The Lancet this week launched a series of article intended to focus thought on the HIV epidemic in the run up to the Barcelona World AIDS Conference with a review of the spread and effect of HIV in sub-Saharan Africa, raising the question: why is Africa worst affected by HIV?
The authors highlight a number of factors which have led to catastrophe for many African nations, and a generalised epidemic throughout sub-Saharan Africa (with the exception of Somalia).
Sex between men and sex workers is identified as an important common factor between Asia and Africa, but the authors note that whilst Thailand and Cambodia launched large-scale interventions to promote condom use, supported at the highest level of government, uptake of condoms and support from government for campaigns have been poor in Africa.
Other factors which have played a role include:
- Subordinate position of women and lack of control over their sex lives; women also tend to marry older men, who are more likely to be infected by the time of marriage
- Decline of social services, and poverty
- Migrancy due to urbanisation; rural migrants tend to be male, aged 15-30, and form a major client group for sex workers. Female migrants form a large proportion of sex workers
- War and displacement of refugees. Soldiers are at high risk of HIV infection, while women are especially vulnerable to rape in times of war.
The full text of the article is available free at The Lancet website in the June 7 edition.