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  • Title: Human immunodeficiency virus infection and AIDS in east Africa: challenges and possibilities for prevention and control.
    Author: Mhalu FS, Lyamuya E.
    Journal: East Afr Med J; 1996 Jan; 73(1):13-9. PubMed ID: 8625855.
    Abstract:
    Human immunodeficiency infection and AIDS are a major recent microbial infection in east Africa with serious health and socioeconomic impacts in the region. At present HIV infection and AIDS account for more than 50% of adult medical admissions into some of the national and provincial hospitals as well as for 10-15% of paediatric admissions. AIDS is also at present the commonest cause of death among those aged 15-45 years. Tuberculosis, a closely associated disease to HIV infection, has increased more than three fold in some countries in the region. The prevalence of HIV infection currently ranges from 10-30% among adults in urban areas and from less than 1% to 25% in adults in rural areas; since this prevalence is still rising, the full impact of the AIDS problem in east Africa is yet to be realised. This is different from the situation in many developed countries where AIDS is no longer a priority health issue and where peak prevalences of the infection have been reached. The differences in HIV prevalences between east Africa and developed countries are due to poverty, ignorance, high prevalence of other STDs and associated cultural and traditional practices which prevail and facilitate HIV transmission in the region. While more than 80% of HIV infection in east Africa is transmitted through heterosexual intercourse, 5-15% of cases are perinatally transmitted and the remaining cases are transmitted through blood and blood products. While a lot of scientific advances have been made in immunopathology of AIDS, diagnostics and in social behavioural studies, we are still a long way towards getting curative therapy and or effective preventive vaccines. Recent discovery that use of zidovudine can significantly reduce perinatal HIV transmission is an additional breakthrough. While knowledge and tools for preventing HIV transmission are available in the world, prospects for AIDS control in east Africa appear gloomy unless major efforts are made in the reduction of poverty, ignorance and in the control of other common sexually transmitted diseases. HIV/AIDS poses a major health and socioeconomic burden in east Africa. More than 50% of adults and 10-15% of children admitted to some of the national and provincial hospitals in the region have HIV/AIDS. AIDS is the leading cause of death among people aged 15-45. Tuberculosis, an opportunistic infection associated with HIV infection, has risen more than three times in some east African countries. 10-30% of adults in urban areas and from less than 1% to 25% of adults in rural areas are infected with HIV. In fact, HIV prevalence is still increasing; so the full impact of AIDS in eastern Africa has not yet occurred. Yet in many developed countries, HIV infection has peaked and HIV/AIDS is no longer a top priority. Poverty, ignorance, high prevalence of other sexually transmitted diseases (STDs), and associated cultural and traditional practices (e.g., inheritance of widows and polygamy), which abound and facilitate HIV transmission, account for the differences in HIV prevalence between east Africa and developed countries. Heterosexual intercourse accounts for more than 80% of HIV infections in east Africa. Perinatal transmission accounts for 5-15% of HIV cases. Blood and blood products transmitted HIV in the remaining cases. There have been considerable scientific advances in immunopathology of AIDS, diagnostics, and social behavioral studies; yet a cure and/or an effective vaccine is not in the near future. Recently, scientists have discovered that a mother's use of zidovudine during the last weeks of pregnancy and labor and zidovudine administered to the newborn significantly reduce perinatal HIV transmission. The knowledge and tools for preventing HIV transmission are available worldwide, but AIDS control in eastern Africa is apt to be for naught unless strong efforts are implemented toward the reduction of poverty, ignorance, and in the control of other common STDs.
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