Africa – overview
Despite significant gains in the reponse to HIV in the last ten years, the epidemic in Africa has remained extremely dynamic, growing and changing in character as the virus exploits new opportunities for transmission. In sub-Saharan Africa – the hardest hit sub-region – the impact of HIV is erasing decades of health, economic and social progress. It is reducing life expectancy by years, deepening poverty, worsening gender inequalities, reducing labour productivity and eroding the capacity of governments to provide essential services.
Sub-Saharan Africa is home to just over 10% of the world’s population but almost two thirds of the people living with HIV. In 2003, an estimated 3 million people became newly infected with HIV, while 2.2 million died. HIV continues to have a devastating impact at the household level. It has taken away income and production capacity of family members that are sick; at the same time it has created extraordinary care needs and increased household expenditure on medical and other costs, such as funeral expenses. Between 1990 and 2003, 5.2 million children in sub-Saharan Africa became orphaned. With the traditional support systems in these countries already under severe pressure, many extended families are, or soon will be, overwhelmed and in greater need of external support and protective safety nets.
The epidemic’s impact is particularly hard on women and girls, as the burden of care usually falls on them. Girls drop out of school to care for sick parents or younger siblings. Older women often take on the burden of caring for ailing adult children, and later, when they die, adopt the orphaned children. Older women caring for orphans and sick children may be isolated socially because of HIV-related stigma and discrimination. Stigma also means that family support is not a certainty when women become HIV positive.
While countries in Africa are facing a virulent epidemic with severe impact, there is no such thing as the ‘African’ epidemic. There is tremendous diversity across the continent in the levels and trends of HIV infection. While prevalence rates in East and Southern Africa include some the highest in the world (for instance, Botswana and Swaziland prevalence rates are above 35%), in West Africa, HIV prevalence has remained lower, with no country having a rate above 10% and most being between 1% and 5%.
Despite some successful national responses to the epidemic, intensive cross-border mobility in the sub-Saharan African region highlights the need for urgent and co-ordinated responses from all sectors of society. In response to the epidemic, many communities – mainly civil society – in the region have taken action on HIV. This has included initiatives to reduce new infections, care for people who are sick and provide support to those affected by HIV. In recognition of the need to mobilise, support and increase these responses, many community-based and non-governmental organisations have formed and expanded their efforts. Appropriate technical support is needed to build and improve skills of such groups. In particular, there exists an urgent need to develop and implement realistic approaches to scaling up non-governmental and community-based organisation responses in the region, and for improving the quality of the responses through the provision of tools, training and technical support.
For more information on the Alliance's response in Africa, see the Africa strategy 2008-10.
