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2.3 Social Development II: Economic Report on Africa 2007
The patterns of spread and levels of prevalence of HIV/AIDS exhibit marked subregional
variations, with the Southern and Eastern subregions being the hardest
hit. The epidemic seems to be slowly gaining ground in Central Africa, while most
of West and North Africa has sustained fairly low levels of prevalence (UNAIDS
HIV/AIDS does not affect men and women equally. In SSA, close to 60 per cent of
those living with HIV/AIDS are women (box 2.3). In some areas, up to six times
more women than men are infected in the 15-24 age group (WHO-AFRO 2003).
Life expectancy, for biological reasons, is generally higher for women than for men.
However, in four countries – Kenya, Malawi, Zambia and Zimbabwe – the higher
prevalence of HIV/AIDS among women has led to life expectancy for women dropping
below that of men (UN-DESA 2005b).
Given the delayed impact of HIV/AIDS and the continued increase in prevalence,
the worst is yet to come. The pandemic is not only an immediate crisis, but is also
a long-term systemic challenge, with profound consequences for Africa (CHGA
One area of particular concern is the impact of HIV/AIDS on food security. In
a recent study of two local communities in rural Ethiopia, UNECA, UNDP and
WFP found that even though the progression of the pandemic in rural Ethiopia was
at an early stage, the impact could already be felt (UNECA/UNDP/WFP 2004).
Households affected by HIV/AIDS have changed their spending patterns, spending
more on health and funerals, financed primarily by borrowing. In addition, the
resource base of these households has been reduced, as they gave up land to sharecropping
and sold livestock. It was also shown that the reliance on social networks
is insufficient to cope with HIV/AIDS. Since most households have continued to
rely on farming as their most important source of income and food, HIV/AIDS has
increased the food insecurity of affected households.
As a result of decades of austerity measures and compression of public expenditure,
the capacity of African health care systems has been cut back while the demand for
services keeps increasing. Health systems are so strained that a large proportion of
Africans do not even have access to the most basic health care. At the same time, the
demand for health care services is rapidly increasing, and the increasing morbidity
as a result of HIV/AIDS adds to the existing burden on overstretched health care
systems (Sandkjaer 2006).
Policy responses to HIV/AIDS - prevention and mitigation
Most African countries have established mechanisms for coordination of the response
to HIV/AIDS, usually through a National AIDS Commission. With assistance from
national and international partners, governments are focusing on how to prevent
new infections, while simultaneously keeping those infected healthy for as long as
Until very recently, the country-level response to HIV/AIDS was limited to prevention
interventions and minimal care and support for those infected. Today, scaledup
resources, coupled with the decreasing costs of treatment and the emergence of
simpler treatment regimes, provide an opportunity to expand national HIV/AIDS
treatment and care responses. As a result, treatment coverage increased from 100,000
people on antiretroviral treatment in December 2003, to 810,000 in December
2005, or an estimated 17 per cent of those in need (WHO 2006a).
In a study exploring the consequences of a prevention-centred response to HIV,
a treatment-centred response, and a combined response, Salomon et al. (2005)
show that an integrated response works best. In the long term, such a response also
reduces both direct and indirect HIV/AIDS-associated costs as fewer people will be
A number of lessons have been learnt and are being applied in the scaling-up of
treatment in Africa. With regard to prevention, traditional individual-focused
approaches are hotly debated. Proponents of an approach that mainly centers on
individual behaviour change argue that, given that HIV/AIDS is mainly transmitted
through unprotected sex between men and women, effective interventions must
focus on severing this transmission route by encouraging individuals to change their
behaviour, and ultimately abstain from sex before marriage, be faithful within marriage,
and use condoms – the so-called ABC approach.
Others argue that a more comprehensive approach is required, as individual behaviour
is conditioned by many contextual factors which, unless addressed, make individuals
unable to change their behaviour even if they so wish. For example, 10-55
per cent of African women surveyed stated that they believe that a wife cannot ask
her husband to use a condom and cannot refuse sex, even if she knows that he has
a sexually transmitted infection. For these women, HIV/AIDS can still meet them
in the conjugal bedroom, regardless of their willingness to protect themselves. Thus,
there is a pressing need for an effective, comprehensive response to the disease in
The Commission on HIV/AIDS and Governance in Africa (CHGA), which was
launched in 2003 by United Nations Secretary-General, Kofi Annan, aimed at bringing back a sense of urgency to HIV prevention. Its final report contains important
findings on this pandemic and gives useful recommendations (box 2.3).
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VI. Module III: National, Regional, and International Support
By United Nations Economic Commission for Africa
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