Overview: The Global Epidemic
While HIV/AIDS can be found throughout the world, the epidemic has established two broadly different patterns: one in the developed world and one in the developing world.
In the countries of the developed world (which are characterized by advanced industrial economies and democratic governments), AIDS first emerged primarily among gay men, injecting drug users, and recipients of blood transfusions. Particularly in North America and western Europe, gay men and injecting drug users have remained heavily impacted, but the epidemic has shifted steadily toward impoverished communities, often composed of racial/ethnic minorities.
In the countries of the developing world (which are characterized by agrarian or partially industrialized economies and often unstable or repressive governments), AIDS has been transmitted mostly through heterosexual intercourse in the general population, although certain populations such as prostitutes and migrants are at particular risk. Sub-Saharan Africa was the earliest and most heavily impacted region of the developing world, but the epidemic is spreading rapidly throughout Asia and Latin America as well.
Advances in treatment of HIV/AIDS have been limited largely to the developed world, remaining out of the financial reach of most developing countries. The major routes of assistance from the developed to the developing world have been a variety of international organizations that have attempted to track and respond to the global profile of the epidemic.
Coverage in the Encyclopedia
The global epidemic is reflected in the Encyclopedia by entries on the various world regions. In many cases, the entries in this section serve as mirrors of the Encyclopedia as a whole, pointing out distinctive features in such other domains as government and activism, policy and law, culture and society, and impacted populations.
For the most part, space constraints have generally made it impossible to cover countries individually. Thus, in this volume, the countries of the world have been divided into regions that share common geopolitical and epidemiological characteristics. In general, countries that were assigned to the same region share many common characteristics that make possible the discussion of broader trends. This is particularly true for the regions of Europe and the Americas. The divisions used here do not necessarily correspond to other classificatory systems, such as those used by the World Health Organization or other international agencies.
Much of this volume focuses on the United States, and major subregions of the United States are discussed in specific entries. Most countries of the world are also covered, although some extremely small countries and those that have reported few or no AIDS cases have in some cases been excluded. Dimensions of the international response to HIV/AIDS are also covered in other essays.
The more than 200 countries, states, or territories covered by name in Encyclopedia entries are listed under the headings following. Many additional provinces, cities, and regions are also discussed in these and other entries. If a particular country was known by more than one name or if countries merged or divided during the period covered by the entry, the change is noted in parentheses.
Entries on the Americas
Entries on Europe
Entries on Asia and the Pacific
Entries on Africa
Entries on the International Response
|Developed and Developing Worlds|
|National AIDS Programs|
Perspectives on the AIDS Epidemic: The Global Epidemic
Parallel Epidemics: AIDS in the Developed and Developing Worlds
Although HIV, and thus the AIDS epidemic, can be found throughout the world, broadly different epidemiological patterns have emerged in the developed world as opposed to the developing world. These patterns can be discussed only in the most general terms and vary considerably from country to country and among subpopulations within countries. However, these patterns can be used to draw useful distinctions between the challenges posed by HIV/AIDS to the developed and developing worlds.
The term developed world refers to the comparatively wealthy countries and regions of the world whose economies are characterized by advanced industrial capitalism and whose political systems are generally representative democracies. The developed world is usually defined as comprising the United States, Canada, the countries of western Europe, Japan, and Australia and New Zealand, although parts of eastern and central Europe, East Asia, and Latin America are also sometimes included. Even though there are variations from country to country, the progression and profile of the HIV/AIDS epidemic in the developed world has had certain similar features.
These features are in sharp contrast to those found in the developing world, or those regions of Latin America, the Middle East, Africa, and Asia with struggling economies and widespread political instability. One part of the developing world, sub-Saharan Africa, has been the single most heavily impacted region of the globe, although the HIV/AIDS epidemic in regions of South and Southeast Asia threatens to escalate to similar proportions.
The AIDS epidemic in the developed world was first detected clinically when a group of gay men from San Francisco were diagnosed with curious failures of the immune system and with swollen lymph nodes. Researchers determined that the virus was transmitted in three ways: by sexual intercourse, often between men; by exposure to contaminated blood or blood products, including by blood transfusions and the sharing of needles during injecting drug use; and from mother to infant before or at time of delivery or through subsequent breast-feeding. At least three main factors contributed to the early spread of HIV in the developed world: the "sexual revolution" of the 1960s and 1970s, an increase in drug use, and the advancement of blood product and transfusion technology.
Sexual liberation had come to Europe and North America in the late 1960s, and with it came gay liberation. Increased casual sex with multiple partners and with partners from other geographic areas and social settings helped foster the spread of HIV. Because the first clinical cases were observed in homosexual males, AIDS was initially thought throughout the developed world to be a "gay disease." The second major route of transmission, which had great impact on the global spread of the disease, was transmission via contaminated blood and blood products. Evidence of contamination of the blood supply by what would later be identified as HIV first appeared in the United States and in parts of Europe in 1982, when people with the blood disorder hemophilia began to manifest symptoms. The third major route of HIV transmission, "vertical" transmission from pregnant, infected women to their unborn children, first occurred mostly among injecting drug users in North America and Europe.
The epidemic in the developing world began in sub-Saharan Africa, with HIV transmission most intense in Uganda, Malawi, the Central African Republic, Kenya, Tanzania, Burundi, Rwanda, and Zambia, some of the poorest countries of the world. One of the earliest recognized manifestations of the epidemic was dramatic weight loss in certain individuals, called "slim disease" in parts of Africa and later correlated with AIDS-related wasting syndrome. Despite early description of the disease, major efforts to stem infection were not mounted internationally until 1987. In contrast to the pattern of sexual transmission in the developed world, it has been heterosexual rather than homosexual sexual behavior that has been responsible for most HIV transmission in the developing world. Thus the illness was generalized throughout societies early in the epidemic. Injecting drug users, recipients of blood transfusions, children born to HIV-positive mothers, prostitutes, refugees, and migrant workers have been heavily impacted. Although the epidemic in sub-Saharan Africa has remained the paradigm of HIV/AIDS in the developing world, later epidemics also emerged in the Caribbean, Latin America, India, and Southeast Asia, particularly Thailand.
Overall, the AIDS epidemic in the developing world has been characterized by extensive HIV transmission prior to the era of prevention; resource constraints, which have hampered education and prevention in spite of unprecedented levels of international aid to affected areas; and continued, preventable transmission despite lessons learned. Key programmatic decisions made by the international aid community included a de-emphasis on individual counseling and testing and on laboratory screening for HIV for these resource-poor settings. Some feel these decisions hampered prevention efforts. Because of these shortfalls, some of the poorest areas of the world are the most heavily affected. The costs in terms of human life and productivity in sub-Saharan Africa are overwhelming, as are projected costs for the epidemics in Latin America and Asia.
Recognizing that the epidemics in the developing and developed worlds are interconnected, there has been a significant international response to the epidemic. Part of this has come in the form of bilateral assistance between individual developed countries and specific developing countries. However, much of the collaboration between developed and developing countries has occurred through multilateral international agencies such as the World Health Organization, the United Nations Development Programme, and the Joint United Nations Programme on HIV/AIDS.
Ann Marie Kimball
The Encyclopedia of AIDS: A Social, Political, Cultural, and Scientific Record of the HIV Epidemic, Raymond A. Smith, Editor. Copyright © 1998, Raymond A. Smith. Carried by permission of Fitzroy Dearborn Publishers.
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