AIDS in Africa: An Epidemiologic Paradigm

THOMAS C. QUINN, ^* JONATHAN M. MANN, JAMES W. CURRAN, PETER PIOT

^* To whom requests for reprints should be addressed at Johns Hopkins Hospital, Blalock 1111, 600 North Wolfe Street, Baltimore, MD 21205.

Reprinted with permission from Science, 1986, 234: 955-963. Copyright 1986
American Association for the Advancement of Science.

Cases of the acquired immune deficiency syndrome (AIDS) have been reported in countries throughout the world. Initial surveillance studies in Central Africa suggest an annual incidence of AIDS of 550 to 1000 cases per milion adults. The male to female ratio of cases is 1:1, with age- and sex-specific rates greater in females less than 30 years of age and greater in males over age 40. Clinically, AIDS in Africans is often characterized by a diarrhea-wasting syndrome, opportunistic infections, such as tuberculosis, cryptococcosis, and cryptosporidiosis, or disseminated Kaposi's sarcoma. From 1 to 18% of healthy blood donors and pregnant women and as many as 27 to 88% of female prostitues have antibodies to human immunodeficiency virus (HIV). The present annual incidence of infection is aproximately 0.75% among the general population of Central and East Africa. The disease is transmitted predominately by heterosexual activity, parenteral expossure to blood transfusions and unsterilized needles, and perinatally from infected mothers to their newborns, and will continue to spread rapidly where economic and cultural factors favor these modes of transmission. Prevention and control of HIV infection through educational programs and blood bank screening should be an immediate public health priority for all African countries.

T.C. Quinn is in the Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, and at Johns Hopkins University School of Medicine, Baltimore, MD 21205. J. M. Mann is in the Control Program on AIDS, World Health Organization, 1211 Geneva 27, Switzerland. J. W. Curran is in the AIDS Program, Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333. P. Piot is in the Department of Microbiology, Institute of Tropical Medicine, B-2000 Antwerp, Belgium.