HIV epidemic continues to make major inroads in sub-Saharan Africa
AIDS deaths estimated at 2.4 million
There were a few bright spots in an otherwise bleak HIV picture in sub-Saharan Africa last year. Adult national HIV prevalence rates appeared to be declining in Kenya, Uganda, and Zimbabwe.1
But the overall news was sobering: An estimated 25.8 million adults and children were living with HIV in 2005 in the region, and AIDS deaths were around 2.4 million, an estimated 300,000 more deaths than in 2003.1
UNAIDS of Geneva, Switzerland, estimates that worldwide close to five million people were newly infected with HIV in 2005, and more than half of them were ages 15 to 24. More than three million people died from AIDS, including half a million children, Peter Piot, MD, executive director of UNAIDS, says in a speech in New Delhi, India, at the launch of the 2005 AIDS epidemic update campaign on Nov. 21. (See charts about AIDS epidemic worldwide.)
Still, global health leaders take some comfort in the good news: "Adult HIV infection rates in Kenya have gone from a peak of 10 percent in the late 1990s to 7 percent in 2003," Piot says.
Likewise, in Zimbabwe, the levels of HIV infection among pregnant women fell from 26 percent in 2002 to 21 percent in 2004, and that was the first country in Southern Africa where such a decline was seen on a national scale, Piot reports.
"In the two African countries, the declines in HIV rates have been due to changes in behavior, including increased use of condoms, people delaying the first time they have sexual intercourse, and people having fewer sexual partners," Piot explains. "HIV information campaigns and voluntary HIV testing and counseling have encouraged those changes. In other words, HIV prevention efforts are working."
Uganda's HIV epidemic peaked in the mid-1990s at more than 15 percent prevalence, and then it began to fall due to a nationwide prevention strategy. Unfortunately, that success may be turning around, as recent data show continued high risk behaviors among men, particularly.1
Despite the encouraging news from a handful of countries, the worldwide picture shows that the AIDS epidemic continues to outstrip global and national efforts to contain it, Piot notes.
Also, the successes witnessed in parts of the developing world do not mean the global health care community can let go of its guard, says Paul De Lay, MD, director of evaluation for UNAIDS.
"If we reduce these [prevention] programs we'll see a resurgence of the epidemic," De Lay says. "This report highlights the need for comprehensive programs for this generation and the next generation."
And sub-Saharan Africa continues to have the world's worst HIV epidemic, with more than 60 percent of all people living with the disease, says Karen Stanecki, senior advisor for demographic and related data at UNAIDS.
The annual UNAIDS report about the epidemic has some limitations, including the fact that HIV prevalence data primarily reflect HIV incidence patterns of several years previously, Stanecki says.
As the UNAIDS report notes, several hundred thousand Zimbabweans were displaced by force in 2005, and this could have an impact on future data.
"The declines we're seeing are not the result of current situations," Stanecki says, explaining why Zimbabwe is showing declines at a time of economic and political turmoil.
"Until recently, Zimbabwe had the second best health infrastructure in all of Africa, with South Africa having the best," De Lay says.
"In Zimbabwe, we saw increases in condoms, declines in casual partners, and these came from pregnant women surveillance data and some localized research studies that were done," Stanecki says. "But that doesn't reflect the current economic and political situation, and we are very much concerned that the current situation will have major implications about what will happen with the epidemic."
Another explanation for Zimbabwe's success is that there has been a massive community response to the epidemic, and this has been invisible to the outside world, which has instead focused on the government's actions and policies, De Lay says.
Studies conducted in Zimbabwe show that condoms are being used in 80 percent of casual sexual partnerships, which is among the highest percentage of condom use in the world, De Lay notes.
"Somehow people are recognizing their risk and are doing something about it even in the current political crisis," De Lay says.
