HIV/AIDS originated in the early 20th century and has become a major public health concern and cause of death in many countries. AIDS rates vary significantly between countries, with the majority of cases concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – approximately 35 million people – were Africans, of whom around 1 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 100 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, leading to raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic, with life-expectancy in some countries reaching as low as thirty-nine years.
Countries in North Africa, West Africa and the Horn of Africa have significantly low prevalence rates, as their populations typically engage in fewer high-risk cultural patterns that promote the spread of the virus in other parts of Africa. Southern Africa is the worst affected region on the continent. As of 2011, HIV has infected at least 10 percent of the population in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe.
In response, a number of initiatives have been launched in various parts of the continent to educate the public on HIV/AIDS. Among these are combination prevention programs, considered to be the most effective initiative, such as the abstinence, be faithful, use a condom campaign or the Desmond Tutu HIV Foundation's outreach programs.
The number of HIV positive people in Africa receiving anti-retroviral treatment in 2012 were over seven times the number receiving treatment in 2005, with nearly 1 million added in the previous year. Between 2000 and 2018, new HIV infections fell by 37%, and HIV-related deaths fell by 45% with 13.6 million lives saved due to ART in the same period. This achievement was the result of great efforts by national HIV programmes supported by civil society and a range of development partners. It reported that 1.1 million people have been newly infected with HIV in 2018. An estimated 420,000 [340,000−530,000] people died in the African Region from HIV-related causes from 1985-2021, implying that mortality has dropped by approximately 55% since 2010.
Overview
In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote:
HIV ... has caused immense human suffering in the continent. The most obvious effect ... has been illness and death, but the impact ... has ... not been confined to the health sector; households, schools, workplaces and economies have also been badly affected. ...
In sub-Saharan Africa, people with HIV-related diseases occupy more than half of all hospital beds. ... [L]arge numbers of healthcare professionals are being directly affected.... Botswana, for example, lost 17% of its healthcare workforce due to AIDS between 1999 and 2005.
...The toll of HIV and AIDS on households can be very severe. ... [I]t is often the poorest sectors of society that are most vulnerable.... In many cases, ... AIDS causes the household to dissolve, as parents die and children are sent to relatives for care and upbringing. ... Much happens before this dissolution takes place: AIDS strips families of their assets and income earners, further impoverishing the poor. ...
The ... epidemic adds to food insecurity in many areas, as agricultural work is neglected or abandoned due to household illness. ...
Almost invariably, the burden of coping rests with women. Upon a family member becoming ill, the role of women as carers, income-earners and housekeepers is stepped up. They are often forced to step into roles outside their homes as well. ...
Older people are also heavily affected by the epidemic; many have to care for their sick children and are often left to look after orphaned grandchildren. ...
It is hard to overemphasise the trauma and hardship that children ... are forced to bear. ... As parents and family members become ill, children take on more responsibility to earn an income, produce food, and care for family members. ... [M]ore children have been orphaned by AIDS in Africa than anywhere else. Many children are now raised by their extended families and some are even left on their own in child-headed households. ...
HIV and AIDS are having a devastating effect on the already inadequate supply of teachers in African countries.... The illness or death of teachers is especially devastating in rural areas where schools depend heavily on one or two teachers. ... [I]n Tanzania[,] for example[,] ... in 2006 it was estimated that around 45,000 additional teachers were needed to make up for those who had died or left work because of HIV....
AIDS damages businesses by squeezing productivity, adding costs, diverting productive resources, and depleting skills. ... Also, as the impact of the epidemic on households grows more severe, market demand for products and services can fall. ... In many countries of sub-Saharan Africa, AIDS is erasing decades of progress in extending life expectancy. ... The biggest increase in deaths ... has been among adults aged between 20 and 49 years. This group now accounts for 60% of all deaths in sub-Saharan Africa.... AIDS is hitting adults in their most economically productive years and removing the very people who could be responding to the crisis. ...
