HIV/AIDS in Africa

thumb|300x300px|The 2026 prevalence of HIV/AIDS in Africa, % of population ages 15–49, [[World Bank

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HIV/AIDS originated in the early 20th century and remains a significant public health challenge, particularly in Africa. Although Africa constitutes about 17% of the world's population, it bears a disproportionate burden of the epidemic. In 2023, around 25.6 million people in sub-Saharan Africa were living with HIV, accounting for over two-thirds of the global total. The majority of new infections and AIDS-related deaths occur in Eastern and Southern Africa, which house approximately 55% of the global HIV-positive population.

In Southern Africa, the epidemic is particularly severe. Countries including Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe have adult prevalence rates exceeding 10%. This has significantly affected life expectancy, with reductions of up to 20 years in the most impacted areas. North Africa, West Africa, and the Horn of Africa report significantly lower prevalence rates, attributed to differing cultural practices and reduced engagement in high-risk behaviors.

Efforts to combat the epidemic have focused on multiple strategies, including the widespread distribution of antiretroviral therapy (ART), which has substantially improved the quality of life and reduced mortality for those living with HIV. Between 2010 and 2020, AIDS-related deaths declined by 43% in sub-Saharan Africa due to increased access to ART and prevention of mother-to-child transmission programs. Challenges persist, including stigma, insufficient healthcare infrastructure, and funding constraints.

Key regional and international organizations, such as UNAIDS, the World Health Organization (WHO), and the African Union, continue to coordinate responses, aiming to achieve the United Nations Sustainable Development Goal of ending the HIV epidemic by 2030. Initiatives such as the PEPFAR program and the Global Fund have been instrumental in scaling up ART distribution and prevention campaigns.

Despite progress, gender inequalities exacerbate the epidemic's impact, with young women in sub-Saharan Africa experiencing HIV infection rates three times higher than their male counterparts. Addressing socio-economic factors and enhancing HIV/AIDS education among at-risk populations remain vital components of comprehensive intervention strategies.

Overview

In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote:

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|+Regional comparisons of HIV in 2011

! World region !! Adult HIV prevalence (ages 15–49)!! Persons living with HIV

| Worldwide || align="center" | 0.8% || align="right" | 34,000,000 || align="right" | 1,700,000 || align="right" | 2,500,000

| Sub-Saharan Africa || align="center" | 4.9% || align="right" | 23,500,000 || align="right" | 1,200,000 || align="right" | 1,800,000

| South and Southeast Asia || align="center" | 0.3% || align="right" | 4,000,000 || align="right" | 250,000 || align="right" | 280,000

| Eastern Europe and Central Asia || align="center" | 1.0% || align="right" | 1,400,000 || align="right" | 92,000 || align="right" | 140,000

| East Asia || align="center" | 0.1% || align="right" | 830,000 || align="right" | 59,000 || align="right" | 89,000

| Latin America || align="center" | 0.4% || align="right" | 1,400,000 || align="right" | 54,000 || align="right" | 83,000

| Middle East and North Africa || align="center" | 0.2% || align="right" | 300,000 || align="right" | 23,000 || align="right" | 37,000

| North America || align="center" | 0.6% || align="right" | 1,400,000 || align="right" | 21,000 || align="right" | 51,000

| Caribbean || align="center" | 1.0% || align="right" | 230,000 || align="right" | 10,000 || align="right" | 13,000

| Western and Central Europe || align="center" | 0.2% || align="right" | 900,000 || align="right" | 7,000 || align="right" | 30,000

| Oceania || align="center" | 0.3% || align="right" | 53,000 || align="right" | 1,300 || align="right" | 2,900

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.!! AIDS deaths, 2021 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,

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! Country !! Adult prevalence ages 15–49, 2011 !! Adult prevalence ages 15–49, 2001 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. || 18,000 || 13,000 || 28,000

| Guinea || 1.4% || 1.5% || 85,000 || 72,000 || 4,000]]

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.

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! Country !! Adult prevalence ages 15–49, 2011

In 2009, the HIV epidemic in Eswatini reduced its life expectancy at birth to 49 years for men, and 51 years for women. 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

400px|thumb|The prevalence of [[Subtypes of HIV|HIV-1 subtypes, 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

400px|thumb|The prevalence of HIV/AIDS in Africa, from 1988 to 2003

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

thumb|400px|right|An AIDS awareness sign in central [[Dar es Salaam, 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".

"It is the consensus in the HIV scientific community that abstinence, be faithful, use a condom [(ABC)] principles are vital guides for public health intervention, but are better bundled with biomedical prevention approaches; lone behavioral change approaches are not likely to stop the global pandemic." 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,