AIDS in Africa has had a short but devastating history.

“It all started as a rumour…  Then we found we were dealing with a disease.  Then we realised that it was an epidemic.  And, now we have accepted it as a tragedy.” - Chief epidemiologist in Kampala, Uganda¹

Adult HIV prevalence (%) in Africa between 1988 and 2003

• 20%-30%
• 10%-20%
• 5%-10%
• 1%-5%
• 0%-1%
• data unavailable

Before the 1960s – African origins of AIDS

There is now conclusive evidence that HIV originated in Africa. A 10-year study completed in 2005 found a strain of Simian Immunodeficiency Virus (SIV) in a number of chimpanzee colonies in south-east Cameroon that was a viral ancestor of the HIV-1 that causes AIDS in humans².
A complex computer model of the evolution of HIV-1 has suggested that the first transfer of SIV to humans occurred around 1930³, with HIV-2 transferring from monkeys found in Guinea-Bissau, at some point in the 1940s⁴.
Studies of primates in other continents did not find any trace of SIV, leading to the conclusion that HIV originated in Africa.

The 1960s- Early cases of AIDS

Experts studying the spread of the epidemic suggest that about 2,000 people in Africa may have been infected with HIV by the 1960s.⁵ Stored blood samples from an American malaria research project carried out in the Congo in 1959 prove one such example of early HIV infection^6 7.

The 1970s – The first AIDS epidemic

It was in Kinshasa in the 1970s that the first epidemic of HIV/AIDS is believed to have occurred. The emerging epidemic in the Congolese capital was signalled by a surge in opportunistic infections, such as cryptococcal meningitis, Kaposi’s sarcoma, tuberculosis and specific forms of pneumonia.
It is speculated that HIV was brought to the city by an infected individual who travelled from Cameroon by river down into the Congo. On arrival in Kinshasa, the virus entered a wide urban sexual network and spread quickly.
The world’s first heterosexually-spread HIV epidemic had begun.

The 1980s – Spread and reaction

Although HIV was probably carried into Eastern Africa (Uganda, Rwanda, Burundi, Tanzania and Kenya) in the 1970s from its western equatorial origin, it did not reach epidemic levels in the region until the early 1980s⁸.
Once HIV was established rapid transmission rates in the eastern region made the epidemic far more devastating than in West Africa, particularly in areas bordering Lake Victoria.  The accelerated spread in the region was due to a combination of widespread labour migration, high ratio of men in the urban populations, low status of women, lack of circumcision, and prevalence of sexually transmitted diseases⁹.  It is thought that sex workers played a large part in the accelerated transmission rate in East Africa; in Nairobi for example, 85 per cent of sex workers were infected with HIV by 1986¹⁰.
Uganda was hit very hard by the AIDS epidemic in the 1980s.  At the beginning of the decade, doctors were confronted by a surge in cases of a severe wasting disease known locally as ‘slim disease’, alongside a large number of fatal opportunistic infections such as Kaposi's sarcoma. By this time doctors were aware of AIDS cases with similar symptoms in the United States:

‘But we just could not connect a disease in white, homosexual males in San Francisco to the thing that we were staring at…’, David Serwadda, former medical resident at the Uganda Cancer Institute in Kampala¹¹.

After the initial clinical recognition of the link between ‘slim disease’ and AIDS, research was initiated to discover transmission patterns, risk factors, and the prevalence of HIV in Uganda¹². By the end of the decade HIV prevalence rates amongst pregnant women in Uganda’s capital had peaked at over 30 per cent¹³.
The early 1980s also saw HIV spread further into Western Equatorial Africa and Western African nations. In the Western Equatorial countries of Gabon, Congo- Brazzaville and Cameroon the virus did not cause large epidemics¹⁴. The long distances between cities, the difficulty of travel, and violence and insecurity meant that there were not the sexual networks that would allow the spread of HIV to epidemic proportions.
West Africa had generally high levels of infection of both HIV-1 and HIV-2, although nowhere near the proportions of East Africa. The HIV-1 epidemic spread across the region beginning with reported cases in Côte d'Ivoire (probably due to rapid urbanisation and immigration)¹⁵. By the end of the decade HIV infection had been identified in all of the West African states. Sex work was also a major driver of early infection in West Africa; in Abidjan the former capital of Côte d'Ivoire, the HIV prevalence amongst sex workers was already 38% by 1986¹⁶.
In the mid-1980s the Western African nation of Guinea-Bissau had the world’s highest level of HIV-2, with 26% of paid blood donors, 8.6% of pregnant women and 36.7% of sex workers testing positive¹⁷. The virus spread into rural areas of southern Senegal and The Gambia but HIV-2 was not infectious enough to generate an epidemic beyond this region.
Truck drivers – alongside other migrants such as soldiers, traders and miners - have been identified as a group which facilitated the initial rapid spread of HIV-1, as they engaged with sex workers and spread HIV outwards on the transport and trade routes. In the 1980s, 35 per cent of tested Ugandan truck drivers were HIV positive¹⁸, as were 30 per cent of military personnel from General Amin’s Ugandan army¹⁹.
In 1988 the second highest prevalence rate of HIV in all of Africa was found on the Tanzam road linking Tanzania and Zambia²⁰.
As the decade progressed so too did the epidemic, moving south through Malawi, Zambia, Mozambique, Zimbabwe and Botswana.
Although the virus arrived comparatively late in this region it spurred a devastating epidemic in the general population. By the end of the 1980s the southern African countries of Malawi, Zambia, Zimbabwe and Botswana were on the verge of overtaking East Africa as the focus of the global HIV epidemic.
It is thought that the first case of HIV in South Africa was in a white, homosexual air steward from the USA who died of pneumonia (PCP) in 1982. Blood specimens showed a 16 per cent infection rate among tested gay men in Johannesburg in 1983. The small-scale epidemic was largely confined to white gay men and remained virtually unheard of in the general population in the mid 1980s. The homosexual epidemic had stopped growing by the end of the decade²¹.

