The HIV & AIDS pandemic since 1980

Today more then 40 million people are living with HIV/AIDS world wide. Around 63 % or 25 million people living with HIV are in sub-Saharan Africa.
Since the beginning of the outbreak of the HIV/AIDS pandemic in 1980 25 million people have died worldwide of AIDS. More then 28 million of them lived on the African Continent.
In South Africa each day 6000 people get infected with the HIV/AIDS virus. Annually more then 200.000 people die because of AIDS in the Democratic Republic of South Africa.

Worldwide HIV & AIDS Statistics

Global HIV/AIDS estimates, end of 2006

The latest statistics on the world epidemic of AIDS & HIV were published by UNAIDS/WHO in November 2006, and refer to the end of 2006.

	Estimate	Range
People living with HIV/AIDS in 2006	39.5 million	34.1-47.1 million
Adults living with HIV/AIDS in 2006	37.2 million	32.1-44.5 million
Women living with HIV/AIDS in 2006	17.7 million	15.1-20.9 million
Children living with HIV/AIDS in 2006	2.3 million	1.7-3.5 million
People newly infected with HIV in 2006	4.3 million	3.6-6.6 million
Adults newly infected with HIV in 2006	3.8 million	3.2-5.7 million
Children newly infected with HIV in 2006	0.53 million	0.41-0.66 million
AIDS deaths in 2006	2.9 million	2.5-3.5 million
Adult AIDS deaths in 2006	2.6 million	2.2-3.0 million
Child AIDS deaths in 2006	0.38 million	0.29-0.50 million

More than 25 million people have died of AIDS since 1981.
Africa has 12 million AIDS orphans.
At the end of 2006, women accounted for 48% of all adults living with HIV worldwide, and for 59% in sub-Saharan Africa.
Young people (under 25 years old) account for half of all new HIV infections worldwide - around 6,000 become infected with HIV every day.
In developing and transitional countries, 7.1 million people are in immediate need of life-saving AIDS drugs; of these, only 2.015 million (28%) are receiving the drugs.

Global trends

The number of people living with HIV has risen from around 8 million in 1990 to nearly 40 million today, and is still growing. Around 63% of people living with HIV are in sub-Saharan Africa.

Regional statistics for HIV & AIDS, end of 2006

Region	Adults & children living with HIV/AIDS	Adults & children newly infected	Adult prevalence*	Deaths of adults & children
Sub-Saharan Africa	24.7 million	2.8 million	5.9%	2.1 million
North Africa & Middle East	460,000	68,000	0.2%	36,000
South and South-East Asia	7.8 million†	860,000†	0.6%†	590,000†
East Asia	750,000	100,000	0.1%	43,000
Oceania	81,000	7,100	0.4%	4,000
Latin America	1.7 million	140,000	0.5%	65,000
Caribbean	250,000	27,000	1.2%	19,000
Eastern Europe & Central Asia	1.7 million	270,000	0.9%	84,000
Western & Central Europe	740,000	22,000	0.3%	12,000
North America	1.4 million	43,000	0.8%	18,000
Global Total	39.5 million	4.3 million	1.0%	2.9 million

* Proportion of adults aged 15-49 who were living with HIV/AIDS
 
During 2006 around four million adults and children became infected with HIV (Human Immunodeficiency Virus), the virus that causes AIDS. By the end of the year, an estimated 39.5 million people worldwide were living with HIV/AIDS. The year also saw around three million deaths from AIDS, despite recent improvements in access to antiretroviral treatment. Adults are defined as men and women aged 15 or above, unless specified otherwise. Children orphaned by AIDS are defined as people aged under 18 who are alive and have lost one or both parents to AIDS.

What are HIV and AIDS?

A virus has been sweeping the world for the past two decades, causing a disease which has killed millions of people and which looks likely to kill millions more. The virus is called HIV which stands for Human Immunodeficiency Virus. After a period of time this virus damages the immune system, and this causes a variety of symptoms known as AIDS. This time period varies, depending on factors such as access to AIDS drugs, and possibly such factors as nutrition, the presence of other medical conditions, and stress. In the absence of treatment, the average time between HIV infection and progression to AIDS is around ten years.

What is AIDS?

