HIV/AIDS in Angola

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Angola has a large HIV/AIDS infected population, however, it has one of the lowest prevalence rates in the Southern Africa zone. [1] 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. [1] 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.

Contents

Prevalence

While the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated adult prevalence at the end of 2003 at 3.9%, recent statistics from the Angolan Ministry of Health and the National AIDS Control Program demonstrate a prevalence of 2.8% among pregnant women who are seeking prenatal care. While the low rate seems to be a good thing, the prevalence could soon mimic the rapid upward trajectory experienced in other African countries. [2]

Since 2003, Angola has made progress towards reducing the prevalence of HIV/AIDS in its population. At the end of 2016, it was estimated that 280,000 people were living with HIV/AIDS in Angola, which corresponds to a prevalence percentage of approximately 2.2% among adults aged 15–49 years old. New infections among people of all ages as of 2016 has shown a decrease from previous years, landing at an approximation of 25,000 cases. However, AIDS related deaths in Angola reached an all-time high in 2016 peaking at approximately 11,000 by the end of the year. [3]

By gender

HIV/AIDS is more prevalent in the female population of adults aged 15 years and older with an estimated 160,000 living with the disease - a prevalence of 2.2% of the female population. While HIV/AIDS is less prevalent in men, the disease still affects an estimated 110,000 individuals living with the disease - a prevalence of 1.5% among the male population in Angola. [3] This prevalence can be partially attributed to the lack of focus on women's education. Angola only has 6 years of compulsory education from age 6 to age 11. [4] After those 6 years, many women are expected to stay at home and assist their families in supporting the household—more so, than males are expected to due to gender bias. [5] This causes many of these women to miss out on some of the health education which takes place between the ages of 9-16 in the Angolan educational system. In addition, there is a trend in which Angolan men marry much younger women, which leaves these women at a greater risk for being with a man who does have HIV/AIDs as the men that they marry are often more sexually experienced. The average age of women who get married in Angola is 18.5 years old where as for men, this age is 23.5 years old.

HIV testing and treatment

While prevalence of HIV/AIDS is low in Angola compared to surrounding countries, the diagnosis and treatment of the disease is a top health priority. As of 2016, approximately 40% of people living with HIV/AIDS know their status. Of the people who know their status, approximately 62,000 people are on Antiretroviral Therapy (ART), which is 22% of the total population of people living with HIV/AIDS in the country. Also, 45,000 of all individuals on ART have suppressed viral load, which is a significant percentage of the population on ART, but only represents 16% of people living with HIV/AIDS in Angola. One of the international problems that arises after individuals are placed on ART is the ability for them to stay on the treatment regimen. This is seen in Angola as well, as only 39% of all individuals placed on ART are known to have been still taking it 12 months after beginning treatment. [3]

History

The 27-year civil war in Angola, lasting from 1975 until 2002, kept the spread of HIV to a minimum due to large parts of the country being inaccessible to people infected with the virus. [6] During the civil war, individuals from neighboring countries such as Zambia, Botswana, and Zimbabwe (all countries with high prevalence rates of HIV) were also not allowed to come into the country, which played a significant role in controlling the spread of HIV. However, since the end of the war, transportation routes between countries and within the country ave reopened and communication between neighboring countries and Angola has reopened, thus providing a greater potential for the spread of HIV/AIDS. [2]

In Angola, about 70% of the population is under the age of 24 years old. In 2003, a knowledge, attitudes, and practices (KAP) survey was conducted among people aged 14 to 24 years old. This survey revealed that approximately 43% of young people surveyed were having sex by the age of 15. This prevalence of sex at such early ages in Angola makes it one of the highest rates in the world. On top of the high rates of sex at early ages, there is a considerable lack of access to condoms, lack of access to adequate health care, a high incidence of sexually transmitted infections, and high rates of commercial sex work in Angola. These are some of the largest barriers to overcome when dealing with HIV prevention in Angola and are all conditions that leave the country ripe for a spike in HIV. [2]

HIV in Angola is transmitted primarily through heterosexual sex with multiple partners, with a male-to-female ratio of 0.8:1, indicating that women are more likely to be infected than men. However, HIV prevalence rates among men who have sex with men are higher than the national average. [1] Contaminated needles, medical devices, and blood transfusions are the second largest spreader of HIV/AIDS, although more specific research in this area is needed. [2]

National response

HIV is not the only problem that Angola is facing, as the country is also dealing with extreme economic, social, and political problems. Approximately 68% of the population lives in poverty, and 26% of those living in poverty are living in extreme poverty. Despite these previously mentioned issues that Angola is facing, the Angolan government has made significant efforts to work within the country as well as with international donors and foundations to combat the HIV/AIDS epidemic. All of these efforts have been put in place to work towards delivering HIV/AIDS prevention methods to the public. [2]

The national AIDS Control Program [Programa Nacional de Luta contra o Sida (PNLS)] was established within the Ministry of Health in 1987. This program was put in place to serve as a way to fight against the HIV/AIDS epidemic as a nation. Most of the financing of this program has come from external donations to helping the country. [2]

