1. OVERVIEW OF HIV/AIDS IN AFRICA INTRODUCTION As of December 1999, the United Nations Programme on HIV/AIDS estimated that 33.6 million people worldwide were living with HIV/AIDS 23.3 million or 69% are in Africa It is estimated that from the start of the epidemic to the end of 1999, 16.3 million people have died globally. Of this total 13.7 million or 84% are from Africa Within Africa, urban areas have exhibited higher levels of HIV infection as compared to rural areas

2. REGIONAL DIFFERENCES IN HIV PREVALENCE Within each of the 5 geographic regions of sub-Saharan Africa, the HIV/AIDS has a distinguishable form The Horn of Africa has relatively low levels of HIV infection except for Ethiopia prevalence rates range from 5-10% The epidemic in East Africa is among the oldest and most mature epidemic in Africa. Prevalence rates range from 15%-25% Whilst other countries in the sub-region have seen dramatic increases in the prevalence rates, Uganda has seen a decline in prevalence rates The HIV/AIDS epidemic in West Africa has been concentrated on specific countries and population groups

3. Cote d’Ivoire is the main hub of infection in this region with prevalence rates of above 15% recorded in Abidjan. The other countries are experiencing a rapidly spreading epidemic

4. Nigeria is estimated to have well over 2 million infected people. Central African countries have reported stable levels of HIV infection, with the Central African Republic being the exception with rates as high as 10%. Southern Africa is experiencing the worst epidemic of HIV/AIDS in the continent. Prevalence rates of HIV infection in Malawi, Zambia and Namibia range between 25% to 30% in Francistown, Botswana, prevalence rates of HIV infection in pregnant women are as high as 45%. South Africa probably has the fastest spreading epidemic in Southern Africa

5. DETERMINANTS OF THE EPIDEMIC The HIV/AIDS epidemic has spread more rapidly in Africa than in any other continent. This inspite of the fact that the first cases of AIDS in Africa were identified long after those in the Western World. Several factors have contributed to the spread of the epidemic.

6. POLITICAL COMMITMENT Strong and sustained political commitment is estimated in putting in place programmes that are essential and crucial in combating the spread of the epidemic. Most African governments were slow in admitting the existence of HIV/AIDS in their countries and in responding adequately by providing resources for prevention and care. There is now a noticeable change in the attitude of governments. Governments are are putting in place mechanisms for effective implementation of programmes and are providing resources for HIV/AIDS in their budgets.

7. MIGRATION AND POPULATION FACTORS The internal strife and economic turmoil that is prevalent in many African countries has meant that migration for the purposes of seeking better opportunities and escaping armed conflicts is on the increase. The migration patterns are linked to, among others, disruption in family life and an increase in sexually transmitted infections including HIV/AIDS. The coming into existence of trans-national highways has meant that sexually transmitted infections have popular truck routes and border towns.

8. SOCIO-ECONOMIC FACTORS The prevalence poor economic conditions of most African countries make it impossible for them to provide adequate financial resources for care and prevention. The low literacy rates and the poverty of most people in Africa are contributory factors towards the spread of the HIV/AIDS epidemic.

9. GENDER INEQUALITY Lack of women’s empowerment against prejudicial cultural and traditional practices in sexual and reproductive matters and relationships are factors that make women vulnerable to HIV infection. Most women are low-income earners. This makes them vulnerable to unsafe sexual practices such as forced and unprotected sex, wife inheritance and commercial sex work.

10. LACK OF SOCIAL DIALOGUE ON SEXUALITY The reluctance to openly discuss issues relating to sex exists in many African societies. The associations between sex and death as it relates to HIV/AIDS has worsened the situation. Adults do not provide young people with the necessary sexual and reproductive health information and education essential to empower them to make informed decisions and thereby ultimately protect themselves against teenage pregnancy, STDs and HIV/AIDS infection

11. STIGMATIZATION Society’s perception of the way HIV/AIDS is acquired has resulted in gross discrimination and stigmatization of people living with HIV/AIDS. The widely held belief that HIV/AIDS is acquired through prostitution, promiscuity, homosexuality and drug abuse serves to worsen matters. Most people living with HIV/AIDS are thus unwilling to openly talk about their situations. The lack of visibility of people who are infected with HIV/AIDS gives a false impression of the levels of infection especially in countries where the epidemic is at relatively low levels.

12. SOCIAL ILLS The prevalence of social ills such as rape and sexual exploitation is on the rise in most African countries. This behaviour presents serious risks for HIV/AIDS infection, especially for women.

13. OPPORTUNITIES FOR THE PRESENT AND THE FUTURE Evidence from Senegal and Uganda shows that a strong combination of political support, broad institutional participation and carefully selected programmes interventions can lead to declines in the number of new HIV/AIDS infections and improved care for those are infected. Many countries have now created institutional structures and mechanisms that put the implementation bodies of HIV/programmes at a high and visible level. The need to create a supportive and open environment in the community and raising general awareness, especially regarding behaviour change can not be overstated. In most countries hand hit by the epidemic, communities are responding innovatively- e.g. the case of Swaziland. HIVAIDS programmes must integrate both prevention and care aspects, if they are to be successful, and communities must be involved in the development of strategies and interventions.