People have been warned about HIV and AIDS for over twenty years now. AIDS has already killed millions of people, millions more continue to become infected with HIV, and there's no cure - so AIDS will be around for a while yet. However, some of us still don't know exactly what HIV and AIDS actually are. This page sorts the myths from the facts about AIDS.

What is HIV?

 

 HIV (Human Immunodeficiency Virus)
HIV is a virus. Viruses infect the cells of living organisms and replicate (make new copies of themselves) within those cells. A virus can also damage human cells, which is one of the things that can make an infected creature become ill.
People can become infected with HIV from other people who already have it, and when they are infected they can then go on to infect other people. Basically, this is how HIV is spread. HIV stands for the 'Human Immunodeficiency Virus'. Someone who is diagnosed as infected with HIV is said to be 'HIV+' or 'HIV positive'.

 

Why is HIV dangerous?

The immune system is a group of cells and organs that protect your body by fighting disease. The human immune system usually finds and kills viruses fairly quickly.
So if the body's immune system attacks and kills viruses, what's the problem?
Different viruses attack different parts of the body - some may attack the skin, others the lungs, and so on. The common cold is caused by a virus. What makes HIV so dangerous is that it attacks the immune system itself - the very thing that would normally get rid of a virus. It particularly attacks a special type of immune system cell known as a CD4 lymphocyte.
HIV has a number of tricks that help it to evade the body's defences, including very rapid mutation. This means that once HIV has taken hold, the immune system can never fully get rid of it.
There isn't any way to tell just by looking if someone's been infected by HIV. In fact a person infected with HIV may look and feel perfectly well for many years and may not know that they are infected. But as the person's immune system weakens they become increasingly vulnerable to illnesses, many of which they would previously have fought off easily.
The only reliable way to tell whether someone has HIV is for them to take a blood test, which can detect infection from a few weeks after the virus first entered the body.

What is AIDS?

 

A damaged immune system is not only more vulnerable to HIV, but also to the attacks of other infections. It won't always have the strength to fight off things that wouldn't have bothered it before.
As time goes by, a person who has been infected with HIV is likely to become ill more and more often until, usually several years after infection, they become ill with one of a number of particularly severe illnesses. It is at this point that they are said to have AIDS - when they first become seriously ill, or when the number of immune system cells left in their body drops below a particular point. Different countries have slightly different ways of defining the point at which a person is said to have AIDS rather than HIV. AIDS (Acquired Immune Deficiency Syndrome) is an extremely serious condition, and at this stage the body has very little defence against any sort of infection.

How long does HIV take to become AIDS?

 

Without drug treatment, HIV infection usually progresses to AIDS in an average of ten years. This average, though, is based on a person having a reasonable diet. Someone who is malnourished may well progress to AIDS and death more rapidly.
Antiretroviral medication (see appendix)can prolong the time between HIV infection and the onset of AIDS. Modern combination therapy is highly effective and, theoretically, someone with HIV can live for a long time before it becomes AIDS. These medicines, however, are not widely available in many poor countries around the world, and millions of people who cannot access medication continue to die.

How is HIV passed on?

 

HIV is found in the blood and the sexual fluids of an infected person, and in the breast milk of an infected woman. HIV transmission occurs when a sufficient quantity of these fluids get into someone else's bloodstream. There are various ways a person can become infected with HIV.

Ways in which you can be infected with HIV :

• Unprotected sexual intercourse with an infected person Sexual intercourse without a condom is risky, because the virus, which is present in an infected person's sexual fluids, can pass directly into the body of their partner. This is true for unprotected vaginal and anal sex. Oral sex carries a lower risk, but again HIV transmission can occur here if a condom is not used - for example, if one partner has bleeding gums or an open cut, however small, in their mouth.
• Contact with an infected person's blood If sufficient blood from an infected person enters someone else's body then it can pass on the virus.
• From mother to child HIV can be transmitted from an infected woman to her baby during pregnancy, delivery and bresastfeeding. There are special drugs that can greatly reduce the chances of this happening, but they are unavailable in much of the developing world.
• Use of infected blood products Many people in the past have been infected with HIV by the use of blood transfusions and blood products which were contaminated with the virus - in hospitals, for example. In much of the world this is no longer a significant risk, as blood donations are routinely tested.
• Injecting drugs People who use injected drugs are also vulnerable to HIV infection. In many parts of the world, often because it is illegal to possess them, injecting equipment or works are shared. A tiny amount of blood can transmit HIV, and can be injected directly into the bloodstream with the drugs.

