International Dental Journal (2004) 54, 352360

HIV/AIDS Situation in Africa

Eyitope O. Ogunbodede
Ile-Ife, Nigeria

The HIV/AIDS pandemic marks a severe

development crisis in Africa, which remains by far
the worst affected region in the world. Forty-two
million people now live with HIV/AIDS of which Correspondence to:
Professor Eyitope O.
29.4 million (70.0%) are from sub-Saharan Africa. Ogunbodede, Department of
Approximately 5 million new infections occurred in Preventive & Community
2002 and 3.5 million (70.0%) of these were also Dentistry, Faculty of Dentisty,
from sub-Saharan Africa. The estimated number Obafemi Awolowo University,
Ile-Ife, Nigeria. Email:
of children orphaned by AIDS living in the region e_ogunbodede@yahoo.co.u
is 11 million. In 2002, the epidemic claimed about k
2.4 million lives in Africa, more than 70% of the
3.1 million deaths worldwide. Average life
expectancy in sub-Saharan Africa is now 47
years, when it would have been 62 years without
AIDS. HIV/AIDS stigma is still a major problem
despite the exten-sive spread of the epidemic. A
complex interaction of material, social, cultural
and behavioural factors shape the nature, process
and outcome of the epidemic in Africa. However,
too many partners and unprotected sex appear to
be at the core of the problem, Even if
exceptionally effective prevention, treatment and
care programmes take hold immediately, the scale
of the crisis means that the human and socio-
economic toll will remain significant for many
generations. Although 70% of people living with
HIV/AIDS are in Africa, only 6,569 (4.7%) of the
140,736 scientific publica-tions on HIV/AIDS, from
1981 to 2000, are directly related to Africa.
Effective responses to the epidemic require a
multisectoral approach, including governments,
the business sector and civil society.

Key words: HIV/AIDS, Africa

 represent 18% of total
More than 20 years into the Human life expectancy in
Immunodeficiency Virus (HIV) and Acquired
these bottom
Immunodefi-ciency Syndrome (AIDS) pandemic, it countries1.
has struck different regions, coun-tries and The trend in most
populations in different ways. It especially marks a African coun-tries has
severe development crisis in sub-Saharan Africa, been to ignore the calls
which remains by far the worst affected region in the for prevention of
world. The effect of AIDS in many African countries HIV/AIDS until the
superseded that of war, drought, famine or any other prevalence becomes
prior emergencies in magni-tude, duration, and unaccept-ably high. This
challenge for programme response. is partly explained by
The presence of widespread poverty and the fact that the region
underdevelopment in Africa exposes communities also faces an acute lack
to all of the major environmental deter-minants of of valid, reliable and
ill-health and this factor has contributed comparable data, as
significantly to the rapid spread of HIV/AIDS. In well as proc-esses for
1999, the WHO estimated Disabil-ity Adjusted Life converting data into
Expectancy (DALE) for 191 countries and the information for
bottom ten countries were all in sub-Saharan planning2. Avail-able
Africa, where the HIV-AIDS epidemic is most data indicate that the
prevalent, resulting in DALE at birth of less than pattern
35 years. Years of healthy life lost due to disability

2004 FDI/World Dental Press 0020-6539/04/06352-09

353

Table 1 Regional HIV/AIDS statistics as at end of 2002

S/ No Region Year epidemic Adults & children Adults & children % % HIVpositive
started living with newly infected prevalence adults who
HIV/AIDS with HIV among adults are women
1 Sub-Saharan Africa Late 70s/ Early 80s 29.4 million 3.5 million 8.8 58
2 North Africa & Middle East Late 80s 550 000 83 000 0.3 55
3 South & South East Asia Late 80s 6.0 million 700 000 0.6 36
4 East Asia & Pacific Late 80s 1.2 million 270 000 0.1 24
5 Latin America Late 70s/ Early 80s 1.5 million 150 000 0.6 30
6 Caribbean Late 70s/ Early 80s 440 000 60 000 2.4 50
7 East Europe & Central Asia Early 90s 1.2 million 250 000 0.6 27
8 Western Europe Late 70s/ Early 80s 570 000 30 000 0.3 25
9 North America Late 70s/ Early 80s 980 000 45 000 0.6 20
10 Australia & new Zealand Late 70s/ Early 80s 15 000 500 0.1 7
11 TOTAL 42 million 5 million 1.2 50

* Data Source: UNAIDS (2002)5.

