Mozambique is a country particularly hard-hit by the HIV/AIDS epidemic. According to 2008 UNAIDS estimates, this southeast African nation has the 8th highest HIV rate in the world. With 1,600,000 Mozambicans (11.5 percent of the population) living with HIV, 990,000 of which are women and children, Mozambique's government realizes that much work must be done to eradicate this infectious disease. To reduce HIV/AIDS within the country, Mozambique has partnered with numerous global organizations to provide its citizens with augmented access to antiretroviral therapy and prevention techniques, such as condom use. A surge toward the treatment and prevention of HIV/AIDS in women and children has additionally aided in Mozambique's aim to fulfill its Millennium Development Goals (MDGs). Nevertheless, HIV/AIDS has made a drastic impact on Mozambique; individual risk behaviors are still greatly influenced by social norms, and much still needs to be done to address the epidemic and provide care and treatment to those in need.
History Beginning in 1964, the Mozambican people initiated a 10-year war of independence from Portugal. Immediately following this fight, in 1977, a 15-year civil war broke out, an event that concluded in 1992, around the same time that HIV first swept through the southern regions of Africa. As a consequence of the war, Mozambique's healthcare system was in shambles, so very little could be done to aid individuals who contracted the virus during this time, especially due to the increasingly evident effects of the end of Mozambique's national isolation and international premiere as a weak post-conflict state. However, with time, HIV began to spread in Mozambique to such high levels that the government was forced to act to save as much of its poor and dying population as possible. With this fervor, the quest to reduce the AIDS epidemic within Mozambique persists, with the country's government partnering with various outside organizations to provide treatment and care for those critically in need.
Mozambique's first case of HIV was reported in 1986 in the Cabo Delgado province. By the year 2001, HIV had infected more than one million people, 53,000 of which were children under 18 years of age and 570,000 of which were women. The first governmental response to the HIV/AIDS epidemic occurred in 1988 with the establishment of four sentinel surveys in Maputo, Beira, Chimoio, and Tete to keep track of HIV rates within the country. In 2004, antiretroviral therapy (ART) medications became publicly available throughout the nation, after having been limited to pilot programs for some years, with the help of international funding. Before the nationwide introduction of ART, only cotrimoxazole prophylaxis and drugs to diminish the effects of opportunistic infections were administered to people living with HIV/AIDS (PLWHA). In 2006, opt-out HIV diagnostic tests were offered to pregnant women for the first time. Several campaigns and organizations have launched since 1986 to combat the HIV epidemic in various ways, and by reaching various sectors of Mozambican society. Yet, since the end of the civil war in 1992, rural areas of Mozambique continue to face repercussions of the HIV/AIDS epidemic, prominently due to the inability of the nation to quickly rehabilitate as a result of inadequate funds allocated towards addressing both educational and healthcare system infrastructural repairs.
Awareness and Risk Perception Although HIV/AIDS spans across all demographic categories, and personal risk perception is generally underestimated amongst all Mozambican individuals, women and children are the groups most at-risk for infection. What's more, women and children are more likely than men to experience a general lack of awareness of the cause, transmission, and ways of prevention of HIV/AIDS.
As Audet et al. points out, high-risk activities amongst both men and women living in Mozambique may stem from the traditional and cultural customs of some subgroups of the Mozambican population, such as intravaginal practices; intergenerational and transactional sex; "widow cleansing," where a close relative of the deceased family member's wife has sex with his widow; and early sexual initiation. HIV could additionally spread through the use of unclean needles and syringes for injections and treatment within Mozambican healthcare settings. Additionally, the lack of a highly effective and efficient national blood bank could further propagate the spread of viral infection through tainted blood transfusions. Untreated coinfections, such as malaria, tuberculosis, and sexually transmitted infections (STIs) can also propagate the spread of HIV within a population through the weakening of the host's immune system. Further, the widely held belief that illnesses and disease are results of witchcraft and, as such, should be treated by traditional healers instead of local healthcare facilities may lead to the inadequate receipt of services to diminish the risk of HIV infection. General development in social acceptance of risk reduction strategies is still under way within the nation.
Education Country-wide education on ways to treat and prevent HIV/AIDS has greatly increased in recent years. The National Strategic HIV and AIDS Response Plan 2010-2014 outlined techniques for prevention—condom use and male circumcision, for example—as well as treatments like antiretroviral therapy and treatment of co-infections. These demonstrated some ways by which the Mozambican government could educate its citizens on the dire need to address the country's AIDS epidemic. Further, several studies have shown that simply educating women on the effects of HIV not only led to decreased risky behaviors in the female population, but also fostered augmented social and economic independence. Female citizens' comprehensive knowledge on HIV/AIDS varies by region, with 39.7 percent of urban women aware of HIV and its effects, as compared to 24.4 percent of rural women.