It is not possible to become infected with HIV through :

• sharing crockery and cutlery
• insect / animal bites
• touching, hugging or shaking hands
• eating food prepared by someone with HIV
• toilet seats

HIV facts and myths

Around the world, there are a number of different myths about HIV and AIDS. Here are some of the more common ones :
'You would have to drink a bucket of infected saliva to become infected yourself' . . . Yuck! This is a typical myth. HIV is found in saliva, but in quantities too small to infect someone. If you drink a bucket of saliva from an HIV positive person, you won't become infected. There has been only one recorded case of HIV transmission via kissing, out of all the many millions of kisses. In this case, both partners had extremely badly bleeding gums.
'Sex with a virgin can cure HIV' . . . This myth is common in some parts of Africa, and it is totally untrue. The myth has resulted in many rapes of young girls and children by HIV+ men, who often infect their victims. Rape won't cure anything and is a serious crime all around the world.
'It only happens to gay men / black people / young people, etc'  . . . This myth is false. Most people who become infected with HIV didn't think it would happen to them, and were wrong.
'HIV can pass through latex' . . . Some people have been spreading rumours that the virus is so small that it can pass through 'holes' in latex used to make condoms. This is untrue. The fact is that latex blocks HIV, as well as sperm - preventing pregnancy, too.

What does 'safe sex' mean?

Safe sex refers to sexual activities which do not involve any blood or sexual fluid from one person getting into another person's body. If two people are having safe sex then, even if one person is infected, there is no possibility of the other person becoming infected. Examples of safe sex are cuddling, mutual masturbation, 'dry' (or 'clothed') sex . . . 
In many parts of the world, particularly the USA, people are taught that the best form of safe sex is no sex - also called 'sexual abstinence'. Abstinence isn't a form of sex at all - it involves avoiding all sexual activity. Usually, young people are taught that they should abstain sexually until they marry, and then remain faithful to their partner. This is a good way for someone to avoid HIV infection, as long as their husband or wife is also completely faithful and doesn't infect them.

What is 'safer sex'?

 

Safer sex is used to refer to a range of sexual activities that hold little risk of HIV infection.Safer sex is often taken to mean using a condom for sexual intercourse. Using a condom makes it very hard for the virus to pass between people when they are having sexual intercourse. A condom, when used properly, acts as a physical barrier that prevents infected fluid getting into the other person's body.

Is kissing risky?

 

Kissing someone on the cheek, also known as social kissing, does not pose any risk of HIV transmission. Deep or open mouthed kissing is considered a very low risk activity for transmission of HIV. This is because HIV is present in saliva but only in very minute quantities, insufficient to lead to HIV infection alone.
There has only been one documented instance of HIV infection as a result of kissing out of all the millions of cases recorded. This was as a result of infected blood getting into the mouth of the other person during open mouthed kissing, and in this instance both partners had seriously bleeding gums.

Can anything 'create' HIV?

 

No. Unprotected sex, for example, is only risky if one partner is infected with the virus. If your partner is not carrying HIV, then no type of sex or sexual activity between you is going to cause you to become infected - you can't 'create' HIV by having unprotected anal sex, for example. You also can't become infected through masturbation. In fact nothing you do on your own is going to give you HIV - it can only be transmitted from another person who already has the virus.

Is there a cure for AIDS?

Worryingly, surveys show that many people think that there's a 'cure' for AIDS - which makes them feel safer, and perhaps take risks that they otherwise shouldn't.
These people are wrong, though - there is still no cure for AIDS.
There is antiretroviral medication which slows the progression from HIV to AIDS, and which can keep some people healthy for many years. In some cases, the antiretroviral medication seems to stop working after a number of years, but in other cases people can recover from AIDS and live with HIV for a very long time. But they have to take powerful medication every day of their lives, sometimes with very unpleasant side effects.
There is still no way to cure AIDS, and at the moment the only way to remain safe is not to become infected.

