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HIV/AIDS in Southern and East Africa

The Pandemic and Interface With Rehabilitation

Myezwa, Hellen, PhD, MSc, DHT

doi: 10.1097/01.REO.0000000000000155

The literature out of Southern and Eastern Africa contributes to understanding of the HIV/AIDS-related disability. The research has extended to assess interventions and their policy implications in the African setting. This commentary explores the trend of research in HIV-associated disability in the region in the last decade. There is an increasing body of knowledge on the burden of HIV/AIDS-associated disability, and there is a need for the inclusion of disability management in HIV/AIDS care.

Member of the Chartered Society of Physiotherapy, and Associate Professor, Department of Physiotherapy, Faculty of Health Sciences, Wits School of Physiotherapy, University of the Witwatersrand, Johannesburg, South Africa

Correspondence: Hellen Myezwa, PhD, MSc, DHT, Department of Physiotherapy, Faculty of Health Sciences, Wits School of Physiotherapy, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, South Africa (

The author declares no conflicts of interest.

Five percent of the world's population lives in Southern and East Africa. Forty-four percent of the world's new HIV infections and 40.4% of AIDS-related deaths worldwide are in Southern and East Africa.1

Nine countries—Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe—have made significant strides in countering the HIV/AIDS pandemic through prevention and treatment efforts. Although these countries have made great strides in reducing the HIV/AIDS prevalence rates, prevalence is currently more than 10%.1 In the last 15 years, Botswana, Ethiopia, Malawi, Namibia, Rwanda, Zambia, and Zimbabwe have reduced prevalence rates by 50%.1 In Kenya, Mozambique, South Africa, and Swaziland, the decrease in prevalence rates has been by more than 25%. Recent reports show that 27.2% and 25% of the residents in Swaziland and Lesotho, respectively, are living with HIV.1 South Africa is home to 7.1 million people (18.9% of the population) living with HIV.1

Unfortunately, there are still 19.6 million adults and children living with HIV in Eastern and Southern Africa, and the figure continues to increase as antiretroviral therapy (ART) ensures millions of people with HIV can now live a longer healthy life. For many of those successfully treated with ART, HIV/AIDS is now a chronic condition. With chronicity, the effects of aging, and the side effects associated with long-term use of ARTs, the presence of disability among persons living with HIV is increasingly recognized. A significant percentage of people who are working (35.5%-51.9%) on ARTs have reported functional activity limitations.2 , 3

In 2014, the UNAIDS global HIV targets stated that “90% of people living with HIV should know their status; of whom 90% should be on treatment; and 90% should be virally suppressed” (hence the 90:90:90 targets).4 In the context of the 90-90-90 targets, the scorecard currently stands at 76:79:83 (Figure 1) for East and Southern Africa5 and 86:65:81 (Figure 2) for South Africa.6

Fig. 1

Fig. 1

Fig. 2

Fig. 2

Although South Africa has not obtained the 90:90:90 targets, it has made significant strides attributable to political will, civic engagement, activism, and advocacy efforts with regard to HIV/AIDS prevention, treatment, support, and care.7 These efforts have led to policy changes and better implementation strategies. The push for policy changes resulted in effective transparent governance, changes in institutional structures, effective communication, monitoring and evaluation, and research.7 Despite the success, HIV/AIDS management policies and structure still stop short of addressing the sequelae of living with a chronic HIV disease, including ART side effects, multimorbidity, aging, and disability. As such, proponents for the inclusion of rehabilitation to address disability have proposed the 90:90:90 target to include a fourth target of disability so that 100% of patients on HIV/AIDS treatment experiencing disability should obtain rehabilitation services to address the fallout that recent literature and research have described.2 , 8 Therefore, Hanass-Hancock et al9 have proposed the 90:90:90:100 target.

Recognition for the need of rehabilitation among PLHIV has started with the inclusion of rehabilitation needs and services for vulnerable populations in the South African National Strategic Plan.10 Table 1 outlines the literature out of Southern Africa that has the potential to contribute to the future of HIV rehabilitation in the region.



These studies have contributed to understanding disability in people living with HIV, interventions, and policy required in response to HIV/AIDS. The burden of HIV/AIDS-related disability in the region has been established, and interventions to reduce HIV/AIDS-related disability have been tested in small-scale studies.15 , 16 Chetty et al19 have recommended the need to engage stakeholders and integrate rehabilitation in HIV/AIDS care. The call to include disability rehabilitation in response to HIV/AIDS care is increasing. However, a government-supported program to implement rehabilitation strategies for HIV/AIDS-related disability is not yet in place in South Africa. There is definitely an urgent need for the inclusion of HIV/AIDS-related disability management in the continuum of HIV/AIDS care, and immediate strategies now point to the need for wide-scale implementation science and research.20 Regional intervention to facilitate the management of HIV/AIDS-related disability could be impeded by the limited workforce of health care practitioners. The disparate ratio of therapist to population of 1 therapist to 10 000 people is a drawback that requires innovative approaches to service delivery.21

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          15. Roos R, Myezwa H, van Aswegen H, Musenge E. Effects of an education and home-based pedometer walking program on ischemic heart disease risk factors in people infected with HIV: a randomized trial. J Acquir Immune Defic Syndr. 2014;67(3):268–276.
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              19. Chetty V, Hanass-Hancock J, Myezwa H. Expert consensus on the rehabilitation framework guiding a model of care for people living with HIV in a South African setting. J Assoc Nurses AIDS Care. 2016;27(1):77–88.
              20. Hovmand PS, Gillespie DF. Implementation of evidence-based practice and organizational performance. J Behav Health Serv Res. 2010;37(1):79–94.
              21. Health Systems Trust. South African Health Review. Durban, South Africa: Health Systems Trust; 2017.

              HIV/AIDS rehabilitation; Southern Africa; East Africa

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