As access to treatment is slowly expanded throughout the continent, millions of lives are being extended and hope is being given to people who previously had none. Unfortunately though, the majority of people in need of treatment are still not receiving it, and campaigns to prevent new infections ... are lacking in many areas.
Regional prevalence
In contrast to Arab North Africa and the Horn of Africa, traditional cultures and religions in Sub-Saharan Africa have generally exhibited a more liberal attitude to female out-of-marriage sexual activity. The latter includes practices such as multiple sexual partners and unprotected sex, high-risk cultural patterns that have been implicated in the much greater spread of HIV in the subcontinent.
Horn of Africa
As with North Africa, the HIV infection rates in the Horn of Africa are quite low. This has been attributed to the Muslim nature of many of the local communities and adherence to Muslim norms regarding sexuality.
Ethiopia's HIV prevalence rate decreased from 3.6 percent in 2001 to 1.4 percent in 2011. The number of new infections per year decreased from 130,000 in 2001, to 24,000 in 2011.
Central Africa
In 2010, HIV infection rates in central Africa were moderate to high.
Eastern Africa
HIV infection rates in eastern Africa are moderate to high.
Kenya
In 2008, Kenya had the third largest number of individuals in Sub-Saharan Africa living with HIV. Kenya had the highest prevalence rate of any country outside of Southern Africa. Kenya's HIV infection rate dropped from around 14 percent in the mid-1990s to 5 percent in 2006. It rose again to 6.2 percent by 2011. The number of newly infected people per year decreased by almost 30 percent, from 140,000 in 2001 to 100,000 in 2011.
In 2012, Nyanza Province had the highest HIV prevalence rate at 13.9 percent, with the North Eastern Province having the lowest rate at 0.9 percent.
Christian men and women had a higher infection rate than their Muslim counterparts. This discrepancy was especially visible among women, with Muslim women having a rate of 2.8 percent versus 8.4 percent among Protestant women and 8 percent among Catholic women. HIV detection was more common among the wealthiest than among the poorest, at 7.2 percent versus 4.6 percent.
Historically, HIV had been more prevalent in urban than rural areas, although the gap is closing rapidly. In 2013, men in rural areas were more likely to be HIV-infected, at 4.5 percent, than those in urban areas, at 3.7 percent.
Tanzania
Between 2004 and 2008, the HIV incidence rate in Tanzania for people aged 15–44 slowed to 3.37 per 1,000 person-years. The rate was 4.42 for women, and 2.36 for men. The number of newly infected people per year increased slightly, from 140,000 in 2001 to 150,000 in 2011. There were significantly fewer HIV infections in Zanzibar, which in 2011 had a prevalence rate of 1.0 percent compared to 5.3 percent in mainland Tanzania.
Uganda
Uganda has registered a gradual decrease in its HIV rates from 10.6 percent in 1997, to a stabilized 6.5–7.2 percent since 2001. This has been attributed to changing local behavioral patterns, with more respondents reporting greater use of contraceptives and a two-year delay in first sexual activity, as well as fewer people reporting casual sexual encounters and multiple partners.
The number of newly infected people per year increased by over 50 percent, from 99,000 in 2001 to 150,000 in 2011. More than 40 percent of new infections are among married couples, indicating widespread and increasing infidelity. This increase has caused alarm. The director of the Centre for Disease Control – Uganda, Wuhib Tadesse, said in 2011 that,
"For every person started on antiretroviral therapy, there are three new HIV infections[,] and this is unsustainable. We are very concerned. Complacence could be part of the problem. Young people nowadays no longer see people dying; they see people on ARVs but getting children. We need to re-examine our strategies.... Leaders at all levels are spending [more] time in workshops than in the communities to sensitive the people[,] and this must stop."
Western Africa
Western Africa has moderate levels of infection of both HIV-1 and HIV-2. The onset of the HIV epidemic in the region began in 1985, with reported cases in Senegal, Benin, and Nigeria. These were followed in 1986 by Côte d'Ivoire. The first identification of HIV-2 occurred in Senegal by microbiologist Souleymane Mboup and his collaborators.