HIV testing

There are three main types of HIV test.
The first type of test is the HIV antibody test. This test shows whether a person has been infected with HIV, the virus that causes AIDS. Information on this page concentrates mainly on HIV antibody testing. Antibody tests are also known as ELISA (Enzyme-Linked Immunosorbent Assay) tests.
The second type of test is an antigen test. Antigens are the substances found on a foreign body or germ that trigger the production of antibodies in the body. The antigen on HIV that most commonly provokes an antibody response is the protein P24. Early in the infection, P24 is produced in excess and can be detected in the blood serum by a commercial test (although as HIV becomes fully established in the body it will fade to undetectable levels). P24 antigen tests are sometimes used to screen donated blood, but they can also be used for testing for HIV in individuals, as they can detect HIV earlier than standard antibody tests. Some of the most modern HIV tests combine P24 and other antigen tests with standard antibody identification methods to enable earlier and more accurate HIV detection.
The third type of test is a DNA or RNA test. These types of tests detect the genetic material of HIV itself, and can identify HIV in the blood within a week of infection. DNA/RNA tests come in a number of forms. Babies born to HIV positive mothers may be tested using a type of DNA test called a PCR (Polymerase Chain Reaction). Blood supplies in developed countries are screened for HIV using an RNA test known as NAT (Nucleic Acid-amplification Testing). When a person already knows that she or he is infected with HIV, they may also have a viral load test to detect HIV genetic material and estimate the level of virus in the blood. DNA/RNA tests are rarely used to test for HIV in adults, as they are very expensive and more complicated to administer than a standard antibody or P24 test.

HIV testing

 

The standard HIV test looks for antibodies in a person's blood. When HIV (which is a virus) enters a person's body, special proteins are produced. These are called antibodies. Antibodies are the body's response to an infection. So if a person has antibodies to HIV in their blood, it means they have been infected with HIV. The only exception might be an HIV negative baby born to a positive mother. Babies retain their mother's antibodies for up to 18 months, so may test positive on an HIV antibody test, even if they are actually HIV negative. This is why babies born to positive mothers may receive a PCR test after birth.
Most people develop detectable HIV antibodies within 6 to 12 weeks of infection. In very rare cases, it can take up to 6 months. It is exceedingly rare for someone to take longer than 6 months to develop antibodies.
Getting tested earlier than 3 months may result in an unclear test result, as an infected person may not yet have developed antibodies to HIV. The time between infection and the development of antibodies is called the window period. During the window period people infected with HIV have no antibodies in their blood that can be detected by an HIV test. However, the person may already have high levels of HIV in their blood, sexual fluids or breast milk. Someone can transmit HIV to another person during the window period even though they do not test positive on an antibody test. So it is best to wait for at least 3 months after the last time you were at risk before taking the test, and in the meantime to abstain from sex. Some test centres may recommend testing again at 6 months, just to be extra sure.
It is also important that you are not exposed to further risk of getting infected with HIV during the window period. The test is only accurate if there are no other exposures between the time of possible exposure to HIV and testing.
If an individual's test is negative at six months and they have not had unprotected sex or shared needles again in the meantime, it means that they do not have HIV, and will not therefore go on to develop AIDS.
The only way to know for sure whether you are infected with HIV is to have an HIV antibody test. It is not possible to tell from any symptoms.
 

What are the reasons to have an HIV test?

Many people who have an HIV test have been worrying unnecessarily. Getting a negative result (which means you are not infected with HIV) can put your mind at rest. If your test result is positive, many things can be done to help you to cope with the HIV positive result and look after your health. If your test is positive, then:

• A doctor can keep an eye on your health. Many people who test positive stay healthy for several years. But if you fall ill, there are many drugs called antiretrovirals that can help to slow down the virus and maintain your immune system. You can also have medicines to prevent and treat some of the illnesses that people with HIV get. You may also have access to trials of new drugs and treatments.
• If you do fall ill, the doctor is going to take your symptoms more seriously if they know that you are HIV positive.
• If you know that you are HIV positive, you can take steps to protect other people. For example, by practising safe sex and informing you past sexual partners.
• Knowing that you have HIV may affect some of your future decisions and plans, for example starting a family.

What does the HIV test involve?

Normally a small sample of blood will be taken from your arm, sent to a laboratory and tested. The test is always strictly confidential and only goes ahead if you agree. Your personal doctor will not be told about the test without your permission. Depending on the test used, it can take anything from a few days to a week or longer to get the result back.
A rapid HIV test is also an antibody test. The advantage of a rapid test is that you do not have return to get your test result. The test results from a rapid test are usually available in approximately 30 minutes. Rapid tests are single-use, and do not require laboratory facilities or highly trained staff. This makes rapid tests very suitable for use in resource-limited countries.