Table 2 Global summary of the HIV/AIDS epidemic as at December, 2002

Group Population affected

Number of people People newly infected AIDS deaths in 2002
living with HIV/AIDS with HIV in 2002

1 Adults 38.6 million 4.2 million 2.5 million

2 Women 19.2 million 2.0 million 1.2 million
3 Children under 15 years 32.0 million 800,000 610,000
Total 42.0 million 5.0 million 3.1 million

* Data Source: UNAIDS (2002)5.

Figure 1. Adults and children estimated to

be living with HIV/ AIDS as of end 2002. *
Source: UNAIDS (2002)5.
 Figure 2. Estimated number of adults and
children newly infected with HIV during
2002. * Source: UNAIDS (2002)5.

end of 2001, 21% million new infections

of HIV/AIDS in (9,993 of 48,226) occurred in 2002 and
developing coun-tries, were probably 3.5 million (70.0%) of
particularly sub- acquired in Africa. these were also from
Saharan Africa, is Also 23% (4,883 of sub-Saharan Africa
unique; the epidemic is 21,291) of those (Table 1). Fewer than
mainly heterosexual, living with diagnosed 30,000 people were
the rates of infection in HIV infec-tion in estimated to have
the general population 2000 were described been benefiting from
are very high and the as black African, antiretroviral drugs at
percentage of HIV- 81% of whom lived in the end of 2001. The
positive women is London4. estimated number of
greater than men. An children orphaned by
additional feature is AIDS living in the
the young age of onset Prevalence of
region is 11 million.
of infection for HIV/AIDS in the
Even if exceptionally
women3. African region
effective prevention,
Infections acquired Forty-two million treatment and care
in Africa and among people now live with programmes take hold
Africans are making an HIV/AIDS of which imme-diately, the scale
increasing contribution 29.4 million (70.0%) of the crisis means that
to HIV infection in are from sub-Saharan the human and socio-
other continents. In the Africa (Tables 1 and 2, economic toll will
United Kingdom, of all Figures 1 and 2). remain significant for
reported HIV infections Approximately 5 many generations.
diagnosed by the

Ogunbodede: HIV/AIDS Situation in Africa

354

According to the UNAIDS5, the HIV/AIDS epidemic is at an early stage of development and despite the manifest potential
current rate of infection, there could be 45 million new cases of HIV by 2010. In any country where 15% of adults are now infe
HIV/AIDS report, AIDS will cause early death in as many as half of the teenagers living in southern Africa. In Botswana, demog
In southern Africa (where the epidemic is the most severe in the world), HIV rates are still on the rise, with HIV infections o
the epidemic may have reached its natural limit, beyond which it would not grow. Thus, it has been assumed that the very hi
Botswana, median HIV prevalence among pregnant women in urban areas already stood at 38.5% in 1997. In 2001, it had rise
in 1997 to 35% in 2000, while in Namibia it rose from 26% in 1998 to 29.6% in 2000, and in Swaziland from 30.3% to 32.3%
thought5.
Startling as these prevalence levels are, they do not reflect the actual risk of acquiring HIV, and prevalence rates are even h

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Figure 3.

