IN 2006, almost two thirds (63%) of all persons infected with HIV were living in sub-Saharan Africa, or 24.7 million. An estimated 2.8 million adults and children became infected with HIV in 2006, more than in all other regions of the world combined. The 2.1 million AIDS deaths in sub-Saharan Africa
Across this region, women bear a disproportionate part of the AIDS burden: not only are they more likely than men to be infected with HIV, but in most countries they are also more likely to be the ones caring for people infected with HIV.
Provision of antiretroviral therapy has expanded dramatically in sub-Saharan Africa: more than one million people were receiving antiretroviral treatment by June 2006, a ten-fold increase since December 2003.
Scale-up efforts have been especially strong of late in a few countries, including Botswana, Kenya, Malawi, Namibia, South Africa, Uganda and Zambia.
However, the sheer scale of need in this region means that a little less than one quarter (23%) of the estimated 4.6 million people in need of anti-retroviral therapy in this region are receiving it.
Southern Africa remains the epicentre of the global HIV epidemic: 32% of people with HIV globally live in this sub-region and 34% of AIDS deaths globally occur here.
In South Africa, some 5.5 million people, including 240,000 children younger than 15 years, were living with HIV in 2005.
The latest data show a continuing, rising trend nationally in HIV infection levels among pregnant women attending public antenatal clinics: from 22.4% in 1999 to 30.2% in 2005. However, HIV prevalence among young people may be stabilising.
As in the rest of sub-Saharan Africa, the epidemic in South Africa disproportionately affects women. Young women (15â€“24 years) are four times more likely to be HIV-infected than are young men.
One in three women aged 30â€“34 years were living with HIV in 2005, compared to one in four men aged 30â€“39 years, according to the 2005 national HIV household survey.
In addition, high infection levels were found among men older than 50 years, more than 10% of whom tested HIV positive.
Yet a large proportion of South Africans do not believe they are at risk of becoming infected with HIV. According to the 2005 national household survey half the respondents who were found to be infected with HIV had reported that they felt they were at no risk of acquiring HIV. Approximately two million South Africans living with HIV do not know that they are infected and believe they face no danger of becoming infected.
Swaziland now has the highest adult HIV prevalence in the world: 33.4%. Many young women in Swaziland appear to be abstaining from sex until at least their late teens. In one study, almost two in three female secondary school students said they had not yet had sex. However, it appears that once young women do become sexually active they encounter huge risks of acquiring HIV. Among young women (15â€“24 years) attending antenatal clinics, HIV prevalence was 39% nationally. Life expectancy had gone down to 31 years due to the epidemic, the lowest in the world.
In Namibia, an estimated 230,000 people were living with HIV in 2005. Adult national HIV prevalence was estimated at 19.6% in 2005. Programmes aimed at reducing mother-to-child transmission of HIV reportedly ensured that 16% of HIV-infected pregnant women in Namibia received antiretroviral prophylaxis in 2005.
Recent population-based HIV surveys, along with other HIV data, provide a more precise picture of Botswanaâ€™s HIV epidemic, where prevalence remains among the highest in the world. A slight decrease in HIV prevalence among pregnant women nationally has been evident since 2001 (36%) to 33% in 2005, especially among those aged 15â€“24 years, which suggests the epidemic could be abating. Nevertheless, at least 40% of pregnant women aged 25â€“39 years were living with HIV in 2005, as was one in two pregnant women aged 30â€“34 years. In the latter age group, HIV infection levels still appear to be on the rise.
Surprisingly, comprehensive knowledge of HIV remains low: only about one in three young people aged 15â€“24 both correctly identified ways of preventing the sexual transmission of HIV and rejected major misconceptions about HIV transmission, which seems to follow the regional pattern.
On the other hand, it is estimated that one in three adults in Botswana know their HIV status, and there appears to be widespread public support for the opt-out voluntary counselling and testing system introduced in 2003.
Adult HIV prevalence in Lesotho has remained relatively stable in recent years but at high levels, with almost one in four adults living with HIV in 2005. Lesotho will need to overcome a host of challenges if it is to control its epidemic. Casual sex remains commonplace, for example, and condom use is infrequent. Two thirds of men and one third of women say they have had sex with someone other than their long-term partner in the past year; fewer than half of them used a condom. Efforts to increase HIV prevention among young people also require improvement. Some 15% of young women and 27% of young men (aged 15â€“24 years) are sexually active before their 15th birthday, yet 40% of surveyed parents do not want children in their early teens to learn about condoms at school.