How accurate are HIV tests?

 

Standard HIV antibody (ELISA) tests are at least 99.5% accurate when it comes to detecting the presence of HIV antibodies. This high level of sensitivity however means that their specificity (ability to distinguish HIV antibodies from other antibodies) is slightly lowered. Once an individual is out of the window period, it is more likely that they will receive a false positive result than a false negative.
Any HIV positive result given by an ELISA test must therefore be confirmed using a second test.
When two tests are combined, the chance of getting an inaccurate result is much less than 0.1%.

But testing is also about the lives people lead, and the personal views they hold, as Jenny explains below.
"Hi, I am a 30 year old heterosexual woman and I currently have no children. I am not an intravenous drug user or a haemophilic. However, I have had unprotected sex with a number of heterosexual men. I know this behaviour can produce deadly results and I have had 2 negative HIV tests in the past 10 years with the last one being in 1996. Since my last HIV test I have had unprotected sex 5 times.
"I hadn't recently given the subject much thought until I received notice that a local family had contracted HIV. I started thinking about my behaviour and how I have been gambling with my life and also putting the lives of others at risk, since I did not know my current status. I have been blessed with two prior negative HIV results. For the past two weeks I have been reading articles on HIV/AIDS, reading the stories of women who have contracted the virus and are courageously battling the disease, and also reading the signs and symptoms. I have prayed for guidance and for a repeated chance to begin a new pattern in my life if only my test would come back negative just one more time.
"This morning I went for another HIV test and, thank god, it came back negative. I urge everyone black, white, gay, and straight to be tested".

Adults

Adults in most reports are defined as men and women aged 15-49. This age range captures those in their most sexually active years. While the risk of HIV infection continues beyond the age of 50, the fast majority of people with substantial risk behaviour are likely to have become infected by this age. Since population structures differ greatly from one country to another, especially for children and the upper adult ages, the restriction of 'adults' to 15-49 has the advantage of making different populations more comparable. When a report refers to 'men' or 'women', it is usually referring to males and females within these age ranges. Most reports define children as males and females aged between 0 and 14 years

HIV & AIDS in Africa

Sub-Saharan Africa is more heavily affected by HIV and AIDS than any other region of the world. An estimated 24.5 million people were living with HIV at the end of 2005 and approximately 2.7 million additional people were infected with HIV during that year. In just the past year, the AIDS epidemic in Africa has claimed the lives of an estimated 2 million people in this region. More than twelve million children have been orphaned by AIDS.
The extent of the AIDS crisis is only now becoming clear in many African countries, as increasing numbers of people with HIV are becoming ill. In the absence of massively expanded prevention, treatment and care efforts, it is expected that the AIDS death toll in sub-Saharan Africa will continue to rise. This means that impact of the AIDS epidemic on these societies will be felt most strongly in the course of the next ten years and beyond. Its social and economic consequences are already widely felt, not only in the health sector but also in education, industry, agriculture, transport, human resources and the economy in general.

 

How are different countries in Africa affected?

Both HIV prevalence rates and the numbers of people dying from AIDS vary greatly between African countries. In Somalia and Senegal the HIV prevalence is under 1% of the adult population, whereas in South Africa and Zambia around 15-20% of adults are infected with HIV. In four southern African countries, the national adult HIV prevalence rate has risen higher than was thought possible and now exceeds 20%. These countries are Botswana (24.1%), Lesotho (23.2%), Swaziland (33.4%) and Zimbabwe (20.1%).
West Africa has been less affected by AIDS, but the HIV prevalence rates in some countries are creeping up. HIV prevalence is estimated to exceed 5% in Cameroon (5.4%), Côte d'Ivoire (7.1%) and Gabon (7.9%).
Until recently the national HIV prevalence rate has remained relatively low in Nigeria, the most populous country in Sub-Saharan Africa. The rate has grown slowly from below 2% in 1993 to 3.9% in 2005. But some states in Nigeria are already experiencing HIV infection rates as high as those now found in Cameroon. Already around 2.9 million Nigerians are estimated to be living with HIV.
Adult HIV prevalence in East Africa exceeds 6% in Uganda, Kenya and Tanzania.

