Geography Reference
In-Depth Information
taboos about the discussion of sexual matters between genders and
generations (UNAIDS et al., 2004). Women's greater biological suscep-
tibility to HIV transmission than men through heterosexual inter-
course and widespread gender-related violence further increase their
vulnerability. More women than men are living with HIV in sub-Saharan
Africa (60 per cent of adults living with HIV are women), a trend which
has not been seen in other world regions, except the Caribbean (where
just over 50 per cent of adults with HIV are women) (UNAIDS, 2010).
However, significant declines in new infection rates among young peo-
ple, particularly young women, have been documented in several
sub-Saharan African countries in recent years (UNAIDS, 2010).
Dominant donor discourses that emphasized prevention activities
throughout the 1990s argued that health systems in sub-Saharan
Africa were too 'undeveloped' to be able to provide effective antiretrovi-
ral treatment (Jones, 2004). The rapid scaling up of antiretroviral
therapy in many sub-Saharan African countries in recent years, in
accordance with the MDGs and universal access targets, has revealed
the fallacy of these assumptions. Rights-based HIV activism, such as
the Treatment Action Campaign led by people living with HIV in South
Africa, helped to secure cheaper access to generic drugs through the
legal system and contributed to increased access to antiretroviral
therapy in many African countries from the mid-2000s onwards
(Leclerc-Madlala, 2005). By 2009, 37 per cent of those requiring treat-
ment in sub-Saharan Africa received antiretroviral therapy (ART),
which corresponds to the global figure of 36 per cent ART coverage
(World Health Organization (WHO), 2010), although large disparities
in access to treatment persist, especially in remote rural locations.
Increased access to antiretroviral therapy has had a dramatic effect
on mortality rates; in sub-Saharan Africa, 20 per cent fewer people died
of AIDS-related causes in 2009 than in 2004 (UNAIDS, 2010).
Furthermore, HIV prevalence rates have stabilized or declined in many
sub-Saharan African countries in recent years. The need to integrate
prevention, treatment, and care and support activities into a holistic
continuum in order to tackle the epidemic and meet the MDG targets
has been increasingly recognized in global health policy and develop-
ment discourses (World Health Organization (WHO), 2002). Furthermore,
the care and support of people living with HIV is finally receiving
greater attention in policy arenas (UK Consortium on AIDS and
International Development, 2008).
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