The Democratic Republic of the Congo (DR Congo) was one of the first African countries to recognize HIV, registering cases of HIV among hospital patients as early as 1983.
The Democratic Republic of the Congo (DR Congo) was one of the first African countries to recognize HIV, registering cases of HIV among hospital patients as early as 1983.
Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) is a disease spectrum of the human immune system caused by infection with human immunodeficiency virus (HIV). [1] [2] [3] As the infection progresses, it interferes more and more with the immune system, making the person much more susceptible to common infections like tuberculosis, as well as opportunistic infections and tumors that do not usually affect people who have working immune systems. The late symptoms of the infection are referred to as AIDS. This stage is often complicated by an infection of the lung known as pneumocystis pneumonia, severe weight loss, a type of cancer known as Kaposi's sarcoma, or other AIDS-defining conditions.
Genetic research indicates that HIV originated in west-central Africa during the late nineteenth or early twentieth century. [4] AIDS was first recognized by the United States Centers for Disease Control and Prevention (CDC) in 1981 and its cause—HIV infection—was identified in the early part of the decade. [5] Since its discovery, AIDS has caused an estimated 36 million deaths worldwide (as of 2012). [6] As of 2012, approximately 35.3 million people are living with HIV globally. [6]
A team at the University of Oxford, United Kingdom, and the University of Leuven, in Belgium, tried to reconstruct HIV's "family tree" and find out where its oldest ancestors came from. Their 2014 study indicated that HIV/AIDS pandemic originated in the Democratic Republic of Congo as a result of social circumstances and the migration of workers. [7]
At the end of 2001, the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that 1.3 million Congolese (adult and children) were living with HIV/AIDS, yielding an overall HIV prevalence of 4.9%. Beyond the 5% mark, the country’s epidemic will be considered "high level," or firmly established within the general population. By the end of 2003, UNAIDS estimated that 1.1 million people were living with HIV/AIDS, for an overall adult HIV prevalence of 4.2%. [8]
The main mode of HIV transmission occurs through heterosexual activity, which is linked to 87% of cases. The most affected age groups are women aged 20 to 29 and men aged 30 to 39. Life expectancy in the DR Congo dropped 9% in the 1990s as a result of HIV/AIDS. [8]
According to UNAIDS, several factors fuel the spread of HIV in the DR Congo, including movement of large numbers of refugees and soldiers, scarcity and high cost of safe blood transfusions in rural areas, a lack of counseling, few HIV testing sites, high levels of untreated sexually transmitted infections among sex workers and their clients, and low availability of condoms outside Kinshasa and one or two provincial capitals. With the imminent end of hostilities and a government of transition, population movements associated with increased stability and economic revitalization will exacerbate the spread of HIV, which is now localized in areas most directly affected by the presence of troops and war-displaced populations. Consecutive wars have made it nearly impossible to conduct effective and sustainable HIV/AIDS prevention activities. In addition, the HIV-tuberculosis coinfection rate ranges from 30 to 50%. [8]
The number of Congolese women living with HIV/AIDS is growing. UNAIDS estimates indicate that, at the end of 2001, more than 60% (670,000) of 1.1 million adults aged 15–49 currently living with HIV/AIDS were women. Infection rates among pregnant women tested in 1999 in major urban areas ranged from 2.7 to 5.4%. Outside the major urban areas, 8.5% of pregnant women tested in 1999 were HIV-positive. [8]
Between 1985 and 1997, infection rates among sex workers in Kinshasa ranged from 27 to 38%. More than one-half (58%) of the total population is under 15 years of age. The AIDS epidemic has had a disproportionate impact on children, causing high morbidity and mortality rates among infected children and orphaning many others. Approximately 30 to 40% of infants born to HIV-positive mothers will become infected with HIV. According to UNAIDS, by the end of 2001 an estimated 170,000 children under the age of 15 were living with HIV/AIDS, and 927,000 children had lost one or both parents to the disease. [8]
In 2003 and 2004, a national HIV surveillance survey conducted jointly by the U.S. Centers for Disease Control and Prevention (CDC) and the National AIDS Control Program among pregnant women revealed an increase in HIV prevalence rates in rural and urban areas highly affected by consecutive wars, e.g., in Lodja (6.6%) and in Kisangani (6.6%). [8]
In 2007, the first Demographic and Health Survey (DHS), a large and statistically representative study of 9,000 people, found a prevalence of 1.3% - 0.9% for men and 1.6% for women. [9] [10]
UNAIDS reported in 2016 that there was an HIV prevalence of 5.7% amongst sex workers, [11] compared with 0.7% amongst the general population. [12] There is a reluctance to use condoms amongst the clients of sex workers, and will pay double the price for unprotected sex. [13] Médecins Sans Frontières distribute condoms to sex workers and encourage their use. [13]
DR Congo is emerging from years of civil conflict. In 2003, former combatants signed peace agreements, and foreign troops left the country. National elections are scheduled for 2005. Despite poor health indicators and rampant poverty—leading to its 2004 rank as one of the 10 poorest countries in the world—DR Congo was one of the first countries in Africa to recognize and address HIV/AIDS as an epidemic and one of the few in which the rate of HIV infection has remained relatively stable. [8]
