Documenting New HIV/AIDS Research and Interventions in Sub-Saharan Africa

Friday Okonofua


Available evidence indicates that sub-Saharan Africa has the highest prevalence of the human immunodeficiency virus and the Acquired Immune Deficiency Disease (HIV/AIDS) in the world.  Of the 35.3 million persons living with HIV/AIDS by the end of 2012, nearly 70% were resident in subSaharan Africa (with an overall prevalence of 4.9%).  Of this, nearly 34% resided in 10 countries in Southern Africa, making this region the epicentre of the pandemic.  Estimates indicate that over 69% of global AIDS deaths occur in subSaharan Africa annually, while up to 31% of new infections and 34% of global AIDS deaths occurred in the continent in 2012.  However, there is evidence that some progress is being made with stabilizing or declining infections achieved in countries such as Malawi, Namibia and Rwanda.  Recent UNAIDS data1 suggests that a 33% decrease in AIDS-related deaths occurred in Africa between 2005 and 2011, with a 7-fold increase in number of HIV positive people receiving antiretroviral treatment during the period.  Despite this, sub-Saharan Africa still lags behind other regions in attaining the global goal of achieving 80% universal access to anti-retroviral treatment and prevention measures.

It is within this context that the African Journal of Reproductive Health (AJRH) launched this special edition to document recent research findings and interventions in efforts to prevent HIV/AIDS in the African continent.  Despite years of international donor support for reducing the burden of HIV/AIDS in Africa, it is becoming evident that only a strategy focused on country ownership and community/stakeholders participation in intervention design and implementation stands a chance of gaining sustained impact in tackling the disease. Specifically, AJRH launched this edition to document some of the most painstaking  indigenous efforts being made to prevent the disease, and to provide care and support for infected and affected persons in the African continent. We believe this would open up  renewed enthusiasm and commitments for scaling up some of the most enterprising and effective solutions for combatting the disease in the continent.
Four categories of research and interventions on HIV/AIDS are featured in this edition of the journal. The first set deals with the nagging problem of the higher susceptibility of adolescents and young people for acquiring HIV/AIDS in the continent.  Available data suggest that a large proportion of new infections in many parts of the continent occur in adolescents, with female adolescents demonstrating a greater tendency to acquire the infection. Indeed, the higher predisposition of young girls to HIV/AIDS acquisition as compared to boys speaks of the greater social and economic inequality suffered by girls as compared to boys.  Apart from girls being less likely to have access to information and services, the paper by Amo-Adjei and Darteh2 from Ghana suggests that HIV stigma may be at the root of young people’s inability to access services, a burden that is borne more severely by girls as compared to boys.  Efforts to deal with the epidemic in Africa must therefore address the prevailing cultural and social norms that prevent evidence-based information and services from reaching young people, especially vulnerable girls. 

The second sets of papers present a framework for realistically addressing the high prevalence of HIV/AIDS among male sex workers, a highly vulnerable population in the region.  While men who have sex with men (MSMs) are increasingly recognized as sources of new HIV infections in the 

African continent, there continues to be official reluctance to recognize them and to address their needs. In particular, there is increasing penchance for many African countries to outlaw the practice of same sex relationships, which has tended to drive the practice underground and prevent the integration of MSMs into official channels of HIV prevention and care.  Yet, the HIV prevalence rate among MSM in Africa is nearly 4 times higher than that in the general population3, with rates ranging between 11-15% in Cote d’Ivoire and Zanzibar, and exceeding 15% in many countries such as Benin, Ghana, Kenya, Mali, Mauritania, Niger, Nigeria and Senegal. Despite this grim statistics, many African countries such as Kenya, Uganda and Nigeria have passed questionable homophobic laws that hamper emerging efforts to deal with the disease in this high-risk group.  The paper by Sylvia Adebajo and her colleagues from the office of the Population Council in Nigeria4 show that it is possible to engage communities of MSMs in legally and socially restrictive settings in research and interventions aimed at mitigating the impact of the disease.  Using a novel “capturerecapture” method, the group was able to estimate the number of male sex workers in urban Lagos.  Such an approach is recommended for further exploration as a crucial method for reaching MSMs with needed reproductive health information and services for HIV prevention and care in contexts where same sex relationships are socially and legally restricted. 

The paper by Ayoola and his group5 also provide evidence of the compelling need for reproductive health services among MSMs resident in metropolitan Lagos.  As shown, only a small proportion of the MSMs captured in the study regularly use condoms during anal sexual intercourse, with many not having a ready source of supply for the commodity. The integration of comprehensive sexuality and reproductive health information and services to the delivery of care for all categories of sexually active people, as part of the recognition of the right to free sexual choice for all persons, will be crucial in efforts to achieve sustainable reduction in the burden of HIV/AIDS in the African continent. 

The third sets of papers in this edition of the journal are those that address the prevention of mother to child transmission of the virus. To date, it is widely known that countries in East and Southern Africa have the highest proportion of pregnant women living with the virus in the world, with South Africa having the highest rate of infection. Although Nigeria has a lower proportion of HIV-positive pregnant women, its high population makes it the country with the second absolute numbers of pregnant women living with the HIV virus in the world.  With comprehensive antiretroviral treatment, it is now possible to reduce the burden of HIV transmission from mother to child from nearly 40% to less than 5%.  UNAIDS data1 indicate that the coverage of services for the prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa reached 59% (CI 43-66%) in 2011.  Six countries – Botswana, Ghana, Namibia, South Africa, Swaziland and Zambia – achieved coverage rates in excess of 75%, with South Africa and Botswana attaining over 95% coverage.  By contrast, seven countries reported PMTCT coverage of less than 25%, including Angola, Chad, Congo, Eritrea, Ethiopia, Nigeria and South Sudan.  Nigeria with a coverage rate of only 15% has one of the highest rates of HIV infection in children in the world, recording an astonishing 60,000 infected children each year6.

