaccessibility of the population during the country's prolonged
conflict may have served to restrict the spread of HIV.) However,
in Zimbabwe, data from national sentinel surveillance, and national
and local community-based surveys show a declining trend in HIV
prevalence. National adult HIV prevalence is estimated at 20.1%
[13.3%-27.6%], down from 22.1% [14.6%-30.4%] in 2003. HIV
prevalence among pregnant women attending antenatal clinics fell
from 32% in 2000 to (a still-very-high) 24% in 2004, while in
Harare it declined from 35% in 1999 to 21% in 2004 (Mahomva et al.,
2006; Hargrove et al., 2005; Mugurungi et al., 2005). ...
Nationally, there appears to have been a substantial increase in
condom use since the early 1990s. Such behavioural change is likely
associated with a combination of AIDS awareness, relatively
extensive health infrastructure and a growing fear of AIDS
mortality. However, a significant part of the decline in HIV
prevalence is attributable to high mortality rates. With 1.7
million [1.1 million-2.2 million] people living with HIV, Zimbabwe
needs to sustain the declining trend in HIV prevalence and
dramatically improve the provision of antiretroviral treatment if
it is to gradually bring its epidemic under control. An estimated
320,000 people needed antiretroviral treatment in 2005, yet about
23,000 were receiving antiretroviral drugs (WHO/UNAIDS, 2006).
South Africa's AIDS epidemic -- one of the worst in the world --
shows no evidence of a decline. Based on its extensive antenatal
clinic surveillance system, as well as national surveys with HIV
testing and mortality data from its civil registration system, an
estimated 5.5 million [4.9 million-6.1 million] people were living
with HIV in 2005. An estimated 18.8% [16.8%-20.7%] of adults (15-49
years) were living with HIV in 2005. Almost one in three pregnant
women attending public antenatal clinics were living with HIV in
2004 and trends over time show a gradual increase in HIV prevalence
(Department of Health South Africa, 2005). While household surveys
with HIV testing in 2003 and 2005 show lower HIV prevalence, they
are plagued by high nonresponse rates (over 40%). The 2005 national
household HIV survey found high levels of HIV infection levels
among young people (aged 15-24 years), which were about the same as
those found in a national young people survey in 2003, a sign that
the epidemic has not lost momentum (Shisana et al., 2005;
Reproductive Health Research Unit and Medical Research Council,
2004). ...
While South Africa's HIV prevention efforts have not made notable
inroads against the epidemic, there has been significant progress
on the treatment front. With approximately 190,000 people receiving
antiretroviral treatment by the end of 2005, South Africa accounts
for a large share of the treatment scale-up in sub-Saharan Africa
overall this decade (WHO/UNAIDS, 2006). However, this still means
that less than 20% of the almost one million South Africans in need
of antiretroviral treatment were receiving it in 2005 (WHO/UNAIDS,
2005).
There are no clear signs of declining HIV prevalence elsewhere in
southern Africa including in Botswana, Namibia and Swaziland, where
exceptionally high infection levels continue. In Swaziland,
national adult HIV prevalence is estimated at 33.4% [21.2%-45.3%].
HIV prevalence among pregnant women attending antenatal clinics
rose from 4% in 1992 to 43% in 2004 (Ministry of Health and Social
Welfare Swaziland, 2005). Although many young women report delaying
their sexual debut, once women do have unprotected sex, the odds of
acquiring HIV are dauntingly high. Sexual aggression appears to be
widespread: in a study among high school students, almost one in
five (18%) of the sexually active female students said their first
sexual experience had been coerced (Buseh, 2004).
Botswana's epidemic is equally serious, with national adult HIV
prevalence estimated at 24.1% [23.0%-32.0%] in 2005. Among pregnant
women attending antenatal clinics, prevalence in 2004 was 34%
overall, and close to 50% among women 30-34 years of age. ...
Lesotho's epidemic seems to be relatively stable at very high
levels, with an estimated national adult HIV prevalence of 23.2%
[21.9%-24.7%]. High infection levels of 27% were observed among
antenatal clinic attendees in 2004, when over one-third (36%-38%)
of pregnant women 25 34 years of age tested HIV-positive. ...
