ArticlesHIV prevalence and trends in sub-Saharan Africa: no decline and large subregional differences
Introduction
Assessment of trends in the HIV epidemic involves a substantial amount of uncertainty. Expansion of surveillance systems in antenatal clinics and the inclusion of HIV testing in nationally representative population-based surveys have improved the availability of data on HIV prevalence in sub-Saharan Africa. As a result, estimates of the number of people living with HIV infection in sub-Saharan Africa have been reduced by about 10% in 2003.1 Adjustments to estimates of the size of the epidemic made because of better data or improvements in estimation methodology could lead to faulty interpretations about a decline in the epidemic at regional and national levels. A careful analysis of empirical trends is crucial.
Since the late 1980s, antenatal clinics have been the primary source of data for national estimates and the mainstay for tracking the epidemic in countries in sub-Saharan Africa.2 The large differences in HIV prevalence seen within the region—with eastern and, later, southern Africa having much higher levels than western Africa—have been downplayed with suggestions that these differences may diminish with time. This prevention perspective prevailed throughout the 1990s and still dominates interpretations of the large differences in the rate of HIV within sub-Saharan Africa. If, however, large differences between the subregions persist into the new millennium, it would be important to pay more attention to the heterogeneity of the HIV/AIDS epidemic and consider different responses in accordance with severity of the epidemic in subregions and countries. Here, we analyse recent trends in HIV prevalence in pregnant women to ascertain the course of the HIV epidemic in sub-Saharan Africa, with special focus on subregional patterns.
Section snippets
Methods
Data collection in women attending antenatal clinics is the primary method of monitoring trends in HIV prevalence in countries where HIV has spread beyond high-risk populations. Typically, sentinel antenatal clinics are simultaneously surveyed for about 6–12 weeks in a year, until samples from a predetermined number (300–500) of pregnant women have been collected. Unlinked anonymous HIV testing is done on residual blood from samples taken for other purposes (usually syphilis testing). Most
Results
Table 1 presents information on the most recent round of HIV surveillance by country with median HIV prevalence for all antenatal clinics. Table 2 shows HIV prevalence trends in clinics that provided data over a number of years in 1997–2003, but excluding clinics with no data for the 1990s.
Discussion
Recent trends in HIV prevalence in women attending antenatal clinics suggest that the epidemic has levelled off since the late 1990s in all countries in Sub-saharan Africa. In eastern Africa, there is an indication of a gradual and modest decline. In western and central Africa there is no consistent evidence of changes in HIV prevalence in recent years and in southern Africa most countries report either a stabilisation or at worst a small increase in HIV prevalence.
The extent to which these
References (20)
- et al.
HIV estimates from national population-based surveys: A new gold standard for surveillance systems?
Lancet
(2003) - et al.
Declining HIV-1 incidence and associated prevalence over 10 years in a rural population in south-west Uganda: a cohort study
Lancet
(2002) - UNAIDS and WHO. Epidemiological update 2003. Geneva....
- et al.
Methods and procedures for estimates HIV/AIDS and its impact: the UNAIDS/WHO estimates for the end of 2001
AIDS
(2003) HIV/AIDS epidemiological surveillance update for the WHO African Region
(2003)Guidelines for using HIV testing technologies in surveillance
WHO/UNAIDS Working Group on global HIV/AIDS and STI surveillance
(2001)Monitoring the declaration of commitment on HIV/AIDS. Guidelines on construction of core indicators
(2002)- et al.
Change in sexual behaviour and decline in HIV infection among young pregnant women in urban Uganda
AIDS
(1997) - et al.
Nelson Mandela/HSRC study of HIV/AIDS: South African national HIV prevalence, behavioural risks, and mass media. Household survey 2002
(2002)
Cited by (121)
Pediatric Anesthesia in Developing Countries
2019, A Practice of Anesthesia for Infants and ChildrenPediatric Anesthesia in Developing Countries
2018, A Practice of Anesthesia for Infants and ChildrenSustainability in global health: a low ceiling, a star in the sky, or the mountaintop?
2022, BMJ Global Health