Statistics on Mozambique show a significant increase in HIV infection levels since the turn of the century. The HIV prevalence in pregnant women rose from 11% in 2000 to 16% in 2004, one of the steepest increases seen in sub-Saharan Africa in recent years. The fact that prevalence has also been rising in young pregnant women suggests that new infections continue to increase, and may signal further growth in the countryâ€™s epidemic.
In Malawi, almost a million people were living with HIV in 2005. Adult national HIV prevalence was estimated at 14.1% in 2005. HIV infection levels in Malawi overall appear to have stabilised since the turn of the century, with some parts of the country showing a decrease. In the capital, Lilongwe, HIV prevalence among women using antenatal services peaked at 27% in 1996 before receding to 17% in 2003. That decline, however, was not sustained in 2005, when prevalence among pregnant women increased slightly to 19%.
Some behavioural changes appear to be associated with the observed declines in HIV prevalence. When surveyed in 2000, smaller percentages of women and men reported having sex with multiple partners, compared with 1996. The proportion of young men with two or more casual partners diminished by more than half and more young women reported using condoms with casual partners in 2000, compared with 1996 (31% versus 22%).
Overall HIV prevalence among women attending antenatal clinics in Zambia has also stayed relatively stable since the mid-1990s, and has remained at 19%â€“20% between 1994 and 2004 among pregnant women aged 15â€“39 years. In rural areas, however, HIV prevalence increased marginally from 11% to 12% in 1994â€“2004. Among older pregnant women (30â€“39 years) in urban areas, HIV prevalence rose considerably (from 24% to 30%) in 1994â€“2004. Among young pregnant women in some urban sites, HIV prevalence has remained high (at 28%â€“30% during 1994â€“2004), while in some rural sites, infection levels almost doubled in the same period. At current levels of HIV prevalence, young persons in Zambia face a 50% life-time risk of dying of AIDS.
The island nations off the southern African coast are experiencing much smaller epidemics. Mauritius needs to focus stronger prevention efforts on injecting drug users and especially on those who also engage in sex work. About three quarters of the HIV infections diagnosed in the first six months of 2004 were among injecting drug users. 75% of sex workers said they injected drugs, and condom use was infrequent - only 32% had consistently used condoms during the previous three months.
In East Africa, the general trends of stabilising or declining HIV prevalence appear to be continuing. Having diminished during the 1990s, Ugandaâ€™s epidemic has stabilised overall. National adult HIV prevalence was 6.7% in 2005 but it was significantly higher among women (nearly 8%) than among men (5%). Approximately one million people were living with HIV in Uganda in 2005. Regionally, prevalence was lowest in the West Nile region and highest in the Kampala, Central and North-Central regions (over 8%).
Trends vary in Ugandaâ€™s epidemic. HIV prevalence fell sharply among pregnant women in Kampala and other cities from the early 1990s to the early 2000s, in the context of significant behaviour change, including sexual abstinence and condom use during casual sex, and increased AIDS mortality. However, in some rural areas there is now evidence of an increase in HIV infection.
With 1.3 million people currently living with HIV, Kenya is still contending with a serious AIDS epidemic, despite evidence of declining HIV prevalence among pregnant women. National adult HIV prevalence fell from 10% in the late 1990s to about 7% in 2003 and just over 6% in 2005. Major HIV prevention efforts were mounted in Kenya from 2000 onwards, and there is evidence that more people have been delaying their sexual debuts, that condom use rates have increased and that a smaller percentage of adults has multiple sex partners. A new concern, however, is the emergence of injecting drug use as a factor in Kenyaâ€™s epidemic. Among injecting drug users in Mombassa, for example, 50% were found to be HIV-infected in a 2004 study, while a study in Nairobi found 53% of injecting drug users were HIV-positive.
An estimated 1.4 million adults and children were living with HIV in Tanzania at the end of 2005, making it one of the most-affected countries in the world. Here, too, HIV infection levels have diminished somewhatâ€”from 8.1% to 6.5% nationally between 1995 and 2004. Projections show that the number of infections in rural areas, where about three quarters of the countryâ€™s population live, could be twice as high as in urban areas by 2010. This reinforces the need to ensure sufficient resources for prevention, treatment and care in rural areas. There are signs that injecting drug use, which has spread rapidly in E. Africa, could also become a contributing factor in Tanzaniaâ€™s epidemic. Especially risky is a practice called â€˜flashbloodâ€™, which involves drawing blood back into the syringe after having injected heroin, and then passing the syringe to a companion. Common among injecting female sex workers in Dar es Salaam, and reportedly intended to share a â€˜highâ€™ with companions who cannot afford their own drugs, this practice carries a risk of HIV transmission.
Source: UNAIDS Report 2006
HIV/AIDS: Southern Africa worst hit