In parts of sparsely populated Namibia, the epidemic is as intense
as in some of its neighbours, with HIV prevalence estimated at
19.6% [8.6%-31.7%] among adults nationally. In antenatal clinic
attendees, HIV prevalence is surpassing 42% in Katima Mulilo (in
the Caprivi Strip flanked by Angola, Botswana and Zambia) and
ranging between 22% and 28% in the port cities of Luderitz,
Swakopmund and Walvis Bay (Ministry of Health and Social Services
Namibia, 2004). To the north, Angola remains an anomaly, with HIV
prevalence much lower than in any other country in this subregion.
An estimated 3.7% [2.3%-5.3%] of adults were HIV-positive in 2005.
Although the country's HIV surveillance system has improved
dramatically in recent years, it remains difficult to discern clear
trends in the epidemic (Ministerio da Saude do Angola, 2004). Where
comparable data do exist in the capital, Luanda, for example
prevalence rose from 0.3% in 1986 to 4.4% in 2004.
On the eastern coastline, a dynamic epidemic is underway in
Mozambique, where the estimated national adult HIV prevalence is
16.1% [12.5%-20.0%]. HIV is spreading fastest in provinces linked
by major transport routes to Malawi, South Africa and Zimbabwe.
High infection levels are being found in Gaza (from where large
numbers of migrants working in South Africa originate) and Sofala
provinces (which is traversed by Zimbabwe's main export route)
(Ministry of Health Mozambique, 2005). In neighbouring Malawi,
national adult HIV prevalence is estimated at 14.1% [6.9%-21.4%].
... Zambia's epidemic appears not to be relenting either, with
adult HIV prevalence estimated at 17.0% [15.9%-18.1%]. There is
wide geographic variation, though, with HIV infection levels among
pregnant women ranging from under 10% in some places (e.g. Kasaba,
Macha and Mukinge) to as high as 30% in others (e.g. Matero and
Livingstone). Cities and towns with the highest HIV prevalence tend
to be clustered along major transport routes including Kabwe,
Livingstone and Ndola (National HIV/ AIDS Council Zambia, 2005).
The picture is starkly different in the island nations of southern
Africa. National adult HIV prevalence in Madagascar stood at an
estimated 0.5% [0.2%-1.2%] in 2005, but low levels of HIV knowledge
and significant risk behaviour mean this could change.
...Meanwhile, high levels of transmission of HIV among injecting
drug users (with estimated HIV prevalence of 10%-20%) and
significant infection levels (3%-7%) among female sex workers in
Mauritius indicate that larger HIV outbreaks are possible there.
In the countries of East Africa, HIV prevalence has either
decreased or remained stable in the past several years. Here, too,
women face considerably higher risk of HIV infection than men,
especially at younger ages. The epidemics are varied, with HIV
prevalence among pregnant women ranging from approximately 2% in
Eritrea to 7% and higher in Kenya, Uganda and United Republic of
Tanzania (Ministry of Health Eritrea, 2006; Ministry of Health
Uganda, 2005; National AIDS Commission Tanzania, 2005; Ministry of
Health Kenya et al., 2003).
While Burundi and Uganda's epidemics appear to have stabilized, HIV
prevalence among pregnant women in Kenya has been declining,
especially in urban areas (Cheluget et al., 2006;WHO,2005a;
Baltazar, 2005). As a result, national adult HIV prevalence is
estimated to have fallen from 10% in the late 1990s to about 7% in
2003 (Ministry of Health Kenya, 2005). Various behavioural surveys
show the proportion of adults with more than one sexual partner is
shrinking, more women are delaying their sexual debut, and condom
use is rising. Increased mortality and the saturation of infection
among people most at risk also appear to be the factors associated
with the decline in HIV prevalence (Cheluget et al., 2006). ...
In Uganda, which saw a steep decline in HIV prevalence during the
mid- and late-1990s, adult HIV prevalence was an estimated 6.7%
[5.7%-7.6%] in 2005. New HIV surveillance data indicate that HIV
prevalence continues to decline among pregnant women in the
capital, Kampala, and has remained stable elsewhere, including in
most rural areas since 2001. However, a 2004-2005 national
household survey found condom use was erratic (only about half the
men and women surveyed reported using a condom the last time they
had sex with a casual partner), and almost one in three men said
they had had more than one sexual partner in the previous year
(Ministry of Health Uganda, 2005).
