In sub-Saharan Africa, the prevalence of AIDS is greater than anywhere else in the world.
According to the latest statistics released by UNAIDS, the Joint United Nations Programme on HIV/AIDS, and the WHO, ahead of 1 December - World AIDS Day - some two million people across Africa have died of the disease so far this year. Seven out of 10 people newly-infected with the HIV virus around the world during 1998 live in sub-Saharan Africa while 83 percent of all AIDS deaths since the epidemic started have been recorded in sub-Saharan Africa. Yet only one-tenth of the world’s population lives in Africa, south of the Sahara.
This report, is based on the latest UN studies and an IRIN interview with Dr Peter Piot, Executive Director of UNAIDS.
Areas most at risk
The regions of Africa worst hit by the crisis are Southern Africa, East and Central Africa and West Africa in that order. The new UN studies show that, in general, West Africa is less affected by HIV than East Africa or Southern Africa.
Since the start of the epidemic an estimated 34 million people living in sub-Saharan Africa have been infected and 11.5 million people, a quarter of those children, have already died, according to a UNAIDS report published on World Aids Day.
“Some 4 million of these people will have contracted the infection in 1998 alone,” it said. “In the course of 1998, AIDS will have been responsible for an estimated 2 million funerals in Africa.”
Dr Piot visited South Africa this week to launch the UNAIDS report because the Southern African region holds the majority of the worst-affected countries. Current UN estimates show that in Botswana, Namibia, Swaziland and Zimbabwe, over one person in five between the ages of 15 and 49 (or roughly 20/26 percent of adults in this age group) is living with HIV or AIDS.
“We know now that despite these already very high levels of HIV infection, the worst is still to come in Southern Africa,” Piot said. “The region is facing human disaster on a scale never seen before, worse than that brought by any drought or natural disaster.”
In South Africa, Malawi, Mozambique, Zambia and Rwanda, between one in seven and one in nine adults is infected with HIV. In Central African Republic, Côte d’Ivoire, Djibouti and Kenya, at least one in ten adults has AIDS. Senegal and Uganda are cited as countries where early and sustained prevention can be credited with new lower rates of AIDS. But in Zimbabwe, where 25 surveillance stations were set up across the country to test pregnant women, between a fifth and half the women tested in 23 of those sites during 1997 were found to have AIDS. South Africa which trailed its neighbours at the start of the decade, is currently recording just over 50 percent of all new aids cases occurring in Southern Africa.
Those most at risk
People most at risk, the studies show, are young people aged between 14 and 24, and that the majority are girls and young women. It noted that in Kenya, where a study of 10,000 schoolgirls showed that their sex lives started between the ages of 14 and 15, there was no reproductive health education or counselling on safer sex.
HIV surveillance data shows that girls and young women often become infected at younger ages and than boys. In Kenya 22 percent of girls aged 15-19 were infected with AIDS, compared to four percent for boys in the same age group. A study of Zambian children the same age showed that 12.3 percent of girls were infected compared to 4.5 percent of boys while a study in Ethiopia found that in the higher 20-24 age bracket, 35.4 percent of young women were infected - a rate over three times higher than the 10.7 percent among young men.
“What comes out in the latest studies we have conducted in Africa, is the young age at which AIDS hits and the fact that it is girls and young women who are mostly infected,” Piot said. “This is what is most striking and most shocking.
New studies show that AIDS now poses perhaps the biggest single threat to development in Africa, bringing with it lower life expectancy, lower household incomes, lower consumer consumption, overburdened health systems, more child deaths and orphans, and with it, bottom-line losses to businesses and households.
It was calculated that a worker with AIDS in Southern Africa costs a business around US $200 a year in lost productivity, treatment, benefits and replacement training, with the costs for senior and skilled staff still higher. In Kenya, for example, AIDS costs translated into 6 percent of all profits in 1994, and are forecast to reach 15 percent of profits by 2005. For South Africa it was forecast that companies will be paying out AIDS-related employee benefits equivalent to 19 percent of salaries, up from seven percent in 1995. In Cote d’Ivoire, studies have shown that when the main earner in a family gets AIDS, the household income is cut by two-thirds and consumption goes down, notably for schooling, by more than 50 percent. Namibia’s infant mortality rate which should have fallen to 45 per 1,000 births in the first decade of the next century, is now expected to reach 72 per 1,000 because of AIDS.
“Companies in hard-hit countries are losing trained staff at rates unheard of in the industrialised world. Extra staff are hired in anticipation of workforce losses to AIDS. Profits are eaten up by health care costs and work-hours lost to sickness and attendance at funerals,” Piot said.
Fighting the scourge
The experts at UNAIDS and WHO say that the first line of defence against AIDS is public awareness. Often critical of governments for failing to acknowledge the extent of the disease, the message being pressed on World AIDS Day, Piot said: “is to fight the silence born of shame which continues to shroud the epidemic”. He said the UN welcomed greater openness being shown lately by the governments of South Africa, Botswana and Zimbabwe.
On the positive side, he noted that in some badly-infected villages in Southern Africa, schemes were being devised to set aside land to be cultivated for orphans and households affected by AIDS. Prevention efforts in the workplace were also proving effective. A recent study in Zimbabwe showed that prevention campaigns in factories cost just US $6 per worker had significantly reduced the number of new infections.
“But the shame associated with AIDS continues to block progress by making people reluctant to talk about HIV, recognise the risks and confront the epidemic openly. Political leaders can be slow to acknowledge the threat facing their country,” Piot said. “Ordinary citizens may hesitate to raise the issue of condom use with their spouse for fear of acknowledging HIV infection.” For further information and the detailed country-by-country breakdown, IRIN subscribers can visit the UNAIDS home page on the internet at www.unaids.org
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions