Current HIV/AIDS Prevalence in Africa and the Control Measures
Africa has been battling with AIDS for over 3 decades now and many measures have been put in place to combat and slow the rate of HIV/AIDS infections. Although the continent is home to about 15.2 percent of the world’s population, more than two-thirds of the total infected worldwide – some 35 million people – are of African ethnicity, of whom 15 million have become fatalities. According to a recent UNAIDS report  , East and Southern Africa is the region most affected by HIV in the world where it is home to the largest number of people living with HIV, estimated to be 19.4 million. Countries in North Africa and the Horn of Africa have significantly lower prevalence rates, as their populations typically engage in fewer high-risk lifestyle patterns that have been implicated in the virus’ spread in Sub-Saharan Africa. In Western Africa region there are moderate levels of HIV infections, with the lowest rate being in Senegal and the highest in Nigeria, which has the second largest number of people living with HIV in Africa after South Africa.
In response to this epidemiological challenge, various African countries have launched initiatives to combat HIV/AIDS prevalence. The most common successful initiative deployed by most of these countries has to be the prevention programmes such as Usage of Condom Campaigns.
In this article, case studies of some African nations have been conducted to highlight the disease control measures implemented to fight HIV/AIDS infections.
More than a decade ago, Botswana had one of the highest rate of HIV infections in the world with nearly 25% of all adults in the country were infected. In 2002, the Botswanan government became the first in Africa to offer free condoms to its citizens. It was also the first country in Africa to provide universal free antiretroviral treatment (ART) to people living with HIV. This led to a significant decrease in new infections, from 15,000 in 2005 to 9,100 in 2013. The government has also dedicated a large sum of money to AIDS Education programmes and free HIV Tests at almost all local medical centres. Botswana also have a successful “Prevention of mother-to-child transmission” (PMTCT) programme that is available in 634 health facilities that provide maternity care. In this programme, pregnant women are given free counselling, free HIV tests and also free antiretroviral medicine. This has reduced the HIV transmission rate from infected mothers to their fetuses and newborn babies from a high of 2.49% in 2013 to 1.8% in 2014 . Botswana also introduced HIV DNA PCR testing to facilitate early infant HIV diagnosis before they became symptomatic. Pre-Exposure Prophylaxis (PrEP), specifically antiretroviral treatment (ART) has also been used in Botswana as an HIV Prevention strategy. The most commonly prescribed PrEP drug in Botswana is the combination ART emtricitabine/tenofovir (Truvada). Currently the Botswana government spends more on health care per capita (US$340 million by 2008) than any other country in Africa and this dedication has seen a decrease in the rate of HIV infections in the country.
By 2017 , Kenya was ranked third in the highest new HIV infections among young people in the East and Central African region. It also has the second highest population of 238,987 young people, between the ages of 15 to 24 years, living with HIV/Aids In Kenya, more than half of the 1.1 million people living with HIV are unaware of their HIV Status and this has prompted the Kenyan Government to embark on various HIV campaigns to encourage its citizens to undergo testing and confirm HIV Status. Various voluntary counselling and testing centres have been established all over the country to encourage the people to undergo free HIV tests and counselling. The government also created the National AIDS Control Council (NACC) that was tasked in overseeing the control of HIV infections in Kenya. The overriding mandate of NACC is to coordinate stakeholders in the multisectoral response to HIV and AIDS in Kenya. NACC together with the government of Kenya along with private sector donors have hosted many events mainly targeting young adults as a public awareness campaign including education on early testing. Notably the Maisha event campaigns whereby several local musicians in Kenya took part to educate young adults about safe sex, abstinence and the benefits of early testing. The country has adopted a number of innovative approaches to HIV testing in recent years, including targeted community-based HIV testing, door-to-door testing campaigns, and the introduction of self-testing kits. In May 2017, the Kenyan government introduced self-testing kits, as part of their ‘Be Self Sure’ campaign. The kits are now available to buy from pharmacies across the country. These efforts have led to a dramatic rise in the number of people testing for HIV. The Kenyan government has only actively promoted the use of condoms since 2001, but distribution has substantially increased year on year. Also the government introduced HIV education as part of the school curriculum, where school pupils and education personnel are taught about HIV prevention and care. Kenya has also implemented voluntary medical male circumcision (VMMC) as an HIV prevention measure and impressive progress has been made in implementing this programme with about 92.6% of men being circumcised by 2016 . Medical researchers in Kenya are exploring an innovation that involves giving people induced antibodies passively to protect them against HIV infection. In a landmark study more than a decade ago, humoral immunity, and specifically immunoglobulin A (IgA) that is directed against human immunodeficiency virus (HIV) ‐1, was shown to contribute to protection against HIV‐1 acquisition at mucosal surfaces . This is a collaborative research initiative being undertaken by both the Kenya Medical Research Institute (KEMRI) and the US Centre for Disease Control and Prevention. With the launch of the Kenya AIDS Strategic Framework (KASF) by NACC and the Kenyan Government, Kenya is aiming to reduce new infections by 75% through a combination of biomedical, behavioral and structural interventions.
