HIV / AIDS in Africa

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Spread of HIV / AIDS in sub-Saharan Africa:
    <1%
    1% - <5%
    5% - <10%
    10% - <20%
    20% - 28%
    no data given
as a percentage of the adult population (ages 15 to 49 )

Africa south of the Sahara is the world's hardest by the HIV epidemic struck the region in 2014 lived with 25.8 million HIV-positive people 70% of all people living with HIV / AIDS in sub-Saharan Africa; 66% (790,000) of all HIV-related deaths occurred there. 1.4 million were newly infected. Compared to the year 2000, the number of new infections in 2014 decreased by 41%.

According to the United Nations Joint Program on HIV / AIDS (UNAIDS), the number of deaths from AIDS decreased by 34% between 2000-2014. The AIDS epidemic has had dramatic demographic consequences: in some countries by the immune deficiency the life expectancy for more than 20 years decreased. In many countries, however, life expectancy has now risen significantly again, for example in South Africa, where life expectancy rose from 52 to 61 years between 2005 and 2014.

Within Africa, North Africa (0.1%) differs significantly from Sub-Saharan Africa (4.8%) in terms of the proportion of infected people in the total population ( prevalence ).

The main modes of transmission of HIV differ fundamentally from those in Europe and North America: Heterosexual intercourse is by far the most common mode of transmission in Africa, accounting for around 50% of HIV infections. Another 5 to 10% of infections are caused by infected blood transfusions. The transmission of the virus from HIV-positive, pregnant women to their newborns during pregnancy, childbirth and breastfeeding is an important route of infection: In 2014, infected pregnant women transmitted the HIV virus to their child with a probability of 14% ( Mother to child transmission - MTCT). Half of them die in the first year of life, most of the others before their fifth birthday.

distribution

Distribution in continental regions based on information from UNAIDS from 2015.

region Proportion
(ages: 15-49)		 Totally infected
2014		 Newly infected
2014		 Fatalities
2014
North Africa / Middle East 0.1% 240,000 22,000 12,000
Sub-Saharan Africa 4.8% 25.8 million 1.4 Million 790,000
Western and Central Europe, North America 0.3% 2.4 million 85,000 26,000
Eastern Europe and Central Asia 0.9% 1.5 million 140,000 62,000
Asia and Pacific 0.2% 5 million 340,000 240,000
Latin America 0.4% 1.7 million 87,000 41,000
Caribbean 1.1% 280,000 13,000 8,800
Worldwide 0.8% 36.9 million 2 million 1.2 million

In these countries, the proportion of people infected with HIV and suffering from AIDS (2014) is highest in relation to the total population (15–49 years).

Country proportion of Infected Deaths
SwazilandSwaziland Swaziland 27.7% 210,000 3,500
BotswanaBotswana Botswana 25.2% 390,000 5,100
LesothoLesotho Lesotho 23.4% 310,000 9,300
South AfricaSouth Africa South Africa 18.9% 6.8 million 140,000
ZimbabweZimbabwe Zimbabwe 16.7% 1.6 million 39,000
ZambiaZambia Zambia 12.4% 1.2 million 19,000
MozambiqueMozambique Mozambique 10.6% 1.5 million 45,000
MalawiMalawi Malawi 10.0% 1.1 million 33,000
Country proportion of Infected Deaths
NamibiaNamibia Namibia 9.5% 210,000 3,100
UgandaUganda Uganda 7.3% 1.5 million 33,000
KenyaKenya Kenya 5.3% 1.4 Million 33,000
TanzaniaTanzania Tanzania 5.3% 1.5 million 46,000
CameroonCameroon Cameroon 4.8% 660,000 34,000
Central African RepublicCentral African Republic Central Afr. republic 4.3% 140,000 9,900
GabonGabon Gabon 3.9% 48,000 1,500
Congo RepublicRepublic of the Congo Republic of the Congo 2.8% 81,000 4,400

history

The HI virus is most likely derived from the SI virus found in chimpanzees.

Exact details about time, place, host animal , type and number of transmissions are not known. In 2006, an international team of researchers conclusively demonstrated that the pathogen originated in chimpanzees in Cameroon . Phylogenetic studies (comparisons of the relationship between the different subtypes of HIV and between HIV and SIV ) suggest that several independent transmissions from chimpanzees to humans took place in Cameroon and / or its neighboring countries. The first blood sample to detect HIV was taken from an adult in 1959 in the Congo . Further samples come from an American (1969) and a Norwegian sailor (1976).

causes

The comparable distribution in North Africa and Western or Central Europe is due to the influence of Europe on the North African part; in addition, the forms Sahara an ecological boundary between northern and southern African countries.