The National AIDS Commission was established in 2002 to work towards a better high-level governmental attention to the HIV/AIDS epidemic. The developmental strategy resulting from the creation of this commission called for a special attention to a plethora of vulnerable populations within Angola: sex workers, truck drivers, mine workers, military personnel, youth, street children, pregnant women, dislocated people, refugees and resettled populations, prisoners, injecting drug users, blood transfusion recipients, traditional healers, traditional birth attendants, health workers, and children living with or affected by HIV/AIDS. [2]

In June 2004, the Angolan National Assembly passed a comprehensive HIV/AIDS law with the purpose of "protecting and promoting full health through the adoption of measures needed to prevent, control, treat and investigate HIV/AIDS". The law was put into place in efforts to protect the rights of the individuals living in Angola who are living with HIV/AIDS. Protections resulting from this law include the right to employment, free public health care, and confidentiality within the country's health care system. [2]

Angola has developed national guidelines for providing integrated care to people living with HIV/AIDS. However, the mechanisms for distributing antiretroviral drugs need to be implemented outside of Luanda, a problem that is seen throughout several nations in Africa and around the world dealing with this epidemic. [2]

Thus far, the low HIV prevalence in Angola has not had a severe impact on Angola's economic productivity; however, if the spread of HIV continues, it is likely that the epidemic will be particularly devastating to the agricultural, transportation, mining, and education sectors. The fear of HIV/AIDS in Angola is prevalent in all aspects of life, often leading to stigmas surrounding those with HIV/AIDS as well. [2]

International response and help efforts

Similar to many other African countries, much of the help to combat HIV infection and progression to AIDS has come from without the country's own confines.

The United States began giving help to Angola in 2001 with the AIDSMark program established under the U.S. Agency for International Development (USAID) which was meant to reduce HIV transmission as well as transmission of other sexually transmitted infections and diseases. The program sought to do this primarily through promoting condom use in some of the highly vulnerable populations described above. Since its start, the program also adopted other prevention methods such as counseling, condom distribution, social networking, and prevention of mother to child transmission. This program was put into place to support all 18 provinces in Angola. [2]

Another way in which the United States helps to support Angola in its fight against HIV/AIDS is through the President's Emergency Plan for AIDS Relief (PEPFAR). Working in conjunction with officials in Angola, PEPFAR provides assistance to maximize the coverage and impact of the national HIV/AIDS response in high risk areas of Angola. PEPFAR also works with the Angolan government to secure investments to make sure that HIV/AIDS prevention is instituted in the necessary social and health service systems within the country. In 2016, PEPFAR helped save the lives of over 20,000 people by providing access to ART and screened over 75,000 for HIV through various testing methods. [7]

Stigma surrounding HIV/AIDS

Due to the large amounts of fear surrounding the HIV/AIDS epidemic in Angola, many individuals who are living with HIV/AIDS are stigmatized greatly by the public. A result from a poll asking if individuals would buy food from someone they knew was HIV positive showed that 51% of people surveyed would not buy the food from that person. Legal efforts made by the government have helped with discrimination against those who are living with HIV/AIDS, but it has not put an end to the issue, a common theme seen across the world. Also, in response to the stigma surrounding this epidemic in the country, many advocacy and awareness campaigns for HIV/AIDS have been started in Angola to help combat the long lasting stigma surrounding this disease. [3]

See also

Related Research Articles

HIV/AIDS in Africa

HIV/AIDS originated in Africa in the early 20th century and is a major public health concern and cause of death in many African countries. AIDS rates vary dramatically although 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 infected worldwide – some 35 million people – were Africans, of whom 15 million have already died. Sub-Saharan Africa alone accounted for an estimated 69 percent of all people living with HIV and 70 percent of all AIDS deaths in 2011. In the countries of sub-Saharan Africa 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-four years.

Presidents Emergency Plan for AIDS Relief United States governmental initiative

The United States President's Emergency Plan For AIDS Relief (PEPFAR) is a United States governmental initiative to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. Launched by U.S. President George W. Bush in 2003, as of May 2020, PEPFAR has provided about $90 billion in cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history until the COVID-19 crisis. PEPFAR is implemented by a combination of U.S. government agencies in over 50 countries and overseen by the Global AIDS Coordinator at the U.S. Department of State. As of September 30, 2019, PEPFAR has saved over 19 million lives, primarily in Sub-Saharan Africa.

Epidemiology of HIV/AIDS Pandemic of Human Immunodeficiency Virus

HIV/AIDS, or human immunodeficiency virus, is considered by some authors a global pandemic. However, the WHO currently uses the term 'global epidemic' to describe HIV. As of 2018, approximately 37.9 million people are infected with HIV globally. There were about 770,000 deaths from AIDS in 2018. The 2015 Global Burden of Disease Study, in a report published in The Lancet, 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, but remained stable from 2005 to 2015.

