An important challenge in managing the spread of AIDS is the lack of

information about the HIV status. Most people in Sub-Saharan African

countries do not undergo testing for HIV regularly. This is usually due to a lack
of financial resources as average income in such countries is low and most
people cannot afford such tests. In Kenya, only 22% of men and 30% of
women aged 15-49 had a HIV test in the past 12 months from 2008-2009.
Most respondents who had not gone for a test attributed it to the cost of the
test. However, as the symptoms of AIDs will only surface for decades, most
people will not be aware of their HIV status without going for testing. This is
an important challenge towards stopping the spread of AIDs. Although
governments may roll out antiretroviral medicine in hospitals and healthcare
facilities, people will only seek treatment if they are firstly aware that they are
HIV positive. When HIV-infected individuals do not take up ARVs, the virus
cannot be kept under control and their chances of passing on the disease to
others will be 30% higher. Ignorance about their status is thus an obstacle
towards stopping the spread of HIV/ AIDs. Additionally, when these individuals
do not realize the need to protect others from the disease, they are unlikely to
take appropriate precautions during sexual encounters such as wearing
contraceptives. A 2011 survey showed that only 23% of sexually active
individuals in Kenya use condoms regularly. Individuals who do not know that
they are carriers of the disease are therefore unlikely to take up responsible
sexual behaviour and use contraceptives to prevent the spread of the
disease, which accounts for the high number of new infections reaching up to
100,000 every year. Thus ignorance about ones status is an important
challenge towards managing the spread of AIDs.
Another challenge to the prevention of AIDs is a cultural acceptability of
having multiple sex partners. In certain Sub-Saharan African countries, having
multiple sex partners is openly accepted and is considered a social norm. In
Zambia, 15% of all males have multiple sex workers, and 10% of all males
have previously engaged sex workers. This makes it hard to contain the
spread of AIDs as it allows for the rapid transmission of the disease through
sexual networks. When an individual becomes infected with AIDs from one of
her sexual partners, he will transmit the disease to all his other sexual

partners during their sexual encounters. An example is in the sex industry,

where 25% of Zambian sex workers have AIDs but continue to work, infecting
many male clients in a single night. This has facilitated the rapid spread of the
disease in Zambia, which has a 12.7% prevalence rate. Yet at the same time,
it is also difficult to get people to give up the practice as such mindsets are
deeply entrenched and have become part of the lifestyle of the people, and
cannot possibly be changed overnight. This therefore is an obstacle towards
stopping the spread of AIDs.
Another challenge in the managing the spread of AIDs is the high cost
of antiretroviral therapy. While antiretroviral therapy has become more
affordable, it remains relatively expensive for most of the poor. In Nigeria,
46.0% of the people live below the poverty line of US$1.25 a day. In
comparison, antiretroviral therapy can cost up to US$40 a month. This makes
it difficult for most Nigerians to be able to afford antiretroviral therapy without
any subsidies or financial help from the government. Only one third of
Nigerians are able to access medical treatment to improve their quality of life,
and to reduce the risk of AIDs transmission. As a result, Nigeria has the
second highest number of new infections every year. It is also not financially
sustainable for governments to provide free antiretroviral therapy to the
majority of the population due to the huge burden on public finances. The
antiretroviral regime must also be continued throughout the entire life of the
individual in order to successfully reduce the viral load and control the
disease. An example is Botswana. While Botswana currently provides free
treatment for AIDs for 84% of the population with a lot of support from
international donors, the cost of providing free treatment is expected to rise to
three times of its GDP by 2030 as HIV-infected individuals are able to live
longer and their numbers gradually increase. The government has decided to
gradually scale back on the antiretroviral programme, which could reduce the
number of HIV-positive individuals receiving treatment, and thus lead to a
renewed increase in infections. Thus it can be seen that the cost of
antiretroviral therapy is a challenge to managing the spread of AIDs, making it
hard to provide universal access to treatment.

Another challenge in managing the spread of AIDs is social stigma.

Even though antiretroviral therapy is available to treat the disease, the social
stigma associated with it causes many people to stay away from being tested
and receiving treatment. Some health professionals may also discriminate
against patients infected with HIV. They may believe that treating these
patients is a waste of valuable resources or they may get infected by treating
these patients. In the 2011 Zambian Behavioural Study, 27% of HIV positive
Zambians reported getting rejected for treatment at medical facilities. As a
result of the persistent discrimination, many people may choose not to seek
treatment or consume their antiretroviral medicine. When left untreated, the
risk of transmitting HIV is high and people infected with the disease may
spread the disease to others. This makes it hard to contain the spread of the
disease. Additionally, many people with HIV also infect their partners because
social stigma causes them to remain silent about their condition. For example,
in the 2011 Zambian Behavioural Study, 35% of HIV-positive Zambains
admitted to not revealing their status to others. Therefore, social stigma is an
important challenge in managing the spread of AIDs, as it causes HIV-positive
individuals to be less willing to reveal their identity, making it harder for them
to receive medical attention and causing them to continue spreading the
disease to others who are unaware of their status.