HIV/AIDS originated in the early 20th century and remains a significant public health challenge, particularly in Africa. Although the continent constitutes about 17% of the world's population,[1] it bears a disproportionate burden of the epidemic. As of 2023, around 25.6 million people in sub-Saharan Africa were living with HIV, accounting for over two-thirds of the global total.[2] The majority of new infections and AIDS-related deaths occur in Eastern and Southern Africa, which house approximately 55% of the global HIV-positive population.[3]
In regions such as Southern Africa, the epidemic is particularly severe. Countries including Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Eswatini, Zambia, and Zimbabwe exhibit adult prevalence rates exceeding 10%.[4] This has significantly affected life expectancy, with reductions of up to 20 years in the most impacted areas.[5] By contrast, North Africa, West Africa, and the Horn of Africa report significantly lower prevalence rates, attributed to differing cultural practices and reduced engagement in high-risk behaviors.[6] Efforts to combat the epidemic have focused on multiple strategies, including the widespread distribution of antiretroviral therapy (ART), which has substantially improved the quality of life and reduced mortality for those living with HIV.[7] Between 2010 and 2020, AIDS-related deaths declined by 43% in sub-Saharan Africa due to increased access to ART and prevention of mother-to-child transmission programs.[8] However, challenges persist, including stigma, insufficient healthcare infrastructure, and funding constraints.
Key regional and international organizations, such as UNAIDS, the World Health Organization (WHO), and the African Union, continue to coordinate responses, aiming to achieve the United Nations Sustainable Development Goal of ending the HIV epidemic by 2030.[9] Initiatives such as the PEPFAR program and the Global Fund have been instrumental in scaling up ART distribution and prevention campaigns.[10]
Despite progress, gender inequalities exacerbate the epidemic's impact, with young women in sub-Saharan Africa experiencing HIV infection rates three times higher than their male counterparts.[11] Addressing socio-economic factors and enhancing HIV/AIDS education among at-risk populations remain vital components of comprehensive intervention strategies.
In a 2019 research article titled "The Impact of HIV & AIDS in Africa", the charitable organization AVERT wrote:
| Worldwide | 0.8% | 34,000,000 | 1,700,000 | 2,500,000 | |
| Sub-Saharan Africa | 4.9% | 23,500,000 | 1,200,000 | 1,800,000 | |
| South and Southeast Asia | 0.3% | 4,000,000 | 250,000 | 280,000 | |
| Eastern Europe and Central Asia | 1.0% | 1,400,000 | 92,000 | 140,000 | |
| East Asia | 0.1% | 830,000 | 59,000 | 89,000 | |
| Latin America | 0.4% | 1,400,000 | 54,000 | 83,000 | |
| Middle East and North Africa | 0.2% | 300,000 | 23,000 | 37,000 | |
| North America | 0.6% | 1,400,000 | 21,000 | 51,000 | |
| Caribbean | 1.0% | 230,000 | 10,000 | 13,000 | |
| Western and Central Europe | 0.2% | 900,000 | 7,000 | 30,000 | |
| Oceania | 0.3% | 53,000 | 1,300 | 2,900 |
The earliest known cases of human HIV infection were in western equatorial Africa, probably in southeastern Cameroon where groups of the central common chimpanzee live. "Phylogenetic analyses revealed that all HIV-1 strains known to infect humans, including HIV-1 groups M, N, and O, were closely related to just one of these SIV cpz lineages: that found in P. t. troglodytes [Pan troglodytes troglodytes i.e. the central chimpanzee]." It is suspected that the disease jumped to humans from butchering of chimpanzees for human consumption.[14] [15]
Current hypotheses also include that, once the virus jumped from chimpanzees or other apes to humans, medical practices of the early 20th century helped HIV become established in human populations by 1930.[16] The virus likely moved from primates to humans when hunters came into contact with the blood of infected primates. The hunters then became infected with HIV and passed on the disease to other humans through bodily fluid contamination. This theory is known as the "Bushmeat theory".[17]
HIV made the leap from rural isolation to rapid urban transmission as a result of urbanization that occurred during the 20th century. There are many reasons why there is such a high prevalence of AIDS in Africa. One of the most formative explanations is the poverty that dramatically impacts the daily lives of Africans. The book, Ethics and AIDS in Africa: A Challenge to Our Thinking, describes how "Poverty has accompanying side-effects, such as prostitution (i.e. the need to sell sex for survival), poor living conditions, education, health and health care, that are major contributing factors to the current spread of HIV/AIDS."[18]
Researchers believe HIV was gradually spread by river travel. All the rivers in Cameroon run into the Sangha River, which joins the Congo River running past Kinshasa in the Democratic Republic of the Congo. Trade along the rivers could have spread the virus, which built up slowly in the human population. By the 1960s, about 2,000 people in Africa may have had HIV,[15] including people in Kinshasa whose tissue samples from 1959 and 1960 have been preserved and studied retrospectively.[19] The first epidemic of HIV/AIDS is believed to have occurred in Kinshasa in the 1970s, signaled by a surge in opportunistic infections such as cryptococcal meningitis, Kaposi's sarcoma, tuberculosis, and pneumonia.[20] [21]
Acquired immunodeficiency syndrome (AIDS) is a fatal disease caused by the slow-acting human immunodeficiency virus (HIV). The virus multiplies in the body until it causes immune system damage, leading to diseases of the AIDS syndrome. HIV emerged in Africa in the 1960s and spread to the United States and Europe the following decade. In the 1980s it spread across the globe until it became a pandemic. Some areas of the world were already significantly impacted by AIDS, while in others the epidemic was just beginning. The virus is transmitted by bodily fluid contact including the exchange of sexual fluids, by blood, from mother to child in the womb, and during delivery or breastfeeding. AIDS first was identified in the United States and France in 1981, principally among homosexual men. Then in 1982 and 1983, heterosexual Africans also were diagnosed.[22]
