AIDS in Africa: diversity in the global pandemic.

Abstract

AIDS presents very different challenges for developing countries as compared to more industrialized nations. There are differences in risk factors clinical presentation care for the affected as well as in the social and economic impact of the virus. This article presents key epidemiological differences between AIDS in African countries and AIDS in the US. The authors emphasize the need for a global perspective on the AIDS pandemic. Background conditions that permit and constrain the responses to the epidemic are discussed. Disparate data and both practical and ethical constraints prevent precise determination of the prevalence and distribution of the HIV infection in Africa. However international research efforts support several basic conclusions about the epidemiology of the disease in African countries. The variable distribution of the HIV infection in Africa reflects the cultural social and economic diversity of the continent. The HIV-1 infection is concentrated in the central and eastern parts of the continent. The epidemic has not reached crisis proportions in the other regions in Africa but fear of more widespread dissemination of HIV is well founded. A second virus HIV-2 has been found in some West African countries. HIV-2 could lead to serious levels of AIDS morbidity and mortality in future years. Adolescents and adults between the ages of 15 and 50 and children under 4 are primarily affected worldwide. Data suggests that significantly more women than men are infected and at risk of HIV infection in Africa. With more women who are HIV positive infections in infants is more frequent in affected Africa than in North America and other Pattern I regions. In a discussion about health systems and clinical care several conditions unique to Africa are identified. High rates of sexually transmitted disease which increases the risk of HIV infection are seen in Africa because of limited access to curative services. There is an increased demand for medical services by seropositive individuals because of higher vulnerability to human pathogens. Another confounding issue is the confusion between symptoms associated with malnutrition tuberculosis malaria and other curable diseases and the AIDS related conditions. Unfortunately the definitive diagnosis of AIDS requires HIV seropositivity. These antibody tests are expensive and largely unavailable outside urban centers. This difficulty with diagnosis means that individuals with curable diseases are being mis-diagnosed with the HIV virus and are not receiving proper treatment. The authors point out that striking variations in HIV prevalence are observed at the microlevel. Networks of kinship and lineage tend to define communities in Africa. Additionally traditional healers provide most of the health services in developing countries. Also women in Africa have a particularly low status which restricts their ability to protect themselves from HIV infection. The authors conclude that the complex nature for AIDS points to the need for small- scale projects geared toward culturally homogenous communities where trained staff can translate the information into locally meaningful terms.