References

1. New Vision, 4 September 1993. In Iliffe, J (2006) ‘The African AIDS epidemic: A History’ James Currey. Oxford.  Pg. 25
2. Keele B.F. et all (2006) ‘Chimpanzee Reservoirs of Pandemic and Nonpandemic HIV-1’, Science 313 (28 July): 523 - 526
3. Korber, B. et all (2000) "Timing the Ancestor of the HIV-1 Pandemic Strains" Science 288 (9 June): 1789-96.
4. Vandamme, A-M et al. (2003) "Tracing the origin and history of the HIV-2 epidemic" PNAS, Vol. 100, No. 11, 27 May
5. Guardian (2006) ‘Hunt for origin of HIV pandemic ends at chimpanzee colony in Cameroon’, May 26
6. Motulsky, A et all (1966) ‘Population genetic studies in the Congo. I. Glucose-6-phosphate dehydrogenase deficiency, hemoglobin S, and malaria’ American Journal of Human Genetics 18, 514-16
7. Nahmias, A. Motulsky et all (1986) ‘Evidence for human infection with an HTLV III/LAV-like virus in Central Africa, 1959’ Lancet May 31;1 (8492): 1279-80.
8. Serwadda, D (1985) ‘Slim disease: a new disease in Uganda and its association with HTLV-III infection.’ The Lancet, October 19;2 849-52 Okware, S (1987) ‘Towards a national AIDS-control program in Uganda.’ West J Med December;147(6):726-9
9. Iliffe, J (2006) ‘The African AIDS epidemic: A History’ James Currey Oxford: 19
10. Piot, P et all (1987) ‘Retrospective seroepidemiology of AIDS virus infection in Nairobi populations.’ Journal of Infectious Diseases 155: 1108-12
11. Simpson, BW (2008) ‘World-Class Research on the "Slim Disease’ John Hopkins Public Health
12. Serwadda, et al. (1985) 'Slim Disease: A New Disease in Uganda and its Association with HTLV-III Infecction.' Lancet 2(8460):849-852
13. Stoneburner RL, Low-Beer D (2004) ‘Population-level HIV declines and behavioral risk avoidance in Uganda.’ April 30;304(5671):714-8
14. Delaporte, E et all (1996) ‘Epidemiological and molecular characteristics of HIV infection in Gabon, 1986-1994.’ AIDS Jul;10(8):903-10
15. World Bank (1990) ‘World development report 1990’ NewYork p. 180
16. Garenne et al. (1996) ‘Mortality impact of AIDS in Abidjan, 1986-1992,’ AIDS 10 (1996), 1283
17. Naucler A et all (1989) ‘HIV-2-associated AIDS and HIV-2 seroprevalence in Bissau, Guinea-Bissau.’ J Acquir Immune Defic Syndr. 2(1):88-93.
18. Carswell et al. (1989) ‘Prevalence of HIV-1 in East Africa lorry drivers’ AIDS 3, 759
19. New Scientist (1987) ‘ Evidence for Origin is Weak’ 118 (15):27
20. Hiza, PR (1988) ‘International co-operation in the national AIDS control programme.’, In ‘The global impact of AIDS. Proceedings of the First International Conference on the Global Impact of AIDS’Alan Fleming, AF et all (eds). New York :233-9.
21. Sher R (1989) ‘HIV infection in South Africa, 1982-1988--a review.’ S Afr Med J. Oct 7;76(7):314-8.