The Caribbean is the second-most affected region in the world in terms of HIV prevalence rates. Based on 2009 data, about 1.0 percent of the adult population is living with the disease, which is higher than any other region except Sub-Saharan Africa. Several factors influence this epidemic, including poverty, gender, sex tourism, and stigma. HIV incidence in the Caribbean declined 49% between 2001 and 2012. Different countries have employed a variety of responses to the disease, with a range of challenges and successes.

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.

HIV/AIDS in the Democratic Republic of the Congo

The Democratic Republic of the Congo was one of the first African countries to recognize HIV, registering cases of HIV among hospital patients as early as 1983.

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(antiretroviral drugs). 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

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%).

HIV/AIDS in Mozambique

Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.

HIV/AIDS in Namibia is a critical public health issue. HIV has been the leading cause of death in Namibia since 1996, but its prevalence has dropped by over 70 percent in the last 10 years(2006-2015). While the disease has declined in prevalence, Namibia still has some of the highest rates of HIV of any country in the world. In 2016, 13.8 percent of the adult population between the ages of 15 and 49 are infected with HIV. Namibia had been able to recover slightly from the peak of the AIDS epidemic in 2002. At the heart of the epidemic, AIDS caused the country's live expectancy to decline from 61 years in 1991 to 49 years in 2001. Since then, the life expectancy has rebounded with men living an average of 60 years and women living an average of 69 years

HIV/AIDS in Rwanda

Rwanda faces a generalized epidemic, with an HIV prevalence rate of 3.1 percent among adults ages 15 to 49. The prevalence rate has remained relatively stable, with an overall decline since the late 1990s, partly due to improved HIV surveillance methodology. In general, HIV prevalence is higher in urban areas than in rural areas, and women are at higher risk of HIV infection than men. Young women ages 15 to 24 are twice as likely to be infected with HIV as young men in the same age group. Populations at higher risk of HIV infection include people in prostitution and men attending clinics for sexually transmitted infections.

HIV/AIDS in Zimbabwe HIV/AIDS in Zimbabwe

HIV and AIDS is a major public health issue in Zimbabwe. The country is reported to hold one of the largest recorded numbers of cases in Sub-Saharan Africa. According to reports, the virus has been present in the country since roughly 40 years ago. However, evidence suggests that the spread of the virus may have occurred earlier. In recent years, the government has agreed to take action and implement treatment target strategies in order to address the prevalence of cases in the epidemic. Notable progress has been made as increasingly more individuals are being made aware of their HIV/AIDS status, receiving treatment, and reporting high rates of viral suppression. As a result of this, country progress reports show that the epidemic is on the decline and is beginning to reach a plateau. International organizations and the national government have connected this impact to the result of increased condom usage in the population, a reduced number of sexual partners, as well as an increased knowledge and support system through successful implementation of treatment strategies by the government. Vulnerable populations disproportionately impacted by HIV/AIDS in Zimbabwe include women and children, sex workers, and the LGBTQ+ population.

With less than 0.1 percent of the population estimated to be HIV-positive, Bangladesh is a low HIV-prevalence country.

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.

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.

According to the Global Fund, Honduras is the Central American country most adversely affected by the HIV/AIDS epidemic. As of 1998, Honduras had the highest prevalence of HIV out of all seven Central American countries according to a study published by the office of the Honduran Secretary of Public Health. As of that same year, Hondurans made up only 17% of the Central American population, yet Honduras contained 50% of the initial AIDS cases in Central America and 60% of all Central American cases in 2001. In more recent years, new HIV infections have decreased by 29% since 2010 while AIDS-related deaths have increased by 11% since then. HIV/AIDS heavily affects the young, active, working population in Honduras, and HIV/AIDS deaths account for 10% of the overall national mortality rate. As of 2008, AIDS was the leading cause of death among Honduran women of childbearing age and the second-leading cause of hospitalization among both men and women. Sexually transmitted infections are common, and condom use in risky sexual encounters is sporadic and variable. HIV remains a mainly heterosexual epidemic in Honduras, as 90% of emerging infections are attributed to heterosexual transmission. 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, MSM, 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 MSM have a prevalence of 17.3%. 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).

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 to be classified as having a generalized HIV epidemic.

References

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  2. 1 2 3 4 5 6 7 8 9 10 11 (PDF). 2008-08-16 https://web.archive.org/web/20080816141649/http://www.usaid.gov/our_work/global_health/aids/Countries/africa/angola_04.pdf. Archived from the original (PDF) on 2008-08-16. Retrieved 2017-12-13.Missing or empty |title= (help)
  3. 1 2 3 4 "Angola". www.unaids.org. Retrieved 2017-12-13.
  4. ↑ "Angola". uis.unesco.org. Retrieved 2018-01-31.
  5. ↑ Castelo, Maria (1999). "A CULTURAL APPROACH TO HIV/AIDS PREVENTION AND CARE: Angola's Experience" (PDF). Retrieved 2018-01-31.
  6. ↑ "AIDS in Angola", Radio Netherlands Archives, August 4, 2002
  7. ↑ "Partnering to Achieve Epidemic Control in Angola". www.pepfar.gov. Retrieved 2017-12-13.
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