HIV/AIDS epidemic ravages Africa
By David Walsh
27 June 1998
- In an estimate researchers call conservative,
one in four people in the African nations of Botswana and Zimbabwe are
infected with HIV, the virus that causes AIDS.
- In 13 sub-Saharan African countries at least 10
percent of the population is infected with HIV, and in many capital
cities the prevalence rates are 35 percent or more.
- In one town on the Zimbabwean-South African
border, 7 out of 10 women attending prenatal clinics in 1995 were
- Perhaps 90 percent of those infected in Africa
are ignorant of the fact because testing is not widely available.
- Life expectancy is receding in certain African
countries to levels not seen since the 1960s.
- In the Zimbabwean capital of Harare, deaths
among children one to five years old jumped by 250 percent between
1988 and 1996.
- Among East Africans, AIDS has more than doubled
adult mortality in rural areas where 10 percent of the population has
HIV. Even where HIV prevalence is slightly lower, AIDS accounts for
four out of five deaths between the ages of 25 and 34.
- Overall, Africa has experienced 83 percent of
the world's AIDS deaths. Four out of five HIV-positive women in the
world live in that continent. An even higher proportion of the
children living with HIV in the world are in Africa--an estimated 87
These are a few of the horrifying statistics revealed in a report issued
earlier this week by the Secretariat of the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO),
on the eve of the 12th World AIDS Conference in Geneva. The study is the
first-ever country-by-country analysis of the global HIV/AIDS epidemic,
and the findings shocked even its organizers.
The report describes both a "prevention gap" between the advanced
countries, where infection rates are leveling off or declining, and the
poorest countries of Africa and Asia, and "a looming divide" between
countries where rates of AIDS deaths are falling and countries where
they are rising.
The major reason for these gaps will come as a surprise to no one. The
study's authors ascribe it to "uneven access" to combination therapy
with antiretrovirals, drugs that fight the human immunodeficiency virus
(HIV) and forestall development of AIDS-related infections and cancers.
These drugs, the report observes, "have come into widespread use in the
developed world over the past two years, yet because they are costly and
difficult to administer they remain inaccessible to most people living
with HIV" in the poorest regions of the world.
The Executive Director of UNAIDS, Dr. Peter Piot, commented, "For nine
out of ten people living with HIV, the overwhelming issue is access to
UNAIDS and WHO estimate that by the end of last year there were more
than 30 million people worldwide living with HIV, 21 million of them in
Africa. Although national rates remain lower in Asia, Latin America and
Eastern Europe, many countries in these areas have experienced a
doubling or tripling of their infections since 1994.
HIV arrived relatively late in Asia, but the region already accounts for
one out of five of the global total of infections and the virus is
spreading rapidly. India has the highest number of people living with
HIV of any single country, an estimated four million. Figures for Asia
are considered to be somewhat unreliable because only a few countries on
that continent have developed methods of adequately monitoring the
spread of the infection.
The UNAIDS-WHO study notes that until the mid-1990s most of the Eastern
European countries had been spared the worst of the HIV epidemic. In the
last few years, however, the former Stalinist countries "have seen
infections increase around six-fold. By the end of 1997, some 190,000
adults in the region were living with HIV infection.... Belarus,
Moldova, the Russian Federation and Ukraine have all registered
astronomical growth in HIV infection rates over the last three years,
most related to unsafe drug injecting. Now there may be nearly four
times as many infections in Ukraine alone as there were in the whole
Eastern European region just three years ago."
Ukraine is the worst affected country in the region. The number of HIV
infections is estimated to have increased by more than 70 times, from
1,500 to 110,000, between 1994 and 1998. The same trend, although not so
dramatic, has been observed in Russia.
The different rates at which rich and poor contract HIV and die from
AIDS are not only reflected in the gaps between the industrialized and
the backward countries of Asia and Africa. The report notes that this
gap is expressed in the differing fates of rich and poor in the US. In a
passage that the American media did not care to publicize, the report
notes that the use of a combination of antiretrovirals grew
"astronomically" in the US over the study period. In 1994, a quarter of
all patients were using combination therapy. By June 1997 that
proportion had grown to 94 percent.
"However, patients with private medical insurance were more likely to be
prescribed protease inhibitors (in addition to other antiretrovirals)
than patients whose medicine was bought through publicly funded
programmes. As a consequence, patients with private medical insurance
were less likely to get sick or die than others. This disparity, even
within a rich country such as the United States, illustrates the
difficulties of ensuring equitable provision of drugs that are expensive
to buy and hard to administer and monitor correctly."