AIDS in subsaharan Africa.

AIDS has existed in subsaharan Africa at least since 1980. However, the genesis of this condition and its emergence as a health problem remain obscured by lack of data and by antibody data that are now questionable. In Africa, as elsewhere, AIDS is associated with an immunodeficiency associated with the LAV/HTLV-III retrovirus. The clinical manifestations vary somewhat because of the different range of opportunistic pathogens in that environment. Although the "classical," more indolent, endemic form of African Kaposi sarcoma is not associated with this virus or with immunodeficiency, a new, aggressive variety of Kaposi sarcoma in Africa appears to be. The origin of LAV/HTLV-III remains unclear, but the clinical syndrome of AIDS has emerged in Africa only in the past decade. A pattern of geographic spread can be recognized, in which AIDS was seen earliest in Kinshasa, Zaïre, and then emerged in Zambia, Rwanda, and Uganda. Recently, reports indicate spread into Tanzania and Kenya. Transmission appears to be primarily heterosexual, but the factors enhancing heterosexual spread in Africa to a greater extent than in the U.S. and Europe need to be further studied.