The almost identical SI virus is considered to be the origin of the HI virus and thus the AIDS pandemic . Two of the two most widespread HIV-related viruses were found in two species of monkeys: in chimpanzees (HIV-1 related) and in soot (HIV-2 related). Before the 1930s, injuries caused by hunting or eating by chimpanzees led to an overcoming of the species barrier and thus a change in the virus to humans. Earlier theories about the origin and spread of the HI virus in Africa included spreading through a contaminated oral vaccination against polio (polio) in the 1950s. However, this theory is now considered refuted.

The following causes are probably responsible for the widespread spread of AIDS in the countries of southern Africa:

  • Late prevention campaigns : While in Europe and North America, shortly after the discovery of the HI virus, the end times mood was spread through the mass media and large parts of the population were thus informed about the transmission routes and prevention, AIDS remained a taboo topic in many parts of Africa, causing the epidemic to almost 20 Years to spread freely.
  • Cost reasons: The population of southern Africa is among the poorest in the world. If condoms and HIV tests are not made available to those affected very cheaply, these funds will not be widely used.
  • Sexual and physical violence against women is one possible reason why, unlike in Europe and North America, more women are infected than men (57% of HIV-infected adults are women), but it does not fully explain this phenomenon. In Tanzania , a study that found out by their partners in young women, the violence, the probability of being infected with HIV, ten times as high as in women who experienced violence.
  • In many areas there is little interest among those affected in knowing their own HIV status and thus being able to protect others. A positive test result amounts to a death sentence in many areas of Africa as there are no treatment options.
  • Strong taboo against AIDS and discrimination and marginalization of AIDS sufferers, which greatly reduces the willingness to carry out an HIV test.
  • Cultural causes: polygamy and the immediate marriage of widows by family members of the deceased are also favorable factors.
  • Overlapping sexual networks: Many people have parallel intimate partnerships through which the virus can spread faster than in monogamous partnerships.

Higher prevalence and a lack of treatment options for other sexually transmitted diseases promote the transmission of the HI virus. The extent to which the prevalence of these diseases affects the spread of HIV is not yet understood. Since many sexually transmitted diseases lead to skin wounds on the sexual organs , the virus can overcome the mucous membrane barriers much more easily during sexual intercourse . Occasionally, genetic factors are also taken into account and the differences between the HIV virus and the strains common in Europe are mentioned. It is known that AIDS is increasingly associated with the common diseases of tuberculosis and malaria in Africa .

Even though all of the above-mentioned causes favor the spread of AIDS, specific causes predominate in certain regions. Central and East Africa are the only regions in Africa that show a decrease in the prevalence in the population - to be able to view this as a gradual alleviation of the problem, the periods observed are too short and the percentage of infected people in the Population still too high. Nevertheless, it is assumed that this decrease is also due to the prevention campaign, which began in the mid-1980s in cooperation with the World Health Organization (WHO) and which is responsible for the fact that the AIDS problem and the possible protective measures are now 99% of the population , especially among young people, is due. In East and Central Africa, UNAIDS found that good, intensive prevention campaigns can have a clearly positive effect.

Prostitution is said to be a major cause in West Africa . For example, 33% of prostitutes in Luanda and 21% in Ouagadougou are HIV-positive - a huge potential for future growth of the epidemic.

According to UNAIDS (2004), the causes in South Africa are the early sexual activity of young people (the average age at first sexual intercourse is 16.4 years for men and 17 years for women, Germany: 16.9 years) in connection with poor or plain lack of preventive education. Among the fifteen to nineteen year olds, 4.8% (2004) are infected, and among the twenty to twenty four year olds it is 16.5% (2004).

