Unit 1
Overview
What this
unit is about
This unit gives an overview of the global situation with regard to the HIV epidemic, and highlights the effects of the epidemic on the Caribbean. We will mostly consider recent data from UNAIDS and CAREC.
Warm-up
questions
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True or false? Almost 40 million people worldwide are infected with HIV.
True False
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What region of the world has been most affected by HIV/AIDS, with an infection prevalence of over 30% in some countries?
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Which region of the world has the second-highest HIV prevalence?
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What region in the Caribbean has been most affected by HIV/AIDS?
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The major factor that accounts for the prevalence rates of HIV/AIDS in the Caribbean is:
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injection drug use
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women’s status and inability to influence partners’ behaviour
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heterosexual transmission
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blood exposure from unsafe medical practises
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all of the above
Introduction
What you
will learn
By the end of this unit, you should:
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have an understanding of the overall HIV/AIDS situation in the world
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be able to describe the main features of the HIV/AIDS situation in the Caribbean.
The HIV epidemic continues to grow worldwide. UNAIDS estimated that 38.6 million [33.4 million-46.0 million] people worldwide were living with HIV at the end of 2005. An estimated 4.1 million [3.4 million–6.2 million] became newly infected with HIV and an estimated
2.8 million [2.4 million-3.3 million] lost their lives to AIDS. Overall, the HIV incidence rate (the proportion of people who have become infected with HIV) is believed to have peaked in the late 1990s and to have stabilised subsequently, despite increasing incidence in several countries.
Figure 1.1. The global HIV epidemic, 1990-2005.
the graph
You can see from Figure 1.1 above that global HIV prevalence (the proportion of people living with HIV) appears to be levelling off; however, the numbers of people living with HIV have continued to rise.
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What could be the causes of each phenomenon?
Factors that affect
HIV prevalence
Worldwide, a variety of factors account for the prevalence of HIV, including the following:
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high prevalence of other sexually transmitted infections (STIs) increases the risk of acquiring and transmitting HIV
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limited access to STI management
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limited access to, or social non-acceptance of, condoms
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war and civil disturbance
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cultural/ethnic practises, such as polygamy and wife inheritance
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women’s low status and inability to influence their partners’ behaviour
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low literacy rates
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increasing urbanisation, migration, mobilisation and separation of families as a result of poverty and/or other social circumstances
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low level of political commitment to the prevention and control of HIV/AIDS
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exposure to blood from unsafe medical practises and/or traditional practises.
Africa
Africa remains the global epicentre of the AIDS pandemic. South Africa’s AIDS epidemic—one of the worst in the world—shows no evidence of a decline. An estimated 5.5 million [4.9 million–6.1 million] people were living with HIV in 2005. An estimated 18.8% [16.8%–20.7%] of adults (15–49 years) were living with HIV in 2005. Almost one in three pregnant women attending public antenatal clinics were living with HIV in 2004, and trends over time show a gradual increase in HIV prevalence.
There are no clear signs of declining HIV prevalence elsewhere in southern Africa. In Swaziland, national adult HIV prevalence is estimated at 33.4% [21.2%–45.3%]. Botswana’s epidemic is equally serious, with national adult HIV prevalence estimated at 24.1% [23.0%–32.0%] in 2005. Lesotho’s epidemic seems to be relatively stable at very high levels, with an estimated national adult HIV prevalence of 23.2% [21.9%–24.7%].
In many areas of West Africa, rates are between 5%-10%. The numbers for East and Central Africa are between these two. Among the notable new trends are the recent declines in national HIV prevalence in two sub-Saharan African countries (Kenya and Zimbabwe), and urban areas of Burkina Faso, alongside indications of significant behavioural change—including increased condom use, fewer partners and delayed sexual debut.
Except for Sudan, national adult HIV prevalence in the countries of the Middle East and North Africa is very low, and does not exceed 0.1%.
Africa, continued
However, available data suggest that the epidemics are growing in several countriesincluding Algeria, Islamic Republic of Iran, Libyan Arab Jamahiriya and Morocco. Across the region, an estimated 64 000 [38 000– 210 000] people were newly infected with HIV in 2005, bringing the total number of people living with the virus to some 440 000 [250 000–720 000]. Sudan accounts for fully 350 000 [170 000–580 000] of those people.
Figure 1.2. HIV prevalence among adults in Africa, 1990 and 2005.
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