HIV and AIDS in Africa

Abstract Africa has the largest number of people living with HIV, with an estimated 25.7 million HIV-positive people in Africa by the end of 2018. This figure represents over two-thirds of infected people globally. African women and girls represent a majority of those infected, and Africa is home to three-fourths of all HIV-infected women and girls. Across African countries, there are differences in the sizes and trajectories of HIV epidemics. Southern Africa has the worst epidemic, with the numbers infected still rising in some countries. Prompting a development and governance crisis in many southern African countries, HIV prevalence rates are as high as 20 percent of the adult population in some countries and nearing 50 percent of the adult population in certain communities. East Africa too has been hit hard by HIV, leading to high mortality and morbidity rates in that region as well. In most of West and North Africa, there has been limited spread of HIV, with most countries in these regions having HIV prevalence rates of less than 3 percent. Africa’s encounter with HIV and AIDS began before it was first identified as a medical condition early in the 1980s. However, it was not recognized as an epidemic in most parts of Africa until much later. Framed largely as a public health crisis rather than a developmental one, much of the world’s focus on the AIDS pandemic in Africa has centered on access to treatment, and developing effective prevention strategies that have principally focused on behavior change practices for targeted populations. However, the HIV and AIDS pandemic in Africa did not emerge in a vacuum. It is the consequence of longer historical processes such as massive demographic growth, urbanization, and social change, as well as global inequalities and historical legacies of colonialism and imperialism. In this regard, a historical account of HIV in Africa offers an important corrective to the dominant biomedical response to AIDS in Africa. It is important to take note of longer historical processes that have shaped both the virus and the human response to it.