Epidemiology of HIV in Mozambique

First, some background on HIV

Human immunodeficiency virus (HIV) is the virus that causes acquired immune deficiency syndrome (AIDS). HIV is transmitted via specific bodily fluids (blood, semen, vaginal secretions, and breast milk); common forms of transmission are sexual intercourse or sharing needles with an infected person. The virus attacks the immune system, destroying a specific type of white blood cell called CD4 and thus reducing a person's ability to fight off infection and cancer. Though great strides have been made in treatment of HIV, there is no vaccine and no cure.

The 30-year anniversary of the HIV/AIDS epidemic passed in June of this year. On June 5, 1981, the CDC first reported on cases of a rare pneumonia in five otherwise healthy young gay men in Los Angeles. By 1985, every region of the world had reported a case of HIV/AIDS, and by 1988 more women than men were living with HIV/AIDS in sub-Saharan Africa.

The advent of rapid HIV testing (1992) and highly active antiretroviral therapy (HAART, 1995) reduced mortality rates in the U.S., but by 2000 it was clear that the burden of the epidemic had shifted resoundingly to the developing world. Today it is estimated that sub-Saharan Africa is home to 60% of all HIV-infected adults and 90% of HIV-infected infants. Almost 25 million people in sub-Saharan Africa are living with HIV, and nearly 3 million are newly infected each year.

Next, some background on Mozambique

The Republic of Mozambique lies on the Indian Ocean in southeastern Africa, bordered by Tanzania to the north and South Africa to the south. The Portuguese arrived in the early 1500s to colonize it. Mozambique became independent in 1975 and promptly fell into a disastrous civil war that lasted until the early 1990s. Since then, Mozambique has struggled to emerge from poverty and take advantage of its resources. The population today is around 22 million; the per capita gross income is US$440; life expectancy at birth is 48.

Epidemiology of HIV in Mozambique: Prevalence

UNAIDS/WHO's most recent estimates show the prevalence of HIV in Mozambican adults at 12.5%. (As contrast, prevalence in the U.S. is <1%.) One hundred thousand children are infected. Mortality continues to rise, with an estimated 81,000 people dying in 2007.

Prevalence varies geographically. Larger urban centers (such as Maputo and Beira) show HIV prevalence in pregnant women (chosen for "sentinel surveillance") at an alarming 25-39%, while prevalence rates in rural areas can be as low as 1-5%.

One of the most dramatic stories in Mozambique is the number of "AIDS orphans"—children who have lost both parents to AIDS. UNAIDS/WHO estimates that as of 2007 there are over 400,000 children who have lost their parents in Mozambique.

Epidemiology of HIV in Mozambique: Access to Care

Access to care is a significant issue for Mozambicans. The UN estimates the prevalence of contraception of any method at 16.5%, and of condoms at 1.1%. UNAIDS/WHO estimates that less than 50% have access to facilities that provide HIV testing and counseling.

Only 90,000 people receive antiretroviral therapy, though it is estimated that almost 400,000 should be on the medications—that is, less than 25% of those people who need antiretroviral therapy are receiving it. These numbers have improved over time, but it is clear that further "ramping up" is necessary.

Progress is being made in preventing mother-to-child transmission. In 2003, only 3% of the pregnant women received antiretrovirals; by 2007 this number was up to 46%.

Epidemiology of HIV in Mozambique: Health Education

The following data is from 2003, and I can only hope that things have changed over the intervening years. A study demonstrated that less than 30% of young people (defined as 15-24) could correctly name two ways of preventing HIV transmission and reject two misconceptions. Less than 20% of those who had more than one partner over the previous 12 months reported use of a condom during the most recent intercourse.

References

Choi R, Farquhar C. AIDS, Epidemiology and Surveillance. In: Heggenhougen K, Quah S, eds. International Encycolopedia of Public Health. Vol. 1. San Diego: Academic Press, 2008:76-90.

Kaiser Family Foundation. The global HIV/AIDS epidemic: a timeline of key milestones. Retrieved October, 2001, from: http://www.kff.org/hivaids/aidstimeline

UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance. Epidemiological fact sheet on HIV and AIDS, Mozambique, 2008 update. Retrived October 2011 from:

UNICEF. Mozambique statistics. Retrived October, 2011, from: http://www.unicef.org/infobycountry/mozambique_statistics.html#73