Report on the Global HIV/AIDS epidemic

AIDS in a new millennium: a grim picture with glimmers of hope
Altogether, there are now 16 countries in which more than one-tenth of the adult
population aged 15-49 is infected with HIV. In seven countries, all in the southern
cone of the continent, at least one adult in five is living with the virus. In Botswana,
a shocking 35.8% of adults are now infected with HIV, while in South Africa, 19.9%
are infected, up from 12.9% just two years ago. With a total of 4.2 million infected
people, South Africa has the largest number of people living with HIV/AIDS in the
world. While West Africa is relatively less affected by HIV infection, the prevalence
rates in some large countries are creeping up. Cote d'Ivoire is already among the 15
worst-affected countries in the world; in Nigeria, by far the most populous country
in sub-Saharan Africa, over 5% of adults have HIV. The prevalence rate in other West
African countries remains below 3%. Infection rates in East Africa, once the highest
on the continent, hover above those in the West of the continent but have been
exceeded by the rates now being seen in the southern cone. The prevalence rate
among adults in Ethiopia and Kenya has reached double-digit figures and continues
to rise.
These rises are not inexorable. Uganda has brought its estimated prevalence rate
down to around 8% from a peak of close to 14% in the early 1990s with strong prevention campaigns, and there are encouraging signs that Zambia's epidemic may be
following the course charted by Uganda (see Box 1, page 10). Yet, even in these
countries, the suffering generated by HIV infections acquired years ago continues to
grow, as millions of adults fall ill and die and as households, communities and whole
sectors of the economy stagger under the burden.
Uganda's was the first government on the continent to recognize the danger of HIV
to national development. Acknowledging an explosive epidemic in the general population very early on, President Yoweri Museveni took active steps to fight its spread
through action by the Government and other groups in society, including religious
leaders and community development organizations, which were encouraged to
tackle HIV and AIDS in ways that made best use of their particular skills. This broadbased approach to the epidemic contributed to a reduction in HIV infections among
young pregnant women living in towns and cities, as recorded in the 1998 Report on
the global HIV/AIDS epidemic. Gratifyingly, data from a large community-based
study now show a similar fall in infection rates in rural Uganda. Figure 1 shows that
the HIV prevalence rate among 13-19-year-old girls has fallen significantly over an
eight-year period, while the rate in teenage boys - always much lower because boys
are less likely than girls to have partners in the older, more heavily infected age
groups - has remained roughly stable. A large increase in condom use (see pages
59-64) probably contributed to these lower rates of infection (and to the significant
decline in teenage pregnancies which accompanied it).