HIV/AIDS pandemic (AP) in Africa: Chronicle of a missed opportunity

Abstract

e22235 Background: AP unlike HTLV-I associated diseases arrived late in parts of Africa, including Nigeria, where retroviral research was already ongoing in collaboration with the US National Cancer Institute (USNCI), thus providing unique preventive interventional opportunity. A World Health Organization sponsored study of the role of sexual behavior in retroviral transmission in Nigeria was performed 1985–86. Methods: Using an ELISA and an investigational Western blot (IWB) assay, a small survey of the seroprevalence rate (SPR%) of HTLV-I and HIV was conducted in 3 regions of the country among 5 population groups with differing sexual behaviors: normal blood donors (NBD), female commercial sex workers (FCSW), sexually transmitted diseases patients, and religious male/female celibates. 204 samples were re-tested with recombinant enhanced “Singapore” HIV-1/2 WB (SWB) in 1994, in view of earlier HIV-1 IWB negativity. All serological tests were done at USNCI. Results: HTLV-I SPR varied by region and lifestyle, highest in eastern region (ER) (p=0.0000095), FCSW of ER (p=0.0006), and frequency of male heterosexual activity (p=0.024). HIV-1 was undetectable by IWB, while SWB revealed 2/204 HIV-1+ for countrywide SPR: ∼1.0; Western NBD: 1/100 (1.0); Western/Northern NBD: 1/184 (0.54): non-high risk Nigerians: 2/237 (0.84); FCSW: 0/46; celibates: 0/71, adult general Nigerian population (AGNP): ∼0.5–1.0, and translating to (∼240–480)x103 HIV-1+ AGNP. Assuming 20 HIV-1+ = 1 case of AIDS death, SWB- determined SPR predicted (∼12–24)×103 AIDS deaths among 48×106 AGNP in 1985–86, ∼5 of (2.4- 4.8)×103 (<0.2%) of whom presented with clinical AIDS features (CAF) at Nigeria's premier health institution (NPHI). Conclusions: In 1985–86, when patients with CAF rarely presented at NPHI and HIV-1 SPR was ≤1.0 in AGNP and FCSW, Nigerian health authority was advised on AP risk, unlike Uganda where it arrived unanticipated. Reports of SPR of 7.7 and 60.0 in AGNP and FCSW in 1996–2000 contrast against contemporary Ugandan SPR (14.0 down to 6.1) and Senegalese (0.4 up to 0.9), probably resulting from varying knowledge gap and angst-related inertia, illustrating mixed fortunes of AP in Africa, transcontinental variation in AP control capability, and providing lessons for the management of future public health challenges. No significant financial relationships to disclose.