The more transmissible HIV-1 variant was first identified in Kinshasa from a 1959 sample, developing from a simian virus In a large urban environment. This variant never spread in West Africa.
AIDS cases were first diagnosed in Uganda, Tanzania and South Africa in 1983, the year after the gay epidemic in the USA began (though it had probably been around Africa much longer). AIDS appeared in the rest of East Africa over the next two years.
By 1998, AIDS was the leading cause of death in sub-Saharan Africa, with 1.8 million deaths annually – double the deaths from malaria.
In Kenya, the incidence in the general population peaked in 1996, the year Jack left Kenya. Jack’s friends Stella, Sabrina and Gladys died in 1995-97 after short illnesses.
By 1995, the death toll in Kenya had reached about 200,000 people. In 1998, the prevalence rate among people aged 15-49 was 9.8%. Near Lake Victoria and Uganda, the prevalence was double this.
Unlike Uganda, which began a successful program of information and testing in 1987, Kenya did not recognise the scale of the problem for many years. At first, both Muslim and Christian leaders found prevention campaigns such as condom promotion difficult to reconcile with their teachings, while the government remained in denial.
Finally in 1999, the Kenyan President Daniel Arap Moi declared AIDS a national disaster, saying “AIDS is not just a serious threat to our social and economic development, it is a real threat to our very existence, and every effort must be made to bring the problem under control.”
Once the authorities stepped in, infection rates and deaths fell rapidly. By this time, antiretroviral therapy was available in advanced countries. However, the high cost of antiviral treatments made their implementation in Africa nearly impossible at first. In 2001 there were more than 20 million people (based on current estimates) living with AIDS in sub-Saharan Africa, but only 8,000 people were accessing drug treatment. Eventually, drug companies were prevailed upon to allow affordable generic brands, and most of those infected were able to stabilise the disease.
By 2008, the incidence of HIV in Kenya among 15-49 year olds was still 44%, but fell to 12% over the next ten years.
Occupations
Intravenous drug users have always shown the highest incidence of HIV infection. Sex workers were said to play a large part in accelerated transmission rate. Truck drivers – alongside other migrants such as soldiers, traders and miners –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 percent of tested Ugandan truck drivers were HIV positive, as were 30 percent of military personnel
Sex workers were at great risk of contracting the disease. In Nairobi (and in Uganda) one study showed 85 percent of sex workers were infected with HIV in 1986. A later study showed most already had the disease by the time they identified as sex workers. Sex workers barely received treatments once they became available, because of discrimination, lack of education, and their own fears that they would lose their livelihoods if identified. Desperate Stella tried to follow Jack home, probably knowing she was infected.
The death toll in SSA is now about 400,000 annually, and over 25 million are still living with the disease. Deaths in Kenya are about 21,000 annually, from 1.4 million infected. The figures are similar in Uganda, where almost all are receiving antiviral therapy.
Although three of Jack’s friends from Buffalo Bill’s died, Njoki and Maggie who were much more careful never contracted HIV. Jack never contracted any STD.
Chance of contracting AIDS in heterosexual sex
There is between a 1 to 4 chance in 1000 of a man being infected in a single sex act by a woman with a high HIV load. This takes place through the urethra or foreskin, or through genital lesions caused by other STDs. The chance increases greatly if blood is present. The chance for women is about 8 in 1000.
Since the beginning of the epidemic, more than 44 million people have died worldwide from AIDS.