In the late 1980s, international development agencies regarded AIDS control as a technical medical problem rather than one involving all areas of economic and social life. Because public health authorities perceived AIDS to be an urban phenomenon associated with prostitution, they believed that the majority of Africans who lived in "traditional" rural areas would be spared. They believed that the heterosexual epidemic could be contained by focusing prevention efforts on persuading the so-called core transmitters—people such as sex workers and truck drivers, known to have multiple sex partners—to use condoms. These factors hindered prevention campaigns in many countries for more than a decade.Although many governments in Sub-Saharan Africa denied that there was a problem for years, they have now begun to work toward solutions.[23]
AIDS was at first considered a disease of gay men and people suffering from drug addiction, but in Africa it took off among the general population. As a result, those involved in the fight against HIV began to emphasize aspects such as preventing transmission from mother to child, or the relationship between HIV and poverty, inequality of the sexes, and so on, rather than emphasizing the need to prevent transmission by unsafe sexual practices or drug injection. This change in emphasis resulted in more funding, but was not effective in preventing a drastic rise in HIV prevalence.[24]
The global response to HIV and AIDS has improved considerably in recent years. Funding comes from many sources, the largest of which are the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President's Emergency Plan for AIDS Relief.[25]
According to the Joint United Nations Program on HIV/AIDS (UNAIDS), the number of HIV positive people in Africa receiving anti-retroviral treatment rose from 1 million to 7.1 million between 2005 and 2012, an 805% increase. Almost 1 million of those patients were treated in 2012.[26] The number of HIV positive people in South Africa who received such treatment in 2011 was 75.2 percent higher than the number in 2009.[12]
Additionally, the number of AIDS-related deaths in 2011 in both Africa as a whole and Sub-Saharan Africa alone was 32 percent less than the number in 2005.[26] [12] The number of new HIV infections in Africa in 2011 was also 33 percent less than the number in 2001, with a "24% reduction in new infections among children from 2009 to 2011".[26] In Sub-Saharan Africa, new HIV positive cases over the same period declined by 25%.[12] According to UNAIDS, these successes have resulted from "strong leadership and shared responsibility in Africa and among the global community".[27]
Numerous public education initiatives have been launched to curb the spread of HIV in Africa.[28]
Many activists have drawn attention to stigmatization of those testing as HIV positive. This is due to many factors such as a lack of understanding of the disease, lack of access to treatment, the media, knowing that AIDS is incurable, and prejudices brought on by a cultures beliefs.[29] "When HIV/AIDS became a global disease, Some African leaders played ostrich and said that it was a gay disease found only in the West and Africans did not have to worry because there were no gays and lesbians in Africa".[30] Africans were blind to the already huge epidemic that was infesting their communities. The belief that only homosexuals could contract the diseases was later debunked as the number of heterosexual couples living with HIV increased. Unfortunately there were other rumors being spread by elders in Cameroon. These "elders speculated that HIV/AIDS was a sexually transmitted disease passed on from Fulani women only to non-Fulani men who had sexual contact with them. They also claimed if a man was infected as a result of having sexual contact with a Fulani woman, only a Fulani healer could treat him".[31] This communal belief is shared by many other African cultures who believe that HIV and AIDS originated from women. Because of this belief that men can only get HIV from women many "women are not free to speak of their HIV status to their partners for fear of violence".[32] Uganda has replaced its ABC strategy with a combination prevention program because of an increase in the annual HIV infection rate. Most new infections were coming from people in long-term relationships who had multiple sexual partners.[35]
The abstinence, be faithful, use a condom (ABC) strategy to prevent HIV infection promotes safer sexual behavior and emphasizes the need for fidelity, fewer sexual partners, and a later age of sexual debut. The implementation of ABC differs among those who use it. For example, the President's Emergency Plan for AIDS Relief has focused more on abstinence and fidelity than condoms[36] while Uganda has had a more balanced approach to the three elements.[37]
The effectiveness of ABC is controversial. At the 16th International AIDS Conference in 2006, African countries gave the strategy mixed reviews. In Botswana,
In Nigeria,
"At the individual level, persons living with HIV/AIDS in Sub-Saharan Africa likely want to conceal their stigmatized identities whenever possible in order to gain these rewards associated with having a 'normal' identity. The rewards of being considered normal' in the context of high-HIV-prevalence Sub-Saharan Africa are varied and great... such rewards for which there is empirical support in this context include perceived sexual freedom, avoidance of discrimination, avoidance of community or family rejection, avoidance of losing one's job or residence, and avoidance of losing one's sexual partners. Other potential rewards of being considered normal include avoidance of being associated with promiscuity or prostitution, avoidance of emotional, social and physical isolation and avoidance of being blamed for others' illness" (150).
The Joint United Nations Program on HIV/AIDS defines combination prevention programs as:
"It is the consensus in the HIV scientific community that abstinence, be faithful, use a condom [(ABC)] principles are vital guides for public health intervention, but are better bundled with biomedical prevention approaches; lone behavioral change approaches are not likely to stop the global pandemic."[32]