South Africa has the biggest and most high profile HIV epidemic in the world, with an estimated 7.1 million people living with HIV in 2016. South Africa accounts for a third of all new HIV infections in southern Africa with an estimated 12% of its population affected by HIV/AIDS. To combat the HIV epidemic the South African Government has invested more than $1.34 billion annually to run its HIV programme making South Africa the largest ART programme spender in the world. In 2016, South Africa implemented ‘test and treat’, whereby everyone with a positive diagnosis was eligible to start treatment. The success of this ART programme is evident in the increases in national life expectancy. South Africa’s female condom programme is also one of the biggest and most established in the world, with over 26 million female condoms distributed in 2016. Also South Africa’s distribution of male condoms has increased in recent years, with more than 392 million condoms being distributed in 2017 . In December 2015 South Africa became the first country in sub-Saharan Africa to fully approve PrEP for indication of prophylaxis in HIV-negative subjects at high-risk of infectivity. The 2017-2022 National Strategic Plan that was launched by the South African National AIDS Council outlines how the country will respond to the prevention and treatment of HIV and AIDS, TB and STIs over the next five years. It seeks to improve on the achievements of the last Plan (NSP 2012 – 2016), which massively scaled up South Africa’s ART programme and reduced the number of Mother-to-Child transmission rate to just 1.5%. This plan aims to expand this, so that PrEP becomes available to all those who are most likely to benefit, including adolescents, sex workers, men who have sex with men and people who inject drugs. The government has also committed to promote HIV Education in South African schools and also increase HIV awareness campaigns all across the country through media platforms. South Africa has made great strides in tackling its HIV epidemic in recent years, with this much dedication and effort by the government, the number of new infections have reduced.
Nigeria has the second largest HIV epidemic in the world with 3.6 million people were living with HIV in 2016. The UNAIDS reported this year that Nigeria accounts for 14% of global HIV infections daily and more preventive care programmes are being implemented by the Government, multinational organisations and NPOs to reduce this rate. In Nigeria, women constitute 58% of the population living with HIV with gender inequality being identified as a key driver influencing the vulnerability of women and girls to HIV infection. In 2015, the National Agency for the Control of AIDS developed a set of Guidelines (National Strategic Framework) to help make gender equality as part of the mainstream response to HIV disease control. The aim of this guidelines is to raise awareness amongst health practitioners on issues around gender inequality and how to address these issues in their HIV programming. The key targets of these guidelines are to provide 90% of the general population with HIV prevention interventions by 2021 and for 90% of key populations to be adopting HIV risk reduction behaviors by 2021. They identify strengthening community structures as being a main way to achieve this. This framework aims to increase regular condom use by 90% of the people by 2021. PrEP is not currently available for the general public in Nigeria, however some sero-discordant couples have been able to access the drug through phase I clinical trials. The guidelines aim to expand the use of PrEP by commercial sex workers, drug users and individuals who engage in anal sex on a prolonged and regular basis. HIV education has been added to the Nigerian school curriculum, where school were required to teach a comprehensive list of topics relating to HIV, including basic facts about HIV transmission and prevention, alongside more complex issues such as stigma and gender-based violence. In Nigeria, not so many people are on treatment and this makes it hard for the country to tackle this epidemic. More needs to be done by the country as a whole to tackle this menace, more commitment, more funding and resources need to be made available to all so that the country can start winning this battle.