The interim DR Congo government has shown growing interest in expanding HIV/AIDS services and improving the quality of services but lacks the necessary infrastructure and resources. Therefore, HIV/AIDS activities have recently resumed, but only to a limited extent. As per the national HIV/AIDS strategic framework (1999–2008), the DR Congo government favors prevention, care, and advocacy activities that highlight community participation, human rights and ethics, and the needs of persons living with HIV/AIDS. To implement this strategy nationwide, the DR Congo government solicits participation from all development partners, including private sector, faith-based, and nongovernmental organizations (NGOs). [8]
Internal migration, endemic poverty, widespread risk behavior, sexually transmitted infections, and lack of a safe blood supply are some of the challenges to stemming HIV/AIDS in DR Congo. [8]
The National AIDS Control Program, chaired by the Minister of Health, was established in the early 1990s. Recently, with considerable support from the World Bank, the DR Congo is establishing a multisectoral national control program called Programme National Multisectorial de Lutte contre le SIDA. It is attached to the Office of the President and will act as the central unit for planning, coordination, and monitoring and evaluation of all HIV/AIDS/STI activities in the country. Another important opportunity offered to the DR Congo is funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. [8]
HIV/AIDS originated in Africa during the early 20th century and has been a major public health concern and cause of death in many African countries. AIDS rates varies significantly between countries, though the majority of cases are concentrated in Southern Africa. Although the continent is home to about 15.2 percent of the world's population, more than two-thirds of the total population infected worldwide – some 35 million people – were Africans, of whom 15 million have already died. Eastern and Southern Africa alone accounted for an estimate of 60 percent of all people living with HIV and 70 percent of all AIDS deaths in 2011. The countries of Eastern and Southern Africa are most affected, AIDS has raised death rates and lowered life expectancy among adults between the ages of 20 and 49 by about twenty years. Furthermore, the life expectancy in many parts of Africa is declining, largely as a result of the HIV/AIDS epidemic with life-expectancy in some countries reaching as low as thirty-nine years.
The global epidemic of HIV/AIDS began in 1981, and is an ongoing worldwide public health issue. According to the World Health Organization (WHO), as of 2021, HIV/AIDS has killed approximately 40.1 million people, and approximately 38.4 million people are infected with HIV globally. Of these 38.4 million people, 75% are receiving antiretroviral treatment. There were about 770,000 deaths from HIV/AIDS in 2018, and 650,000 deaths in 2021. The 2015 Global Burden of Disease Study estimated that the global incidence of HIV infection peaked in 1997 at 3.3 million per year. Global incidence fell rapidly from 1997 to 2005, to about 2.6 million per year. Incidence of HIV has continued to fall, decreasing by 23% from 2010 to 2020, with progress dominated by decreases in Eastern Africa and Southern Africa. As of 2020, there are approximately 1.5 million new infections of HIV per year globally.
In 2008, 4.7 million people in Asia were living with human immunodeficiency virus (HIV). Asia's epidemic peaked in the mid-1990s, and annual HIV incidence has declined since then by more than half. Regionally, the epidemic has remained somewhat stable since 2000.
Since the first HIV/AIDS case in the Lao People's Democratic Republic (PDR) was identified in 1990, the number of infections has continued to grow. In 2005, UNAIDS estimated that 3,700 people in Lao PDR were living with HIV.
Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. The status of the HIV/AIDS epidemic in Angola is expected to change within the near future due to several forms of behavioral, cultural, and economic characteristics within the country such as lack of knowledge and education, low levels of condom use, the frequency of sex and number of sex partners, economic disparities and migration. There is a significant amount of work being done in Angola to combat the epidemic, but most aid is coming from outside of the country.
Kenya has a severe, generalized HIV epidemic, but in recent years, the country has experienced a notable decline in HIV prevalence, attributed in part to significant behavioral change and increased access to ARV. Adult HIV prevalence is estimated to have fallen from 10 percent in the late 1990s to about 4.8 percent in 2017. Women face considerably higher risk of HIV infection than men but have longer life expectancies than men when on ART. The 7th edition of AIDS in Kenya reports an HIV prevalence rate of eight percent in adult women and four percent in adult men. Populations in Kenya that are especially at risk include injecting drug users and people in prostitution, whose prevalence rates are estimated at 53 percent and 27 percent, respectively. Men who have sex with men (MSM) are also at risk at a prevalence of 18.2%. Other groups also include discordant couples however successful ARV-treatment will prevent transmission. Other groups at risk are prison communities, uniformed forces, and truck drivers.
HIV/AIDS in Lesotho constitutes a very serious threat to Basotho and to Lesotho's economic development. Since its initial detection in 1986, HIV/AIDS has spread at alarming rates in Lesotho. In 2000, King Letsie III declared HIV/AIDS a natural disaster. According to the Joint United Nations Programme on HIV/AIDS (UNAIDS) in 2016, Lesotho's adult prevalence rate of 25% is the second highest in the world, following Eswatini.