Overall, Rwanda's epidemic has been stable in recent years, with
190,000 people [180,000-210,000] (3.1% of adults [2.9%-3.2%])
estimated to live with HIV in 2005. Observed national HIV
prevalence has declined since the late 1990s, but improved HIV
surveillance methodology probably accounts for an important part of
that trend. ... HIV trends in neighbouring Burundi, where adult HIV
prevalence is estimated at 3.3% [2.7%-3.8%], are also ambiguous.
...
On the mainland of the United Republic of Tanzania, an estimated
1.4 million people [1.3 million-1.6 million] (6.5% of adults [5.8%-
7.2%]) were living with HIV in 2005, highlighting the challenges of
improving prevention efforts and substantially expanding access to
treatment and care. HIV infection trends suggest a relatively
stable epidemic, but prevalence has increased markedly in older age
groups, reaching 13% among women aged 30-34 years (Tanzania
Commission for AIDS, 2005). Injecting drug use is increasing here,
too not only in Dar es Salaam, but also on the island of Pemba
(Beckerleg et al., 2005).
In Ethiopia's urban areas, HIV prevalence among women seeking
antenatal care has remained stable at high levels since the late
1990s (almost 15% in Addis Ababa and 12% in other urban areas in
2003), the exception being among 15-24-year-old pregnant women
where prevalence fell from 15.0% in 2000 to 11.5% in 2003. (Hladik
et al., 2006; Federal Ministry of Health Ethiopia, 2004).
Meanwhile, the epidemic appears to have intensified in some rural
areas in recent years, with rising HIV infection levels in women
attending antenatal clinics (2.6% in 2003, up from 1.9% in 2000)
(Hladik et al., 2006; Federal Ministry of Health Ethiopia, 2004).
... Meanwhile, neighbouring Eritrea's epidemic appears to be
stable, with adult HIV prevalence having remained at 2.4% [1.3%-
3.9%]. However, infection levels are considerably higher in the
south of the country and in 2005 exceeded 7% in Assab town
(Ministry of Health Eritrea, 2006).
Less is known about HIV trends in Djibouti and Somalia. The former
has a serious epidemic, with national adult HIV prevalence
estimated at 3.1% [0.8%-6.9%] in 2005. ... In Somalia, a 2004
survey indicated that the virus was present in most of the country,
but HIV prevalence among pregnant women nationally was still low,
at 0.6% (WHO, 2005b). ...
West Africa is less severely affected than other parts of
sub-Saharan Africa, with national adult HIV prevalence estimates
lower than 2% in several countries. The highest adult prevalence in
the region is in Cote d'Ivoire at 7.1% [4.3%-9.7%]. Significant
declines in HIV prevalence among pregnant women have been observed
in urban areas of Burkina Faso, and in Abidjan, Cote d'Ivoire, and
Lome , Togo, (WHO, 2005). However, in Dakar, Senegal, and Accra,
Ghana, infection levels have been rising among antenatal clinic
attendees (WHO, 2005). Nigeria has the third-largest number of
people living with HIV -- 2.9 million [1.7 million-4.2 million] --
in the world. The median HIV prevalence among antenatal clinics has
levelled off at around 4%, but infection levels vary radically
across this large country (from 2.6% in the South West to 6.1% in
the North Central zones) (Federal Ministry of Health Nigeria,
2006). ...
Senegal's epidemic, meanwhile, still pivots mainly on the sex
trade, and there is an ongoing danger of HIV spreading more widely
from sex workers and their clients to lower-risk sections of the
population. HIV prevalence among female sex workers has remained
high (at around 20% in Dakar and 30% in Ziguinchor) for almost a
decade (Gomes et al., 2005; WHO, 2005a). National HIV prevalence
was estimated at 0.9% [0.4%-1.5%] in 2005, ... Sex work is also a
driving factor in Ghana's epidemic, where adult HIV prevalence is
estimated at 2.3% [1.9%-2.6%]. ...
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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