Africa

It is in Africa, in some of the poorest countries in the world, that the impact of the virus has been most severe. At the end of 2007, there were 9 countries in Africa where more than one tenth of the adult population aged 15-49 was infected with HIV. In three countries, all in the southern cone of the continent, at least one adult in five is living with the virus. In Botswana, a shocking 23.9% of adults are now infected with HIV, while in South Africa, 18.1% are infected. With a total of around 5.7 million infected, South Africa has more people living with HIV than any other country.

A mural in Ghana challenging HIV-related stigma

Rates of HIV infection are still extremely high in sub-Saharan Africa, and an estimated 1.9 million people in this region became newly infected in 2007. This means that there are now an estimated 22 million Africans living with HIV/AIDS. In this part of the world, particularly, women are disproportionately at risk. As the rate of HIV infection in the general population rises, the same patterns of sexual risk result in more new infections simply because the chances of encountering an infected partner become higher.

Although West Africa is less affected by HIV infection, the prevalence in some large countries is creeping up. Côte d'Ivoire is already among the fourteen worst affected countries in the world, and in Nigeria around 2.6 million adults and children are infected with HIV.

Infection rates in East Africa, once the highest on the continent, hover above those in the West but have been exceeded by the rates now seen in the southern cone. In 2007, HIV prevalence among adults in Kenya, Tanzania and Uganda exceeded 5%.

Increasing prevalence rates are not inevitable. In Uganda the estimated prevalence rate fell to around 5% from a peak of about 15% in the early 1990s. This trend is thought in part to have resulted from strong prevention campaigns, and there are encouraging signs of the same effect happening in parts of Zambia, Kenya and Zimbabwe. Yet the suffering generated by HIV infections acquired years ago continues to grow, and a drop in HIV prevalence is generally associated with a massive number of AIDS deaths. Under half of those in sub-Saharan Africa in need of antiretroviral treatment were receiving it at the end of 2008.

It is widely thought that North Africa managed to sidestep the global AIDS epidemic - perhaps due to its strict rules governing sexual behaviour. However, the latest UNAIDS estimates indicate that 35,000 people in North Africa and the Middle East acquired an HIV infection in 2008, bringing the total number of people living with HIV/AIDS in the Middle East and North Africa to an estimated 310,000. AIDS killed a further 20,000 people in this region in 2008.