HIV prevalence in western Africa is lowest in Senegal and highest in Nigeria, which has the third largest number of people living with HIV in Africa after South Africa and Mozambique. Nigeria's infection rate, of the number of patients relative to the entire population, is much lower, at 3.7 percent, compared to South Africa's 17.3 percent.
In Niger in 2011, the national HIV prevalence rate for ages 15–49 was 0.8 percent. For sex workers, it was 36 percent.
Southern Africa
In the mid-1980s, HIV and AIDS were virtually unheard of in southern Africa. It is now the worst-affected region in the world. Currently, Eswatini and Lesotho have the highest and second highest HIV prevalence rates in the world, respectively. Of the nine southern African countries (Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe), four are estimated to have an infection rate of over 15 percent.
In Botswana, the number of newly infected people per year declined by 67 percent, from 27,000 in 2001 to 9,000 in 2011. In Malawi, the decrease was 54 percent, from 100,000 in 2001 to 46,000 in 2011. All but two of the other countries in this region have recorded major decreases (Namibia, 62 percent; Zambia, 54 percent; Zimbabwe, 47 percent; South Africa, 38 percent; Eswatini, 32 percent). The number has remained virtually the same in Lesotho and Mozambique.
Zimbabwe's first reported case of HIV was in 1985.
There are widespread practices of sexual networking that involve multiple overlapping or concurrent sexual partners. Men's sexual networks, in particular, tend to be quite extensive, a fact that is tacitly accepted or even encouraged by many communities. Along with having multiple sexual partners, unemployment and population displacements resulting from drought and conflict have contributed to the spread of HIV/AIDS.
A study in 2000 found that local men refuse to use condoms during intercourse with girls or women performing sex work. The girls and women are in desperate need of money and do not have a choice. This leads to multiple sex partners, which increases the likelihood of their infection with HIV/AIDS.
A 2008 study in Botswana, Namibia, and Eswatini, found that intimate partner violence, extreme poverty, education, and partner income disparity explained almost all of the differences in HIV status among adults aged 15–29 years. Among young women with any one of these factors, the HIV rate increased from 7.7 percent with no factors, to 17.1 percent. Approximately 26 percent of young women with any two factors were HIV positive, with 36 percent of those with any three factors and 39.3 percent of those with all four factors being HIV-positive.
Eswatini
In 2011, the HIV prevalence rate in Eswatini was the highest in the world, at 26.0 percent of citizens aged 15–49. The United Nations Development Program wrote in 2005,
The immense scale of AIDS-related illness and deaths is weakening governance capacities for service delivery, with serious consequences on food security, economic growth[,] and human development. AIDS undermines the capacities of individuals, families, communities[,] and the state to fulfill their roles and responsibilities in society. If current trends are not reversed, the longer-term survival of Swaziland as a country will be seriously threatened.
In 2009, the HIV epidemic in Eswatini reduced its life expectancy at birth to 49 years for men, and 51 years for women. Life expectancy at birth in 1990 was 59 for men and 62 for women.
In 2011, Eswatini's crude death rate of 19.51 per 1,000 people per year was the third highest in the world, behind only Lesotho and Sierra Leone. HIV/AIDS in 2002 caused 64 percent of all deaths in Eswatini.
Origins of HIV/AIDS in Africa
The earliest known cases of human HIV infection were in western equatorial Africa, probably in southeastern Cameroon where groups of the central common chimpanzee live. "Phylogenetic analyses revealed that all HIV-1 strains known to infect humans, including HIV-1 groups M, N, and O, were closely related to just one of these SIV cpz lineages: that found in P. t. troglodytes [Pan troglodytes troglodytes i.e. the central chimpanzee]." It is suspected that the disease jumped to humans from butchering of chimpanzees for human consumption.