With a population of over 102 million people, there are nearly 1.2 million people living with HIV/AIDS in Ethiopia . The adult prevalence rate being estimated at 2.4% and 0.29% for the incidence rate. There is limited epidemiological data available in the public domain on HIV/AIDS in Ethiopia and so the main sources of the data comes from the Antenatal Clinic (ANC) with other sources from reported cases in clinics and infrequent surveys of the general population or high risk groups. The most affected areas are the rural areas where the infection rate is increasing with a 0.9% HIV prevalence rate. In the urban areas there has been a decline in new infection rates with a prevalence of 7.7 %. This difference in statistics between urban and rural areas can be attributed to the accessibility of better health care facilities and ARTs. High rates of male circumcision (92%) and low rates of reported premarital sex (under 10% for women) and extra-marital sex (under 1% for women and 3% for men) help explain the low intensity of the HIV epidemic in Ethiopia compared to other African countries. To combat the spread of the HIV epidemic, the Government of Ethiopia (GOE) has provided ARTs to clinics, encouraged its citizens to get tested and also encouraged safe sex by distributing over 150 million condoms annually. In 2017, the government bought an estimated five million HIV test kits to be used to conduct HIV tests all over the country. Ethiopia’s Federal Ministry of Health launched its Catch-Up-Campaign in 2017 to implement targeted testing in geographic areas where evidence suggests there are large numbers of undiagnosed HIV cases, with the expectation that it will significantly “catch up” in reaching its treatment targets. The responses to the HIV/AIDS epidemic by GOE has shown considerable progress but a few challenges are making it hard for the country to meet its target for HIV/AIDS control. Insufficient human resources, weak supply of management and distribution, and weak mid-level managerial capacity at regional and district levels are key challenges in the country’s response to HIV/AIDS.
According to the 2016 UNAIDS HIV/AIDS report around 220 000 people (85000 of them are men, 120 000 are Women and 16 000 are children under the age of 14) who are living with HIV . The prevalence rate for women aged 15 to 49 is at 3.8% while the prevalence rate for men aged 15 to 49 is at 2.3%. In 2017, 87% of Rwandans living with HIV knew their status and 80% were on ART drugs. The first case of HIV infection in Rwanda was reported in 1983  leading to the establishment of a national AIDS case reporting system in hospitals and health centres in 1984. This was the first effort by the government of Rwanda in monitoring the spread of the epidemic. The 1990–1994 civil war and genocide had a devastating impact on the national health infrastructure and control of the spread of HIV in the country. Since then Rwanda has come up with strategies to fight the spread of the epidemic, one of them is introducing free HIV testing and counselling services in all public health facilities and private clinics all over the country. Use of ARTs has been promoted in Rwanda with The President’s Emergency Plan for AIDS Relief (PEPFAR) paying for 94,000 of the 180,000 people who are on ART drugs. Prevention of mother to child transmission (PMTCT) services have been increased with 97% of all facilities providing pre and post-test HIV counseling, initiation of ART and counseling (PMCTC) services by 2013 countrywide. As part of the PMCTC initiative, health workers have been encouraged to seek out women who miss follow-up appointments. Rwanda has also distributed 5 million condoms between 2009 and 2013 to promote safe sex. HIV testing and counselling services are offered free of charge at all public health accredited facilities in Rwanda and at a small fee in private clinics. HIV testing and counselling campaigns are regularly carried out at the community level for the ‘hard to reach’ areas through the collaboration and partnership with community-based organizations, churches and NGOs. Voluntary medical male circumcision was also added to the 2013–2018 National Strategic Plan of HIV with surgical kits provided to all facilities and two healthcare workers trained per facility.
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