Too Little, Too Late: Responses to the HIV/AIDS Epidemics in Sub-Saharan Africa
Barrett, Hazel R., Geography
ABSTRACT: The latest UNAIDS report (2006) on the global AIDS pandemic states that while there has been progress in tackling AIDS, the epidemic continues to outpace responses. Almost a quarter of a century after the disease was first identified, AIDS remains an exceptional threat. Recent data estimate that in 2006 there were 39.5 million people living with HIV globally. In the same period 4.3 million people were newly infected with HIV while 2.9 million died of AIDS (UNAIDS, 2006, p. 1). Over the last two years the number of people living with HIV has increased in every global region. HIV/AIDS is now acknowledged as 'one of the most destructive epidemics in recorded history' (UNAIDS, 2005, p. 2). This article explores the responses to the epidemic in sub-Saharan Africa and discusses future challenges in the fight against this disease.
The HIV/AIDS pandemic
Sub-Saharan Africa continues to bear the brunt of the global AIDS/HIV pandemic. In 2006 almost two thirds (63%) of all people infected with HIV were living in this region. In that year 24.7 million people in the region were living with HIV, with 2.8 million new infections and 2.1 million deaths from this disease (comprising 72% of the global total number of deaths from AIDS) (UNAIDS, 2006). Figure 1 shows the trend in the epidemic in this region. The graph seems to suggest that the epidemic is slowing in sub-Saharan Africa, with prevalence rates stabilising at about 6-7% of the adult population (aged 15-49). But stabilisation does not necessarily mean that the epidemic is slowing, it can be quite the opposite. As stated in the UNAIDS report for 2006, these figures can disguise the worst phases of an epidemic when 'the number of people newly infected with HIV roughly equal the number of people dying of AIDS' (UNAIDS, 2006, p. 10). In many parts of subSaharan Africa, the epidemic does not yet show any sign of abating (UNAIDS, 2006, p. 23).
It is, however, unhelpful to speak of a single sub-Saharan African HIV/AIDS epidemic. The epidemics affecting this region are highly varied, with differences between and within regions (UNAIDS, 2004). Figure 2 shows the national prevalence rates of HIV in sub-Saharan Africa. This clearly shows the varied intensity of the disease across the region, with the highest prevalence rates found in southern Africa, followed by eastern Africa, with some countries in western and central Africa displaying some worrying prevalence rates. Southern Africa accounts for approximately 32% of global cases of HIV/AIDS and 34% of AIDS deaths (UNAIDS, 2006), yet is home to only 2% of the world's population. The Republic of South Africa has the second highest number of HIV/AIDS cases of any country, after India. The number of HIV+ people living in South Africa is estimated to exceed 5.5 million (UNAIDS, 2006) and 'has not yet reached a plateau' (UNAIDS, 2006, p. 11). In terms of prevalence, Swaziland (33.4%) has the highest levels in the world with adult prevalence (aged 15-49) exceeding 30%. Botswana, Lesotho and Namibia have rates between 20% and 24% (UNAIDS, 2006). It is clear that the HIV/AIDS epidemics in sub-Saharan Africa 'continue [s] to outstrip global efforts to contain it' (UNAIDS, 2005, p. 6).
The main transmission route of the disease in sub-Saharan Africa is unsafe heterosexual intercourse. The epidemic in the region dis- proportionately affects women, with more than 59% of cases in the region occurring among females (UNAIDS, 2006). Young women aged 15-24 are particularly vulnerable and are four times more likely to be infected with HIV than young men. In 2005 the prevalence rate among young women in South Africa was 17% compared with 4.4% among men of the same age group (Shisana et al., 2005). The peak ages of AIDS cases in sub-Saharan Africa are 20-29 years for females and 25-34 years for males. It is therefore not surprising to find that over 0.5 million infants a year are infected with HIV as a result of mother-tochild transmission. …