Three papers in the journal illustrate the continuing efforts to implement PMTCT of HIV in various parts of Africa. The paper by Iroezi and colleagues7 present data that illuminate the factors that act as barriers or facilitators to women receiving care in a PMTCT program in Malawi, a country currently implementing one of the most progressive policies on PMTCT in Africa.  This paper provides an approach for scaling up some of the best practices relating to PMCTC, not only in Malawi but in the entire African region.  It demonstrates what can be achieved when a country deploys its arsenal of resources for tackling the disease in some of its most vulnerable populations.  A second paper by Imade and colleagues8from Jos, North-Central Nigeria provides evidence of declining rates of maternal HIV infection in women attending tertiary institutions for delivery.  A major limitation of the study is the non-use of community collated data.  In a country where up to 60% of women deliver outside 

the hospital, it is not known to what extent such hospital generated data can be generalized to the rest of the population.  Nevertheless, the fact that rates were lower in the same hospital compared to previous years, may suggest a declining rate of infection in hospital attended deliveries.

The third paper on PMTCT is an important paper that describes the progress made in scaling up the prevention of mother to child transmission within primary health care settings in North-West Nigeria. The Primary Health care system is the entry point into health care systems in many parts of Africa and is the form of care that is most accessible and affordable to some of the most vulnerable populations in the continent.  Yet, there have been limited attempts to integrate the provision of HIV services into this level of care.  The paper by Okusanya and colleagues9 indicates that efforts to scale up PMTCT within primary health care are achievable.  The approach is recommended to all governments in sub-Saharan Africa as a model for achieving sustainable PMTCT service delivery in the continent.

The last sets of papers in this edition of the journal can best be described as a mix bag that covers some of the neglected topics on HIV research and innovations in Africa.  They range from a paper that describes the methodological and ethical issues relating to HIV research and intervention in Africa10 to a paper that examines the old question as to whether HIV transmission is facilitated by the cultural practice of female genital cutting11.  The two papers speak of the deficit of research for addressing some of the most pressing and unanswered questions relating to HIV transmission in the continent.  There are also papers that address the yet un-navigated areas of sexual dysfunction12 and psychological disorders13 that may be associated with the experience of HIV/AIDS.

In conclusion, this edition of AJRH is a compilation of emergent issues relating to HIV/AIDS prevention and care in sub-Saharan Africa.  Written by advocates and researchers in the frontline of impactful social change, it provides scientific evidence of the most endearing indigenous efforts being made to scale up the prevention of the virus in the continent. Efforts to deepen participatory ownership of HIV/AIDS control and to leverage political commitment and support for scaling up the best interventions will be the most effective ways to achieve sustainable reduction in the prevalence of HIV/AIDS in subSaharan Africa in the foreseeable future.   

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UNAIDS Report on the Global Epidemic

: /documents/epidemiology/2012/gr2012/21 Retrieved October 26, 2013.

Amo-Adjei J, Darteh EKM. Drivers of young people’s attitudes towards stigma and discrimination: evidence from Ghana. Afr J Reprod Health 2013 (Special Edition); 17[4]: 51-59).

AmfAR AIDS Research. MSM, HIV and the road to universal access – how far have we come? Special Report, 2008. Accessed from: uploaded files/ In_the-Community. October 29, 2013.

Adebajo SB, Eluwa GI, Tocco JU et al. Estimating the number of male sex workers with the capturerecapture technique in Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]: 83-89).

Ayoola OO, Sekoni AO, Odeyemi KO. Transactional Sex, Condom and Lubricant use among Men who have Sex with Men in Lagos state, Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]: 90-98).

National Action Committee on AIDs. 2013. National HIV trend 1991-2008. NACA, Abuja, Nigeria.

Iroezi ND, Mindry D, et al. A qualitative analysis of the barriers and facilitators to receiving care in a motherto-child prevention program in Nkhoma, Malawi. Afr J Reprod Health 2013 (Special Edition); 17[4]: 118129).

Imade GE, Sagay AS, Musa J, et al. Declining rates of maternal HIV infection detected at delivery in north central Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]: 138-145).

Okusanya BO, Ashimi AO, et al. Scaling up prevention of mother to child transmission of HIV infection to primary health facilities: evidence from two primary health centres in Northwest Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]: 130-137).

Erinosho O Joseph R et al. Research methodological issues in HIV-related social research in Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]: 146155).

Olaniran AA. The relationship between female genital mutilation and HIV transmission in sub-Saharan Africa. Afr J Reprod Health 2013 (Special Edition); 17[4]: 156-160).

Lema VM. Sexual dysfunction among HIV patients. Three case reports and review of the literature. Afr J Reprod Health 2013 (Special Edition); 17[4]: 161170).

Ofovwe CE, Ofovwe CE. Psychological disorders among human immunodeficiency virus-infected adults in Southern Nigeria. Afr J Reprod Health 2013 (Special Edition); 17[4]:


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