The spread and effect of HIV-1 infection in sub-Saharan Africa

Lancet. 2002 Jun 8;359(9322):2011-7. doi: 10.1016/S0140-6736(02)08823-2.


Africa is the continent most severely affected by the global HIV-1 epidemic, with east and southern Africa in general more severely affected than west and central Africa. Differences in the spread of the epidemic can be accounted for by a complex interplay of sexual behaviour and biological factors that affect the probability of HIV-1 transmission per sex act. Sexual behaviour patterns are determined by cultural and socioeconomic contexts. In sub-Saharan Africa, some traditions and socioeconomic developments have contributed to the extensive spread of HIV-1 infection, including the subordinate position of women, impoverishment and decline of social services, rapid urbanisation and modernisation, and wars and conflicts. Populations in many parts of Africa are becoming trapped in a vicious circle as the HIV-1 epidemic leads to high mortality rates in young and economically productive age groups, and thus leads to further impoverishment. Interventions to control HIV-1 should not only target individuals, but also aim to change those aspects of cultural and socioeconomic context that increase the vulnerability to HIV-1 of people and communities.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / epidemiology
  • Condoms / statistics & numerical data
  • Disease Outbreaks*
  • Female
  • HIV Infections* / economics
  • HIV Infections* / epidemiology
  • HIV Infections* / transmission
  • HIV-1*
  • Humans
  • Male
  • Poverty
  • Pregnancy
  • Prevalence
  • Sexual Behavior