HIV rates HIV rates vary drastically by region, with southern Mozambique (City of Maputo, Maputo Province, Gaza, and Ingambane) containing the highest rate of infection (21 percent), central Mozambique (Manica, Sofala, Tete, and Zambézia) containing the second highest (18 percent), and northern Mozambique (Nampula, Niassa, and Cabo Delgado) containing the lowest (9 percent). The highest rates within the country occur within Sofala, a central province with a rate of 26.5 percent. Rate disparities are attributed to numerous factors such as: population displacement after the Mozambican civil war, ease of access to various regional provinces, similarities in health facilities, presence of groups with high risk of HIV infection in certain provinces, and similarities in social, cultural, economic, and educational levels that might impact the degree to which individuals are informed about the methods for transmission and prevention of HIV. Further, urban and district hospitals tend to have much greater ease of access to the HIV medications nevirapine and zidofudine as opposed to more rural areas of the nations. Moreover, the HIV/AIDS epidemic in Mozambique is predominantly spread heterosexually (in nearly 90 percent of adult cases) and through vertical transmission. Mozambique has the 8th highest HIV rate in the world, an 11.5 percent rate of HIV infection within adults aged 15 to 49, an estimated total of 34,000 AIDS-related deaths in individuals 15 years or older, and approximately 802,659 adults living with HIV on ART.
Affected Groups As of 2015, 11.5 percent of the entire Mozambican population (1,600,000 individuals) was infected with HIV, with women and children accounting for 990,000 of these infections. Nevertheless, infection rates of and treatment provided to each affected demographic group differ, with heterosexual transmission through sex and vertical transmission being the main causes for continued HIV infection. As of 2014, an estimated 62.5 percent of HIV-positive adults were receiving treatment.
Men About 450,000 Mozambican males are infected with HIV, and data supports that men are much more likely than women to know of HIV's transmission pathways and take measures to avoid infection. Further, men who migrate to other regions of Mozambique or other neighboring countries for of work obligations are at a higher risk of transmitting HIV—by bringing HIV back from outer-country sexual networks or spreading it to those countries. Much of the data on men who have sex with men (MSM) living in Mozambique is unknown due to the view of homosexuality as taboo and generally unacceptable within Mozambican society, yet what is known is that MSM contribute to 5 percent of the incidence of HIV/AIDS within the nation.
Women About 810,000 women within the country have contracted HIV. In fact, in 2007, approximately 58 percent of all adults living with HIV within Mozambique were women, and females accounted for more than three-fourths of the infected 15-year-old to 19-year-old population. This higher rate in women, as Audet et al. points out, may be somewhat accounted for by an increased biological susceptibility for contraction of the disease, as well as other socioeconomic and sociocultural factors. Women, for example, are less likely than men to understand transmission methods and, consequently, are more susceptible to infection. Further, women may engage in sexual acts to augment their sexual status and—with the help of an older man, ensure a more secure financial future, and afford higher education and daily goods. Such is a response of living in a society where women only receive 18 percent of the pay that men do. Several studies have shown that educating women not only reduces risky behavior, but also help increase social and economic independence. With increased schooling and access to information, women would be more capable of informing themselves with information provided in HIV prevention campaigns, leading to an overall reduction in their risky behaviors. Currently, an estimated 95 percent of HIV-positive pregnant women receive ART for PMTCT.
Children Mozambique ranks third in the world in new pediatric HIV infections, after both Nigeria and South Africa, according to UNAIDS. Consequently, the nation has taken great measures to begin addressing and reducing HIV within its pediatric population. With approximately 590,000 orphans due to AIDS, 180,000 of which are infected with the virus themselves, the government has begun administering antiretroviral drugs to promote early intervention in younger populations. One underlying reason behind adolescents' - and especially adolescent girls'- early introduction to and infection with HIV is the need to obtain money to stay in school and to purchase goods and food in exchange for sex work. A disparity exists regarding the comprehensive knowledge of HIV even as adolescents, with 27.4 percent of adolescent females well-informed of HIV and its effects as opposed to 48.5 percent of adolescent males. As of 2014, 36 percent of HIV-positive children were receiving treatment, yet education regarding the effects of HIV infection are commonly communicated to children through fairytales or drama sessions based on African animals or local folktales.
HIV/AIDS' Impact in Mozambique