Problems of education

Thabo Mbeki, former South African president and AIDS denier

In many African countries, medical professionals and AIDS educators have to contend with violent rejection of scientific knowledge about the HI virus and with widespread ignorance of AIDS research. Contributed to this as AIDS deniers ( english AIDS denialists hereinafter) group of people who, with a varying theories the connection between HIV and AIDS, or even the existence of the virus in question. A particularly prominent representative of this group is the German-American molecular biologist Peter Duesberg , who was appointed to the AIDS advisory commission of the South African government despite his theses on the disease, which were completely discredited in the West. South Africa's former President Thabo Mbeki has repeatedly denied the link between HIV and AIDS, as well as the fact that AIDS is a disease at all. Other African heads of state also positioned themselves accordingly. For example, Gambia's dictator Yahya Jammeh advised residents of his country against taking antiviral drugs .

The controversial German vitamin seller Matthias Rath was also active in South Africa and, supported by the local health minister, sold vitamin preparations as alleged drugs against AIDS. At the end of 2006 there were reports that a fundamental change in course in AIDS policy in South Africa was on the horizon. The protagonists of the controversial AIDS policy remained in office for the time being.

Situation of the infected

AIDS has been responsible for a decline in life expectancy in some South African countries.

While life expectancy and quality of life for HIV-infected people have increased or improved significantly in the industrialized nations - be it through antiretroviral drugs, better treatment of opportunistic infections or drug prophylaxis of infections - the prospects for HIV-infected people are in most of them African countries continue to be bad. Where medical care is often a privilege , lifelong antiretroviral therapy remains priceless for millions of people.

At least 85% (nearly 900,000) of South Africans in need of antiretroviral drugs did not get these funds in 2005, as did at least 90% of those in need in countries such as Ethiopia, Ghana, Lesotho, Mozambique, Nigeria, the United Republic of Tanzania and Zimbabwe.

Antiretroviral therapy costs between 10,000 and 15,000 US dollars per person per year in Europe. The costs are u. a. so high because these drugs have patent rights . Thanks to pharmaceutical factories in South Africa , India , Brazil , Thailand and China, as well as donations, it is possible to provide generics in certain African countries for US $ 140 per person per year.

At the beginning of 2004, the Clinton Foundation reached an agreement between various generic and brand-name manufacturers and negotiated significantly more favorable terms for the countries most affected by the pandemic . UNAIDS announced the goal of providing three million people in these countries with access to antiretroviral therapy by 2005. In 2003 the WHO started the 3 by 5 initiative: 3 million infected people were to be provided with medication in 2005. In 2004, around 700,000 people in poor countries were provided with medication; in 2005 the target was not achieved.

Situation of the families of infected people

Young girls often have to drop out of school to look after their sick parents or to look after their younger siblings. By 2006, AIDS had orphaned 12 million children in Africa. They often do not go to school, are marginalized and discriminated against. The large families are increasingly overwhelmed with the care of these children in view of the huge number of orphans. You are at high risk of malnutrition .

Fight AIDS

AIDS activists in South Africa
Advertisement for HIV testing
Activists of the “Star for Life” program

The "Three Ones" core principles developed by UNAIDS and others in 2003:

  1. a strategy to fight HIV / AIDS
  2. a national, multisectoral AIDS coordination center
  3. a nationwide monitoring and evaluation system.

They are intended to improve the coordination of funds for the fight against HIV / AIDS within a country and to harmonize the activities of various donors and cooperation partners. In the sense of the "Three Ones", activities to fight HIV / AIDS in most African countries are the responsibility of the respective health ministries and national AIDS councils. Most funding for activities against AIDS flowing through multilateral institutions (World Bank, Global Fund to Fight AIDS, Tuberculosis and Malaria u. A.) Or bilateral agreements between developed countries and African governments (eg., Via the Federal Ministry for Economic Cooperation and Development , the German Society for Technical Cooperation , PEPFAR).

This funding provides significant support to African countries in setting up national programs to combat the HIV epidemic. Critics often call for a better involvement of civil society groups and the churches.

  • World bank
In 1988 the World Bank began to financially support projects against HIV / AIDS. In Africa, the World Bank supports government programs against HIV / AIDS through grants made under the “Multi-Country AIDS Program for Africa” (MAP) and the smaller “Treatment Acceleration Program” (TAP), which focuses on the implementation of AIDS therapy. 2006–2008).
In the first phase of MAP (2001 to 2006) the World Bank financed 39 national or supraregional projects with a volume of 1.286 billion US dollars.
  • PEPFAR
In 2003, US President George W. Bush initiated the global US program to fight AIDS, PEPFAR (President's Emergency Plan for AIDS Relief). PEPFAR is one of the major donors in the fight against HIV / AIDS, especially in Africa, and supports preventive, therapeutic and care measures in the recipient countries through bilateral partnerships. From 2003 to 2008, US $ 15 billion was earmarked for the fight against AIDS in developing countries:

For the continuation program PEPFAR 2 (2009 to 2013) 48 billion US dollars were planned.

