Author: Sara Habibipour
This past summer, I’ve had the opportunity to produce a research project relating to HIV, with samples from patients in Uganda--a country in Africa with one of the highest number of HIV cases in the world. This led me to wonder what makes this so.
East and Southern Africa is the region most affected by HIV in the world, and is home to the largest number of people living with HIV--20.7 million (Avert.org). Out of this 20.7 million, let’s take a look at who this disease most affects, the reasons why, and what is being done to improve the public health situation.
Groups Most Affected and Why
Young Women (ages 15-24)
In 2018, HIV prevalence in young women in East/Southern Africa was double that of men; in some countries, the disparity is even greater (Avert.org).
The reasons why this is are complex, but high levels of sexual violence against women play a large role. South Africa, one of the countries most affected by HIV, has one of the highest rates of rape in the world; if young women are raped by HIV-infected offenders, the disease spreads to this population even further (SOS Children’s Villages).
The lack of sex education campaigns in the young female population may also contribute to this disparity, which is largely due to stigma surrounding HIV. HIV-infected people are highly stigmatized by society; many keep their illness a secret, even from their sexual partners (which leads to further infection of others).
Children (ages 0-14)
In 2018, 1.1 million children were living with HIV in East/Southern Africa (Avert.org). The main route for transmission to children is mother-to-child transmission (through birth). But, unfortunately, there is also a high rate of child marriage in the region that contributes to the spread of the disease as well.
Girls who marry as children are more likely to be beaten, threatened, and forced into sexual activity by their husbands than girls who marry later. As minors, child brides are rarely able to assert their preferences to practice safer sex. These factors all increase HIV risk.
There are also groups of “AIDS Orphans” in Africa--children who have lost their parents to HIV/AIDS. In total, nearly 14 million AIDS orphans live in sub-Saharan Africa (SOS Children's Villages).
While their parents were sick, many of these children had to uphold the household and care for their parents and younger siblings, adding a lot of mental stress to their lives. If the orphans are not received by relatives after the death of their parents, they are completely on their own. Many of them then end up on the street, facing even more poverty and disease (SOS Children’s Villages).
More than half (55%) of all sex workers in South/Eastern Africa are estimated to be living with HIV (Avert.org).
Condom usage by sex workers and their clients varies greatly. In some cases, sex workers have no access to condoms, have trouble negotiating their use with clients, or are unaware of their importance.
Drug Users and Prisoners
Kenya, Madagascar, Mauritius, Mozambique, South Africa, Tanzania and Uganda are all home to significant populations of injection drug users. In Kenya, for example, HIV prevalence among people who inject drugs was 18% in 2011, compared to 5.6% among the general population (Avert.org).
Although data is limited, East and Southern Africa is thought to have one of the highest rates of HIV prevalence among prisoners in the world at just under 30% (Avert.org). This is reflective of high HIV prevalence in the general population and the continued criminalization of key population groups (sex workers, IV drug users, etc.). Prison environments are also high risk environments for HIV transmission (ex: limited access to health care, drug use, unprotected sex, tattooing, etc.).
Men who Have Sex with Men + Transgender People
HIV transmission between men who have sex with men accounted for 4% of new infections in the region in 2018 (Avert.org). However, evidence suggests the majority of the region’s men who have sex with men also engage in heterosexual sex, often with long-term female partners (Avert.org); perhaps this is due to the stigma surrounding homosexuality in these regions. The HIV epidemic is therefore interlaced among all of the vulnerable groups mentioned, and the wider population.
Improvements Thus Far
Although the HIV epidemic still continues to be a pressing crisis, countries such as Botswana, Kenya, Malawi, and Rwanda have begun to implement national campaigns to expand HIV testing and counseling. As of 2019, 73% of infected adults are on antiretroviral treatment, and the number continues to increase. Although there’s still a long way to go, this is definitely a start to providing health equity for all groups in South and East Africa.
This was a really informative article, Sara! Sexually transmitted diseases, HIV included, regardless of the country, are very stigmatized to this day in our society. In school during health class we are taught about safe sex, yes, but there is a greater emphasis placed on abstinence. Abstinence is fine but (consensual) sex is a natural part of life and it should not be feared or stigmatized but rather educated on. Similarly, with the already existing taboo and lack of sex education, especially in third world countries, I think NGOs and other such organizations should educate these populations to promote safe sex, hygiene, and end the stigma surrounding STIs and HIV/AIDS. And it's amazing to see the improvement in the number of people that are seeking treatment for HIV/AIDS, it's definitely a great start!