Figure 4.

and costs
spouses,
African co

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g
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Figure 5. Percentage of workforce lost to AIDS by 2005 and 2020 in selected African countries.

morbidity across sub-Saharan Africa are tuberculosis, bacterial infections, and malaria 16.
Factors contributing to spread of HIV/AIDS in Africa
A complex interaction of material, social, cultural and behavioural fac-tors shape the nature, process and outcome of the epide
In sub-Saharan Africa, some traditions and socioeconomic developments have contributed to the extensive spread of HIV
and modernisa-tion, and wars and conflicts. The sub-Saharan African region is plagued with incessant armed conflicts: Angol
sexual violence increases dramatically. There are large numbers of mobile, vulnerable and unaccompanied women who beco
civil war has hindered data collection, a significant increase in prevalence has been documented among pregnant women atten

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n
357

personne
measure
Earlie
minimal r
patient cl
It mu
in sub-S

Post-ex
Another
after-car

HIV Infe
In Chad

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g
358

Figure 6. HIV/AIDS deaths in 2001 and number of people using antiretroviral drugs by end 2001, according to region.

including an alarming number of orphans in sub-Saharan Africa. At the end of 2001, an estimated 14 million children worldw
Without the care of parents or an appointed care-giver, children are likely to face extraordinary risks of malnutrition, poor health
Nyambedha et al. have described a rural community in western Kenya in which one out of three children below 18 years of age ha
fees, food and access to medical care. The high number of orphans overwhelmed the traditional mechanisms for orphan care, which

Bicego et al. reported on direct estimates of orphan prevalence in 17 countries during the period 19952000 and foun
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Table 3 HIV/AIDS publications from Africa compared with the rest of the world (1981
2000)

S/No Continent HIV/AIDS publications (19812000)

Dentally related Non-dentally related Total
No % No % No %
1 Africa 53 2.5 6516 4.7 6569 4.7
2 Rest of the world 2066 97.5 132101 95.3 134167 95.3
Total 2119 100.0 138617 100.0 140736 100.0

* Data extracted from Pubmed, URL: http://www.ncbi.nlm.nih.gov/pubmed40

poverty, ignorance, poorly
resourced or even non-
existent medical facilities
predominate, combating the
spread of HIV infection
becomes an onerous task.
HIV/AIDS poses the
greatest single challenge to
the marginalised poor of
Africa, where it has found a
malnourished, vulnerable,
defence-less host. Collective
response required from
physicians and health profes-
sionals who must be at the
fore-front of restoring hope
and a dignified quality of life.
In sub-Saharan Africa,
HIV/AIDS is not a security
threat but a painful slow
death that forces victims into
exhausting their lifetime
savings on expensive
medicines and massive
hospital bills. It leaves
Figure 7. Public expenditure on health as percentage of general helpless orphans to struggle
government expenditure in African countries: 1998. for survival in countries
where government subsidy
on education and healthcare
has been long withdrawn so
as to chan-nel the meagre
state resources into debt
servicing42. HIV/AIDS has
given rise to numerous
orphans on
to form AIDS Watch Africa. African countries have Conclusion
An example of peer also agreed to work
education at the highest towards allocating 15% of Many of the worlds most
level, this initiative enables general government margin-alised countries are
members to alert other expen-diture to health with in Africa and it is now
Heads of State to the threat special emphasis on apparent that these coun-
AIDS poses to HIV/AIDS. The public tries need long-term
development, and to expenditure on health as a international solidarity,
encourage them to tackle percentage of general cooperation and financial
the epidemic. Presi-dents government expenditure in support. More equitable
or ministers now chair African countries for 1998 investment and trade flows
many of the National is presented in Figure 7. can help ensure that global
coordinating bodies economic progress also
dedicated to dealing with profits the worlds poor. So,
the epidemic. too, could higher levels of
Official Development
Assistance in support of the African continent epidemic. This is very
poverty-reduction strategies and there is an urgent crucial to the success of
and improvement of social need to look into the health education and other
services. Since 1990, official provision of basic preventive measures.
development assistance needs of these Further research is
provided to the 28 coun-tries orphans43. therefore suggested in this
Although the factors
with the highest adult HIV direction.
contribut-ing to the spread
prevalence rates (more than
of HIV/AIDS in Africa have
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International Dental Journal (2004) Vol. 54/No.6 (Supplement)