Trends in Africa's AIDS epidemic

Large variations exist between the patterns of the AIDS epidemic in different countries in Africa. In some places, the HIV prevalence is still growing. In others the HIV prevalence appears to have stabilised and in a few African nations - such as Kenya and Zimbabwe - declines appear to be underway, probably in part due to effective prevention campaigns. Others countries face a growing danger of explosive growth. The sharp rise in HIV prevalence among pregnant women in Cameroon (more than doubling to over 11% among those aged 20-24 between 1998 and 2000) shows how suddenly the epidemic can surge.
Overall, rates of new HIV infections in Sub-Saharan Africa appear to have peaked in the late 1990s, and HIV prevalence seems to be levelling off, albeit at an extremely high level. Stabilisation of HIV prevalence occurs when the rate of new HIV infections is equalled by the AIDS death rate among the infected population. This means that a country with a stable but very high prevalence must be suffering a very high number of AIDS deaths each year. Although prevalence remains stable, the actual number of Africans living with HIV is rising due to general population growth.

What is the effect of these high levels of HIV infection?

 

Over and above the personal suffering that accompanies HIV infection, the AIDS epidemic in sub-Saharan Africa threatens to devastate whole communities, rolling back decades of development progress.
Sub-Saharan Africa faces a triple challenge of colossal proportions:

• Providing health care, support and solidarity to a growing population of people with HIV-related illness, and providing them with treatment.
• Reducing the annual toll of new HIV infections by enabling individuals to protect themselves and others.
• Coping with the cumulative impact of over 20 million AIDS deaths on orphans and other survivors, on communities, and on national development.

What is the impact of AIDS on Africa?

HIV & AIDS are having a widespread impact on many parts of African society. The points below describe some of the major effects of the AIDS epidemic.

• In many countries of Sub-Saharan Africa, AIDS is erasing decades of progress made in extending life expectancy. Millions of adults are dying from AIDS while they are still young, or in early middle age. Average life expectancy in Sub-Saharan Africa is now 47 years, when it could have been 62 without AIDS.
• The effect of the AIDS epidemic on households can be very severe. Many families are losing their income earners. In other cases, income earners are forced to stay at home to care for relatives who are ill from AIDS. Many of those dying from AIDS have surviving partners who are themselves infected and in need of care. They leave behind orphans grieving and struggling to survive without a parent's care.
• In all affected countries, the HIV/AIDS epidemic is putting strain on the health sector. As the epidemic develops, the demand for care for those living with HIV rises, as does the number of health workers affected.
• Schools are heavily affected by HIV/AIDS. This a major concern, because schools can play a vital role in reducing the impact of the epidemic, through education and support.
• HIV/AIDS dramatically affects labour, setting back economic activity and social progress. The vast majority of people living with HIV/AIDS in Africa are between the ages of 15 and 49 - in the prime of their working lives. Employers, schools, factories and hospitals have to train other staff to replace those at the workplace who become too ill to work.
• Through its impacts on the labour force, households and enterprises, HIV/AIDS can act as a significant brake on economic growth and development. HIV/AIDS is already having a major affect on Africa's economic development, and in turn, this affects Africa's ability to cope with the epidemic.

HIV prevention in Africa

A continued rise in the number of Africans living with HIV and dying from AIDS is not inevitable. There is growing evidence that HIV prevention efforts can be effective, and this includes initiatives in some of the most heavily affected countries.
In some countries there have been early and sustained HIV prevention efforts. For example, effective HIV prevention campaigns have been carried out in Senegal, which is still reflected in the relatively low adult HIV prevalence rate of 0.9%. Also, the experience of Uganda shows that a widespread AIDS epidemic can be brought under control. HIV prevalence in Uganda fell from around 15% in the early 1990s to around 5% by 2001. This change is thought to be largely due to intensive HIV prevention campaigns.
More recently, similar declines have been seen in Kenya, Zimbabwe and urban areas of Zambia and Burkina Faso. However, the extremely severe AIDS epidemics in South Africa, Swaziland and Mozambique continue to grow.
Overall a massive expansion in prevention efforts is needed, and although there is no single or immediate tool to prevent new HIV infections, the major components of a successful HIV prevention programme are now known.