HIV/AIDS in Eswatini was first reported in 1986 but has since reached epidemic proportions. As of 2016, Eswatini had the highest prevalence of HIV among adults aged 15 to 49 in the world (27.2%).
UNAIDS has said that HIV/AIDS in Indonesia is one of Asia's fastest growing epidemics. In 2010, it is expected that 5 million Indonesians will have HIV/AIDS. In 2007, Indonesia was ranked 99th in the world by prevalence rate, but because of low understanding of the symptoms of the disease and high social stigma attached to it, only 5-10% of HIV/AIDS sufferers actually get diagnosed and treated. According to the a census conducted in 2019, it is counted that 640,443 people in the country are living with HIV. The adult prevalence for HIV/ AIDS in the country is 0.4%. Indonesia is the country is Southeast Asia to have the most number of recorded people living with HIV while Thailand has the highest adult prevalence.
Since HIV/AIDS was first reported in Thailand in 1984, 1,115,415 adults had been infected as of 2008, with 585,830 having died since 1984. 532,522 Thais were living with HIV/AIDS in 2008. In 2009 the adult prevalence of HIV was 1.3%. As of 2016, Thailand had the highest prevalence of HIV in Southeast Asia at 1.1 percent, the 40th highest prevalence of 109 nations.
HIV/AIDS in Bolivia has a less than 1 percent prevalence of Bolivia's adult population estimated to be HIV-positive. Bolivia has one of the lowest HIV prevalence rates in the Latin America and Caribbean region.
The Dominican Republic has a 0.7 percent prevalence rate of HIV/AIDS, among the lowest percentage-wise in the Caribbean region. However, it has the second most cases in the Caribbean region in total, with an estimated 46,000 HIV/AIDS-positive Dominicans as of 2013.
Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. It is estimated that the prevalence of HIV among Honduran adults is 1.5%.
In 2016, the prevalence rate of HIV/AIDS in adults aged 15–49 was 0.3%, relatively low for a developing country. This low prevalence has been maintained, as in 2006, the HIV prevalence in Mexico was estimated at around 0.3% as well. The infected population is remains mainly concentrated among high risk populations, men who have sex with other men, intravenous drug users, and commercial sex workers. This low national prevalence is not reflected in the high-risk populations. The prison population in Mexico, faces a fairly similar low rate of around 0.7%. Among the population of prisoners, around 2% are known to be infected with HIV. Sex workers, male and female, face an HIV prevalence of around 7%. Identifying gay men and men who have sex with other men have a prevalence of 17.4%. The highest risk-factor group is identifying transgender people; about 17.4% of this population is known to be infected with HIV. Around 90% of new infections occur by sex-related methods of transmission. Of these known infected populations, around 60% of living infected people are known to be on anti-retroviral therapy (ART).
Nicaragua has 0.2 percent of the adult population estimated to be HIV-positive. Nicaragua has one of the lowest HIV prevalence rates in Central America.
With 1.28 percent of the adult population estimated by UNAIDS to be HIV-positive in 2006, Papua New Guinea has one of the most serious HIV/AIDS epidemics in the Asia-Pacific subregion. Although this new prevalence rate is significantly lower than the 2005 UNAIDS estimate of 1.8 percent, it is considered to reflect improvements in surveillance rather than a shrinking epidemic. Papua New Guinea accounts for 70 percent of the subregion's HIV cases and is the fourth country after Thailand, Cambodia, and Burma to be classified as having a generalized HIV epidemic.
With an estimated 150,000 people living with HIV/AIDS in 2016, Haiti has the most overall cases of HIV/AIDS in the Caribbean and its HIV prevalence rates among the highest percentage-wise in the region. There are many risk-factor groups for HIV infection in Haiti, with the most common ones including lower socioeconomic status, lower educational levels, risky behavior, and lower levels of awareness regarding HIV and its transmission.
Health problems have been a long-standing issue limiting development in the Democratic Republic of the Congo.
Prostitution in Angola is illegal and prevalent since the 1990s. Prostitution increased further at the end of the civil war in 2001. Prohibition is not consistently enforced. Many women engage in prostitution due to poverty. It was estimated in 2013 that there were about 33,00 sex workers in the country. Many Namibian women enter the country illegally, often via the border municipality of Curoca, and travel to towns such as Ondjiva, Lubango and Luanda to work as prostitutes.
Since reports of emergence and spread of the human immunodeficiency virus (HIV) in the United States between the 1970s and 1980s, the HIV/AIDS epidemic has frequently been linked to gay, bisexual, and other men who have sex with men (MSM) by epidemiologists and medical professionals. It was first noticed after doctors discovered clusters of Kaposi's sarcoma and pneumocystis pneumonia in homosexual men in Los Angeles, New York City, and San Francisco in 1981. The first official report on the virus was published by the Center for Disease Control (CDC) on June 5, 1981 and detailed the cases of five young gay men who were hospitalized with serious infections. A month later, The New York Times reported that 41 homosexuals had been diagnosed with Kaposi's sarcoma, and eight had died less than 24 months after the diagnosis was made.
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