AIDS in Africa
Sansone, R.; Carobbi, S.; Alloro, G.; Strigini, P.
Annali di Igiene Medicina Preventiva e di Comunita 1(5): 1057-1066
1989
ISSN/ISBN: 1120-9135 PMID: 2483891 Document Number: 342892
In regard to AIDS, attention has focused on Africa for the following reasons: 1) Solid evidence indicates that antibodies against HIV were present in African sera collected in the early 1960s. 2) Up to 1986, AIDS epidemiology was hampered by inconsistent demographic data, inadequate public health services, and scanty laboratory evidence. 3) Prevalent infection routes in Africa are not entirely overlapping with Western countries. 4) Clinical aspects of AIDS progression in Africa appear linked to the different opportunistic agents and to the prevailing hygienic and social conditions. In 1983, in Rwanda and Zaire, the annual incidence of HIV infection ranged from 17 to 800/million and 170/ million, respectively. In the first five months of 1985, the range of annual incidence in Africa was 50-1000/million. In Zaire, the male-female infection ratio was 1:1.2 and the average age of infected people was 33.6 years. Seropositivity ranged from 1% to 15%. The distribution of African AIDS is characterized by heterosexual transmission, transmission via contaminated syringes, blood transfusion, and maternal-fetal transmission. Lack of condom use among prostitutes and multiple partners are the main routes of heterosexual transmission. Other routes are high risk sexual practices as well as traditional and tribal rituals (clitoridectomy/female genital mutilation). Perinatal infection results from maternal-fetal transmission but also from blood transfusion and the use of unsterilized syringes. In 1986, in Zaire, among 2384 hospital workers, significantly more seropositivity occurred in a group who had had injections in the previous three years. A 1986 study also hinted at the possible role of insects in HIV infection. The major symptoms of AIDS in an African context, in addition to the usual depletion of CD4 lymphocytes, include diarrhea and weight loss, candida, cryptococcus, cytomegalovirus, cryptosporidium, and herpes simplex. Only 14% of AIDS patients in Africa have pneumonia carinii as compared with 63% of AIDS patients in Europe. The concomitant infection with both HIV and tuberculosis is particularly high in Africa.