Unfortunately, the positive news does not extend to southern Africa as a whole. The report found that in South Africa, HIV prevalence among pregnant women has climbed to 29.5 percent of women attending antenatal clinics in 2004, and HIV prevalence among women aged 25-34 years is estimated to be more than one in three.1
To put the data in perspective, South Africa's HIV prevalence was less than 1 percent in 1990. By 2000, it had climbed to nearly 25 percent.1
"Having lagged behind most other epidemics in the sub-region, AIDS in South Africa is now taking a devastating toll in human lives," the UNAIDS report says. "A recent study of death registration data has shown that deaths among people 15 years of age and older increased by 62 percent in 1997 to 2002, with deaths among people aged 25-44 years more than doubling."
Also, Botswana, Lesotho, Namibia, and Swaziland also have very high HIV prevalence with rates often exceeding 30 percent among pregnant women.1
UNAIDS officials say that despite the severity of global AIDS deaths, these numbers would be significantly higher if it weren't for the universal access to HIV prevention, treatment, and support programs.
"Access to HIV treatment has improved over the past two years," Piot says. "Even if the 'Three by Five' goal will not have been reached as of June 2005, there are now more than one million people in developing countries living longer and better lives because they are on antiretroviral therapy."
The number of people who died from AIDS last year would have been 3.4 million instead of 3.1 million if it weren't for the antiretroviral access efforts, says Jim Yong Kim, MD, director of HIV/AIDS for the World Health Organization of Geneva, Switzerland.
"In some African countries, we're seeing a treatment dividend," Kim says. "We know that when treatment is available, the interest in knowing one's status goes up significantly."
The UNAIDS report includes these statistics about various African nations and the HIV epidemic:
- Botswana, Lesotho, Namibia, and Swaziland are nations with very high HIV prevalence, which exceeded 30 percent among pregnant women and soared to 43 percent in 2004 in Swaziland.1
- Mozambique's epidemic has risen with HIV prevalence among pregnant women rising at two thirds of the clinics surveyed in 2004, and the estimated adult HIV prevalence rate rose to over 16 percent in 2002 to 2004.1
- Pregnant women in Namibia have an HIV prevalence that ranges from 8.5 percent in the remote Northwest area of Opuwo to more than 42 percent in Katima Mulilo, which is in the Caprivi Strip between Angola, Botswana, and Zambia.1
- While data suggest Botswana's epidemic is stabilizing, the HIV prevalence among pregnant women remains between 35 percent and 37 percent, and the prevalence rate even has risen among pregnant women ages 25 and older.1
- HIV prevalence in Madagascar, Mauritius, and Seychelles is low compared with other areas in Southern Africa, but it has risen in Madagascar, reaching an estimated 1.8 percent prevalence in 2005. And in Mauritius, HIV prevalence among injection drug users (IDUs) is between 10 percent and 20 percent.1
- Nigeria is home to an estimated 3.2-3.6 million people who live with HIV infection, according to 2003 data, and the median HIV prevalence among pregnant women has leveled at 4 percent.1
The world's focus must continue to be on prevention, even as countries increase their treatment programs, Piot says.
World AIDS Day in 2005 was the first time the international community declared a single plan of action on HIV prevention, Piot says.
The UNAIDS report stresses that prevention and treatment are partners and should be conducted together.
"We should shoot for a universal offer of voluntary testing and counseling," Kim says. "We have a nice quiver full of arrows of effective prevention programs for every kind of transmission of the virus."
One of the first places to start a prevention scale-up project would be to reduce mother to child transmission (MTC), because without prevention efforts about 35 percent of children born to HIV-positive women will contract the virus.1
"Closing the gap on HIV prevention will also require a greater attention to the needs of children and young people," Piot says. "The response to AIDS has to be unprecedented because this is an unprecedented epidemic, both as a crisis today and as a threat into the future."
Reference:
- AIDS epidemic update: December 2005. Joint United Nations Programme on HIV/AIDS (UNAIDS), World Health Organization (WHO);05.19E:1-98. Available on-line: www.unaids.org.
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