This is part 4 of a multi-part article on the Ugandan kill-the-gays bill. Links to parts 1, 2, and 3 are after the quote. Part 5 will be published in a couple of days.
Sub-Saharan Africa remains the region most
heavily affected by HIV. In 2008, sub-Saharan
Africa accounted for 67% of HIV infections
worldwide, 68% of new HIV infections among
adults and 91% of new HIV infections among
children. The region also accounted for 72% of the
world’s AIDS-related deaths in 2008. (3)
Uganda is located in Sub-Saharan East Africa. It’s adult (aged 15-49) HIV prevalence as of 2005 was 6.4%. (3) For comparison, the U.S. HIV prevalence for the entire population is 0.36% (2009 CDC statistics).
Heterosexual transmission is currently the most prevalent mode of new infections, followed by rate increases in men having sex with men, IV drug use, and medical injections in clinics not always using sterile needles. A person is 2.35 times more likely to contract HIV if they’ve had 5 or more injections in a year. The Ugandan blood supply wasn’t always 100% safe until recently. (3)
HIV prevalence as of 2007 is higher among adults in the wealthiest group than among those in the poorest group (3). This seems counter intuitive because wealth is usually thought to correspond to higher levels of education. Education level and HIV infection rate are closely related. Those with the highest levels of education are the least likely to become infected. (3)
Heterosexual couples over age 25 have the fastest-growing rate of new HIV infections. Proportions of people transmitting HIV in supposed low-risk heterosexual partnerships are actually high. People in monogamous relationships with one partner HIV positive and the other HIV negative were estimated to account for 43% of incident infections in 2008. (3)
In some African countries, as is true in many other countries around the world, there is a high incidence of regular non-marital sexual partners among married people. This is widely known and socially tolerated. In Uganda, the proportion of long-term partnered men (aged 15–49) reporting multiple sexual partners increased from 24% in 2001 to 29% in 2005. In 2008, 46% of new HIV infections in Uganda were estimated to have occurred among people with multiple sexual partners and the partners of such individuals. Some men choose other men as extramarital sexual partners some of the time. (3)
Though married and long-term partnered couples are at the highest risk for new HIV infections, they are the group least targeted for preventive measures, testing, and treatment. (3)
A household survey in 2008 indicated that HIV-infected individuals who knew their HIV status were more than three times more likely to use a condom during their most recent sexual encounter compared with those who did not know their status. Not knowing one’s HIV status leads to unintended virus transmission. (3)
From 2000-2008, about 42% of men who have sex only with men are HIV positive. Men who have sex with both women and men have a lower incidence (as low as 1/4) of the male homosexual-only HIV prevalence. (3)
Widowed people are more than six times more likely to be infected with HIV than those who have never been married as of 2006. (3)
Many more women aged 15-24 are infected with HIV compared to men the same age. 5% of women in this age group are HIV positive while 2% of men the same age are HIV positive. These women are in the range of being most likely to bare children. If undiagnosed and untreated during pregnancy, the newborn children will have HIV. (3)
As of 2007, only 25%-49% of HIV infected pregnant women received antiretroviral treatment to prevent HIV infection of their unborn children. But this rate of treatment has significantly prevented the infection of babies born with HIV and is reducing the rate at which children are orphaned. (2) “A study in Uganda found that timely initiation of antiretroviral therapy and co-trimoxazole prophylaxis reduced mortality by 95% and also produced a 93% reduction in HIV-related orphanhood”. (3)
Because of the wider availability of antiretroviral drugs to treat HIV, many people may have become complacent about using preventive measures. HIV is seen as a chronic, treatable disease and not a death sentence. But, not everyone knows their HIV status and about half of all people affected don’t have access to treatment should they become infected. Since Africa’s drugs are paid for by other countries, the cost of having HIV is not borne by the infected individuals. (3)
In general in Sub-Saharan Africa the HIV-AIDS epidemic peaked in 1995, and HIV prevalence has declined, but current downward trends are much slower or stagnant. After nearly 20 years of effort to bring the HIV-AIDS epidemic under control, some countries are making real progress in education, behavioral changes and treatment. In other countries, there is little data and few programs are available to those populations. Even in the countries with better access to resources, only about 50% of those who need antiretroviral treatment are receiving it. (3)
Sources:
(1) The Rachel Maddow Show
(2) UNAIDS 2008 Global AIDS Epidemic Report
(3) UNAID AIDS Epidemic Update December 2009
Part 5 is located at this link.
Photo from BBC News
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