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 2006).
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 2004a).
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 possible.
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 infected.
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 Africa.
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).
To learn more about this author, visit United Nations Economic Commission for Africa's Website.
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