In South Africa, numerous small organizations and groups are involved in AIDS work in the particularly affected province of KwaZulu-Natal . Often these are village initiatives that no longer want to stand idly by the suffering of their neighbors. What they lack are technical knowledge and financial resources. The AIDS Foundation South Africa (AFSA) helps the grassroots groups with professional advice and money from a fund set up specifically for this purpose . In the next three years, AFSA wants to provide financial support and professional advice to 16 initiatives that are committed to AIDS education and help affected families. This ensures that the small initiatives and groups can concentrate fully on their actual work and receive help when they no longer know what to do. In 2016, the national health ministry announced that all South African people infected with HIV would be treated free of charge.

In Ethiopia, Kenya, Tanzania and Uganda, the German Foundation for World Population supports AIDS education, among other things by supporting self-help initiatives of the population.

In Angola , Botswana, Guinea-Bissau , Mozambique, Namibia, Zambia, Zimbabwe and South Africa (but also in India and China ), Total Control of the Epidemic is working in 50 areas with 100,000 inhabitants , one of them several times excellent campaign to fight HIV / AIDS by the NGO Humana People to People . On the basis of a strict organization, it carries out the education and mobilization of the population in visits from trained locals from house to house. At the end of 2006 it had reached 4.8 million people.

See also

literature

Web links

Individual evidence

  1. ↑ a b c d How AIDS changed everything , UNAIDS , 2015 (PDF; 12.3 MB).
  2. ↑ AIDS by the numbers 2015 , Joint United Nations Program for HIV / AIDS , 2015 (PDF; 790 kB).
  3. ↑ Federal Ministry for Economic Cooperation and Development. 2013. Hunger and malnutrition have many causes. Background.
  4. ^ KM De Cock et al: Prevention of mother-to-child transmission in resource-poor countries. In: Jama. 283, 2000, pp. 1175-1182.
  5. ↑ UNAIDS , 2015.
  6. ↑ Source, unless otherwise stated: UNAIDS How AIDS changed everything, 2015
  7. ↑ Kathrin Zinkant: Root of a Pandemic. In: time online . May 26, 2006.
  8. ↑ Marx, printers and Apetrei in: Journal of Medical Primatology. 2004.
  9. ↑ M. Worobey, M. Santiago, B. Keele, J. Ndjango, J. Joy, B. Labama, B. Dhed'A, A. Rambaut, P. Sharp, G. Shaw, B. Hahn: Origin of AIDS : contaminated polio vaccine theory refuted . In: Nature . tape 428 , no. 6985 , 2004, p. 820-820 , doi : 10.1038 / 428820a , PMID 15103367 .
  10. ↑ a b c The AIDS epidemic. Status report: December 2005. ( Memento of November 7, 2011 in the Internet Archive ) UNAIDS , 2005 (PDF).
  11. ^ Helen Epstein: The Invisible Cure. Africa, the West, and the Fight against AIDS. New York 2007.
  12. ^ Final report of the South African AIDS Expert Commission 2001 , p. 10 (English, PDF; 1.07 MB).
  13. ↑ a b c Perspectives for Africa: Plague of Ignorance. In: Spiegel Special. 2/2007, May 22, 2007.
  14. ^ Peter-Philipp Schmitt: The AIDS critic of Toronto. In: FAZ . August 19, 2006.
  15. ↑ Alexander von Paleske: End of the deadly HIV treatment mistake , Indymedia , November 8, 2006.
  16. ↑ Unicef: Report on AIDS Orphans in Africa - "Africa's Orphaned Generations"
  17. ↑ The Three Ones (English; PDF)
  18. ↑ theglobalfund.org
  19. ↑ bmz.de
  20. ↑ gtz.de
  21. ↑ pepfar.gov
  22. ↑ web.worldbank.org
  23. ↑ TAP ( Memento of November 27, 2011 in the Internet Archive ) (English; archive version)
  24. ^ South Africa to give free treatment to all infected. ctvnews.ca from September 1, 2016, accessed on September 1, 2016.