Condom use & HIV

Condoms play a key role in preventing HIV infection around the world. In Sub-Saharan Africa, most countries have seen an increase in condom use in recent years. In studies carried out between 2001 and 2005, eight out of eleven countries in Sub-Saharan Africa reported an increase in condom use.3
The distribution of condoms to countries in Sub-Saharan Africa has also increased: in 2004 the number of condoms provided to this region by donors was equivalent to 10 for every man,4 compared to 4.6 for every man in 2001.5 In most countries, though, many more condoms are still needed. For instance, in Uganda between 120 and 150 million condoms are required annually, but less than 40 million were provided in 2005.6
Relative to the enormity of the HIV/AIDS epidemic in Africa, providing condoms is cheap and cost effective. Even when condoms are available, though, there are still a number of social, cultural and practical factors that may prevent people from using them. In the context of stable partnerships where pregnancy is desired, or where it may be difficult for one partner to suddenly suggest condom use, this option may not be practical.

Provision of Voluntary HIV Counselling & Testing (VCT)

The provision of voluntary HIV counselling and testing (VCT) is an important part of any national prevention program. It is widely recognised that individuals living with HIV who are aware of their status are less likely to transmit HIV infection to others, and that through testing they can be directed to care and support that can help them to stay healthy. VCT also provides benefit for those who test negative, in that their behaviour may change as a result of the test. The provision of VCT has become easier, cheaper and more effective as a result of the introduction of rapid HIV testing, which allows individuals to be tested and find out the results on the same day. VCT could – and indeed needs to be – made more widely available in most Sub-Saharan African countries.

Mother-to-child transmission of HIV

Around 2 million children in Sub-Saharan Africa were living with HIV at the end of 2005. They represent more than 85% of all children living with HIV worldwide. The vast majority of these children will have become infected with HIV during pregnancy or through breastfeeding when they are babies, as a result of their mother being HIV-positive. Mother to child transmission (MTCT) of HIV is not inevitable. Without interventions, there is a 20-45% chance that a HIV-positive mother will pass infection on to her child. If a woman is supplied with antiretroviral drugs, though, this risk can be reduced significantly. Before this measures can be taken the mother must be aware of her HIV-positive status, so testing also plays a vital role in the prevention of MTCT.
In many developed countries, these steps have helped to virtually eliminate MTCT. Yet Sub-Saharan Africa continues to be severely affected by the problem, due to a lack of drugs, services and information. The shortage of testing facilities in many areas is also contributing. Fewer than 6% of pregnant women in Sub-Saharan Africa were offered services to prevent MTCT in 2005.
Given the scale of the MTCT crisis in Africa, it is remarkable that more is not being done (by both the international community and domestic governments) to prevent the rising numbers of children becoming infected with HIV, and dying from AIDS.

HIV/AIDS related treatment and care in Africa

Antiretroviral drugs

Antiretroviral drugs (ARVs) - which significantly delay the progression of HIV to AIDS and allow people living with HIV to live relatively normal, healthy lives – have been available in richer parts of the world since around 1996. Distributing these drugs requires money, a well-structured health system and a sufficient supply of healthcare workers. The majority of developing countries are lacking in these areas and have struggled to cope with the increasing numbers of people requiring treatment.
For most Africans living with HIV, ARVs are still not available - fewer than one in five of the millions of Africans in need of the treatment are receiving it. Many millions are not even receiving treatment for opportunistic infections, which affect individuals whose immune systems have been weakened by HIV infection. These facts reflect the world’s continuing failure, despite the progress of recent years, to mount a response that matches the scale and severity of the global HIV/AIDS epidemic.
Botswana pioneered the provision of ARVs in Africa, starting its national treatment programme in January 2002. By 2005 this programme was providing treatment to the vast majority of those in need. According to World Health Organisation figures, 84,000 people were receiving treatment at the end of 2006, including those using the private sector, giving a coverage rate above 95%. Thousands of lives have been saved as a result.
While most African countries have now started to distribute ARVs, progress in providing sufficient quantities of the drugs has been uneven and Botswana’s success has not been emulated elsewhere. Among the other countries that have made advances are Rwanda and Namibia, where more than 70% of people in need of ARVs are receiving them. In Cameroon, Côte d’Ivoire, Kenya, Malawi and Zambia, between 25% and 45% of people requiring antiretroviral drugs were receiving them in December 2006. While South Africa is the richest nation in Sub-Saharan Africa and should have led the way in ARV distribution, its government was slow to act; so far, only 33% of those in need of treatment in South Africa are receiving it. In other countries, such as Ghana, Mozambique, Nigeria, the United Republic of Tanzania and Zimbabwe, the figure is less than 20%.

The latest international target of the World Health Organisation (WHO) is aiming at universal access to treatment by 2010. There are still, however, a number of impediments to ARV provision. One major challenge is the fact that the majority of African countries have a poor healthcare infrastructure and a shortage of medical professionals. A considerable emphasis needs to placed not only on the availability of ARVs, but also the availability of professionals who are able to administer the drugs.

Another major challenge is ensuring that drugs are not only supplied to a lot of areas, but that sufficient quantities of drugs are supplied to those areas. This is critically important, because once an individual starts to take ARVs they have to take them for the rest of their life. If, for instance, their local hospital runs out of ARVs, the interruption that this causes in their treatment could result in them becoming resistant to the drugs. To improving treatment programs, African countries face the double challenge of getting new people to start treatment and maintaining the supply of treatment to those who are already receiving ARVs.

HIV & AIDS in South Africa

South Africa is currently experiencing one of the most severe AIDS epidemics in the world. By the end of 2005, there were five and a half million people living with HIV in South Africa, and almost 1,000 AIDS deaths occurring every day.
A number of factors have been blamed for the increasing severity of South Africa’s AIDS epidemic, and debate has raged about whether the government’s response has been sufficient. This page looks at the impact that AIDS has had on South Africa, the historical context of the epidemic, and the major issues surrounding the crisis.

The scale of South Africa’s AIDS crisis

It is difficult to overstate the suffering that HIV has caused in South Africa. With statistics showing that almost one in five adults are infected, HIV is widespread in a sense that can be difficult to imagine for those living in less-affected countries. For each person living with HIV, in South Africa and elsewhere, not only does it impact on their lives, but also those of their families, friends and wider communities.
With antiretroviral drug treatment, HIV-positive people can maintain their health and often lead relatively normal lives. Sadly, few people in South Africa have access to this treatment. This means that AIDS deaths are alarmingly common throughout the country. It is thought that almost half of all deaths in South Africa, and a staggering 71% of deaths among those aged between 15 and 49, are caused by AIDS. So many people are dying from AIDS that in some parts of the country, cemeteries are running out of space for the dead.3 A recent survey found that South Africans spent more time at funerals than they did having their hair cut, shopping or having barbecues. It also found that more than twice as many people had been to a funeral in the past month than had been to a wedding.
As well as the death and suffering that HIV has caused on an individual and community level, South Africa’s AIDS epidemic has also had a substantial impact on the country’s overall social and economic progress:

• Average life expectancy in South Africa is now 54 years – without AIDS, it is estimated that it would be 64. Over half of 15 year olds are not expected to reach the age of 60.
• Between 1990 and 2003 – a period during which HIV prevalence in South Africa increased dramatically – the country fell by 35 places in the Human Development Index, a global directory that ranks countries by how developed they are.
• Hospitals are struggling to cope with the number of HIV-related patients that they have to care for. In 2006 a leading researcher estimated that HIV-positive patients would soon account for 60-70% of medical expenditure in South African hospitals.
• Schools have fewer teachers because of the AIDS epidemic. In 2006 it was estimated that 21% of teachers in South Africa were living with HIV.

It is clear that AIDS is having a devastating impact on South Africa. There are many possible reasons why South Africa has been so badly affected by AIDS, including poverty, social instability and a lack of government action. One way to gain a better insight into the situation is to look back on the history of AIDS in South Africa ( see appendix).

The Uganda studies of 1992 proved to the world the importance of communication and providing information in the battle against AIDS. Halfway reaching the Millenium goals of 2015 we face a new challenge in 2007. Many young people all over the world are aware of the dangers of HIV/AIDS. Many of them know how the virus can be transmitted. Nonetheless they do not act accordingly in terms of protecting themselves from becoming affected with HIV/AIDS.

The aim of the internet competition is to ask the future generations why in their view so many people still behave in such a risky and dangerous way by having un safe sex, thus challenging the school pupils to think of new or better ways to make young people actually protecting themselves.

Deadline for handing in senario to the Jury is on 29 October 2007.

 

Oleanworld Foundation'

© Ciska de Hartogh                                                                                   20 August 2007