HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION AND AIDS IN EAST-AFRICA - CHALLENGES AND POSSIBILITIES FOR PREVENTION AND CONTROL

Human immunodeficiency infection and AIDS are a major recent microbial infection in east Africa with serious health and socioeconomic impact s in the region. At present HIV infection and AIDS account for more th an 50% of adult medical admissions into some of the national and provi ncial hospitals as well as for 10-15% of paediatric admissions. AIDS i s also at present the commonest cause of death among those aged 15-45 years. Tuberculosis, a closely associated disease to HIV infection, ha s increased more than three fold in some countries in the region. The prevalence of HIV infection currently ranges from 10-30% among adults in urban areas and. from less than 1% to 25% in adults in rural areas; since this prevalence is still rising, the full impact of the AIDS pr oblem in east Africa is yet to be realised. This is different from the situation in many developed countries where AIDS is no longer a prior ity health issue and where peak prevalences of the infection have been reached. The differences in HIV prevalences between east Africa and d eveloped countries are due to poverty, ignorance, high prevalence of o ther STDs and associated cultural and traditional practices which prev ail and facilitate HIV transmission in the region. While more than 80% of HIV infection in east Africa is transmitted through heterosexual i ntercourse, 5-15% of cases are perinataly transmitted and the remainin g cases are transmitted through blood and blood products. While a lot of scientific advances have been made in immunopathology of AIDS, diag nostics and in social behavioural studies, we are still a long way tow ards getting curative therapy and or effective preventive vaccines. Re cent discovery that use of zidovudine can significantly reduce perinat al HIV transmission is an additional breakthrough. While knowledge and tools for preventing HIV transmission are available in the world, pro spects for AIDS control in east Africa appear gloomy unless major effo rts are made in the reduction of poverty, ignorance and in the control of other common sexually transmitted diseases.