Africa

More than two out of three HIV-positive adults and nearly 90% of all HIV-positive children live in sub-Saharan Africa, where national HIV prevalence rates range from less than 2% to more than 26% of adult populations. In total, some 22.5 million people were living with HIV/AIDS in the region in 2007, including the 1.7 million who were newly infected during that year. Also in 2007, 1.6 million sub-Saharan Africans died of AIDS. And more than half of all PLWHAs in sub-Saharan Africa (61%) are women.

Southern Africa is the area of the world most affected by HIV/AIDS, with nearly one third of all new HIV infections and AIDS deaths in 2007, and 35% of all PLWHAs. In East Africa, where AIDS first emerged on the continent, most countries are experiencing either a stabilization or a decline in adult HIV prevalence, although it remains high in many places. In West and Central Africa, HIV prevalence is either stable or declining, though conflict has increased the risk for HIV transmission in a number of countries.¹ Unprotected heterosexual sex is responsible for the largest number of HIV infections in sub-Saharan Africa. But there is growing evidence of high rates of HIV transmission among MSM in the region.

In North Africa (and the Middle East, represented by a few countries included in the above section on Asia), epidemiological surveillance has been minimal. Available information, however, suggests that some 380,000 people are living with HIV/AIDS in the region. While few HIV/AIDS cases are being reported, men in urban areas account for the majority of infections. In some countries, commercial sex and injection drug use are also important factors in HIV transmission. In most countries, there is little knowledge of HIV/AIDS and few prevention efforts, even among the most vulnerable populations.

Review of Country Progress Reports

African countries reviewed: Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Libya, Madagascar, Malawi, Mali, Mauritania, Mauritius, Morocco, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia, Zanzibar, Zimbabwe.

1. Country Reporting: How Many Countries Reported on MSM?

Country reporting of five UNGASS indicators relevant to MSM

Summary: Out of the 52 countries reviewed, 35 did not report on any of the five indicators (Algeria, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Guinea, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Malawi, Morocco, Mozambique, Namibia, Rwanda, Sierra Leone, Somalia, South Africa, Tanzania, Togo, Uganda, Zimbabwe). Twelve countries (Angola, Benin, Ghana, Kenya, Mali, Mauritania, Niger, Senegal, Swaziland, Tunisia, Zambia, and Zanzibar) reported on 1-3 indicators. Five countries (Ivory Coast, Mauritius, Nigeria, Sao Tome and Principe, and Sudan) reported on 4-5 indicators.

2. Seroprevalence: What percentage of MSM Are Living With HIV?

UNGASS Indicator: Percentage of MSM who are living with HIV

Summary: Forty-two countries did not report on HIV seroprevalence among MSM (Algeria, Angola, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Guinea, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Malawi, Mauritius, Morocco, Mozambique, Namibia, Rwanda, Sao Tome and Principe, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia, and Zimbabwe.) Of the countries that reported on HIV seroprevalence rates among MSM, none reported prevalence of 0-10%. Two countries (Ivory Coast and Zanzibar) reported HIV seroprevalence of 11-15%. Eight countries (Benin, Ghana, Kenya, Mali, Mauritania, Niger, Nigeria, and Senegal) reported an HIV seroprevalence rate among MSM exceeding 15%.

3. Testing: What Percentage of MSM Have Taken an HIV Test in the Last Year?

UNGASS Indicator: Percentage of MSM who received an HIV test in the last 12 months and who know their result.

Summary: Forty-two countries in the region did not report on HIV testing among MSM (Algeria, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Malawi, Mali, Morocco, Mozambique, Namibia, Niger, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, Zanzibar, and Zimbabwe). Six countries (Benin, Mauritania, Mauritius, Nigeria, Sudan, and Tunisia) reported HIV testing rates among MSM of less than 40%. Three countries (Angola, Ivory Coast, and Kenya) reported testing rates of 40-59% and one country (Sao Tome and Principe) reported a rate of 60% or higher.

4. Knowledge: What Percentage of MSM Know How to Prevent HIV?

UNGASS Indicator: Percentage of MSM who both correctly identify ways of preventing the sexual transmission of HIV and who reject major misconceptions about HIV transmission

Summary: Forty-nine countries in the region did not report on the level of understanding among MSM of HIV prevention (Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Ivory Coast, Kenya, Lesotho, Liberia, Libya, Madagascar, Malawi, Mali, Mauritania, Morocco, Mozambique, Namibia, Niger, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia, Zanzibar, and Zimbabwe). Two countries (Mauritius and Nigeria) reported rates of 40-59% and one country (Sao Tome and Principe) reported a rate of 60% or more.

5. Behavior: What Percentage of MSM Used a Condom the Last Time They Had Sex?

UNGASS Indicator: Percentage of men reporting the use of a condom the last time they had anal sex with a male partner

Summary: Forty-one of the 52 African countries did not report on condom use among MSM (Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Guinea, Guinea Bissau, Lesotho, Liberia, Libya, Madagascar, Malawi, Mauritania, Morocco, Mozambique, Namibia, Niger, Rwanda, Sao Tome and Principe, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Togo, Uganda, and Zimbabwe). Two countries (Tunisia and Zanzibar) reported condom use among MSM of 20-39%. Seven countries (Ivory Coast, Ghana, Mali, Mauritius, Nigeria, Senegal, and Tanzania) reported rates of 40-59%. Two countries (Kenya and Zambia) reported rates of 60-79%. No country reported condom use rates among MSM of 80% or higher.

6. Coverage: What Percentage of MSM Are Being Reached by HIV Prevention Programs?

UNGASS Indicator: Percentage of MSM reached with HIV prevention programs

Summary: Forty-six countries in Africa do not know how many MSM are being reached by HIV prevention programs (Algeria, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comores, Congo, Djibouti, Egypt, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea Bissau, Kenya, Lesotho, Liberia, Libya, Madagascar, Malawi, Mali, Mauritania, Morocco, Mozambique, Namibia, Niger, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Sudan, Swaziland, Tanzania, Togo, Tunisia, Uganda, Zambia, Zanzibar, and Zimbabwe). One country (Angola) reported reaching less than 20% of MSM. No countries reported reaching 20-39% of MSM. Two countries (Mauritius and Nigeria) reported reaching 40-59% of MSM. Three countries (Benin, Ivory Coast, Sao Tome and Principe) reported reaching 60% or more of MSM.

References

1. Adapted from UNAIDS website. Available online at www.unaids.org/en/CountryResponses/Regions/SubSaharanAfrica.asp.

2. Nigeria National Agency for the Control of AIDS: Nigeria 2007 UNGASS Country Progress Report (2008).

3. Federal Republic of Nigeria, Federal Ministry of Health: HIV/STI Integrated Biological and Behavioural Surveillance Survey 2007 (2007).

4. International Gay and Lesbian Human Rights Commission (IGLHRC): Voices from Nigeria: Gays, Lesbians, Bisexuals, and Transgenders Speak Out About the Same Sex Bill (2006).

5. Interview with Dr. Oliver Ezechi, Nigerian Institute of Medical Research, May 22, 2008.

6. Cameroon National AIDS Control Committee: Cameroon 2007 UNGASS Country Progress Report (2008)

7. Cary Alan Johnson: Off the Map: How HIV/AIDS Programming Is Failing Same-Sex Practicing People in Africa (IGLHRC, 2007).

8. Interview with Steave Nemande, director of Alternatives-Cameroon, May 23, 2008.

9. "Human Rights Activists Protest Continued Arrests of Gay Men in Cameroon: Demonstrations in Paris, Pretoria and Washington, D.C." (IGLHRC, 2007).

10. Johnson.