A Review: The African AIDS Epidemic

In John Iliffe’s, “The African AIDS Epidemic”, he explores a full spectrum of the HIV/AIDS from its origins to its future outlook. The book contains 14 chapters starting from Origins to Epidemic, to the Penetration in West Africa, to Responses and Containment. My research on HIV/AIDS between Johannesburg and Lagos will concern Chapters 2-6 and 12-14. Chapter 2 begins with the origins of the Acquired Immune Deficiency Syndrome in 1959. In this year, an “American researcher studying malaria took blood specimens from patients in the city” (Iliffe 2006, 3). Twenty years later, “…when procedures for HIV [testing] became available…”, one unnamed man from Kinshasa tested positive among the blood samples taken (Iliffe 2006, 3). This test became the first recorded incident of the HIV/AIDS infection. Furthermore, “… the fact that the likely viral ancestor of HIV-1 has been found only in the chimpanzees of western equatorial Africa is one of the…reasons for thinking that the virus originated there.” Illife indicates that the “…second reason is that only that region [Western Africa] harbored not only all three groups of HIV-1, but all the subgroups of the dominant group M (Iliffe 2006, 5). Doubtless, there has since been controversy surrounding the verity of the genetic transmission of HIV-1 to Cameroon and Cote D’Ivoire. Additionally, because of the rapid mutation rate of HIV, by the time incidences of the disease were recorded in the 1980s and 1990s, “…the range of specimens from Africa, North America, and Europe…differed from one another in their composition by up to 30 percent” (Iliffe 2006, 5). This problem emerged largely because there was no “…visible epidemic…” of HIV from 1959, “…nor for the next twenty years” (Iliffe 2006, 5). The second reason Illife indicates for the slow emergence of a visible epidemic is the “…very gradual development of the disease within human bodies” (Iliffe 2006, 8). Chapter 3 begins to introduce HIV’s transition into West Africa as the “…silent epidemic”(Iliffe 2006, 13). In the decades since the disease’s initial discovery, there were strong links being made between transmission, through birth, blood transfusion, and through sex. In particular, Iliffe indicates that the findings in the Piot report concerning the heterosexual transmission of HIV proved extremely controversial. The report prompted Joseph McCormick and the Centers for Disease Control and Prevention to fund a research project in Kinshasa. The report went beyond a quantitative analysis of HIV infection rates in West Africa and observed the cultural norms and contexts in which HIV exists in heterosexual relationships. In this way, the report prompted a necessary conversation about how the public should handle the discourse surrounding HIV/AIDS serostatus. Chapter 4 explains how HIV migrated to East Africa, and details the regions rates of infection twenty years passed 1959. Chapters 5 and 6 give similar treatment to South and West Africa. Chapters 12, 13 and 14, present the outlook on HIV/AIDS from the 2000s onward. In particular Iliffe points to the necessity for a shift in focus that changes the priorities of donors, and makes access to Antiretroviral Treatment more widely available. One means of achieving this is to not only focus on prevention, but to also screen communities most at risk for HIV infection. This way, they understand their serostatus and, if infected, can begin highly active antiretroviral therapy at the point of need. This screening method proved extremely effective in The Bronx, New York City. The New York Department of Health and Mental Hygiene indicates that major focus of activity in New York City has been the expansion of HIV testing, including both routine HIV screening and targeted testing in non‐clinical settings, with prompt linkage to care (New York City 2011, 583). CDC estimates of HIV transmission rates for persons aware versus unaware of their HIV status suggest that knowledge of serostatus and engagement in HIV treatment can decrease the HIV transmission rate by more than two‐thirds (CDC 2010, 4546). Measures to increase knowledge of HIV in New York City have included funding hospitals, clinics, and community based HIV testing, social network recruitment strategies engaging individuals with high risk behavior, and local approaches, such as, “The Bronx Knows”, where all sectors within the community raise awareness, promote, and conduct HIV screenings with prompt linkage to care (New York City 2011, 584). Together, these approaches have led to a significant increase in screening throughout New York City. The data collected from the New York Department of Health and Mental Hygiene shows that the percentage of New Yorkers, aged 18‐64, who report that they have ever tested for HIV grew from 63.2% in 2007 to 67.4 % in 2009. (New York City 2011, 584) This rate compares to a national rate for 18‐64 year‐olds of 45%. (New York City 2011, 586) Perhaps most encouraging, is the progress made in the Bronx. This is not only the poorest borough in New York City, but it is also the borough with the highest HIV/AIDS seroprevalence and systemic risk. In the Bronx, 79 percent of all residents aged 18 to 64 reported ever testing for HIV in 2009, up from 72.3 % in 2007. Also, efforts to improve linkage to care and treatment adherence have been stepped up dramatically. Currently, more than three-quarters of individuals newly diagnosed with HIV were linked to care within three months of their diagnosis resulting in the decreased incidence of HIV/AIDS between years 2007 and 2009 (CDC 2010, 4546). Additionally, using generic antiretroviral cocktails in the early stages of infection, and maintaining this treatment, not only reduces the intial HIV CD4 cell count, but also hinders the severity of HIV mutation. This means that the drugs weaken the opportunistic infection when it is first spotted, and, in turn, weaken the virus when it attempts to replicate. The power of HAART medications has been clearly demonstrated by the recent case of the Mississippi baby born with HIV/AIDS who has seen no signs of HIV/AIDS infection after only 18 months of HAART treatment. Therefore, institutions should prioritize making access to such life-changing treatment possible.

Centers for Disease Control and Prevention (U.S.), and Centers for Disease Control and Prevention (U.S.). 2010. Centers for Disease Control and Prevention infectious diseases snapshot 2008. Atlanta, GA: Dept. of Health and Human Services, Centers for Disease Control and Prevention.

Iliffe, John. 2006. The African AIDS epidemic: a history. Athens: Ohio University Press.

New York City HIV/AIDS Annual Surveillance Statistics. 2010. New York: New York City Department of Health and Mental Hygiene, 2011. Updated January 4, 2012. Accessed July 17, 2012. http://www.nyc.gov/html/doh/downloads/pdf/ah/surveillance2010-tables-all.pdf