Illustrating Global Health 4: Africa is Not a Country

Africa HIV Composit

These images show the progression of the HIV epidemic in Africa over 20 years; in 1990, 2000, and 2010. North Africa stands out in all three images as basically unaffected, with very little loss of life. Likewise, with the exception of Cote d’Ivorie, west Africa has apparently passed through largely unscathed, as has the horn. That DR Congo is apparently so little affected may be a reflection of persistently poor data quality due to ongoing conflict – I don’t feel qualified to say.

Meanwhile, in 1990 we see the explosive early impact in Uganda and the landlocked southern nations – Zimbabwe, Zambia and Botswana. Uganda to some degree lead the charge on grassroots campaigns for control, the results of which are now apparent. South Africa was quiescent early on, but by 2000 the epidemic as we recognise it now had started to take shape, causing substantial loss of life not only there but across the south-eastern nations.

Since then, a notable shift has taken place. The tide is turning in almost all the dramatically affected nations, after the wider availability of ART and increased public health response, and mortality has apparently dropped across the region. Two nations are noticeably bucking the trend – Mozambique, which has only now reached moderate levels of mortality, and South Africa, where the epidemic has continued to gather momentum and now causes over 40% of all deaths.

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