[HIV infections in the African space: setting forth a geographic question]

Epidemiological dynamics and spatial distribution of the HIV-1 epidemic in Africa reflect a very clever pathogen which rages in large and small cities and in economically active rural areas. It especially attacks the most exposed groups (e.g. prostitutes). It enters communities in a generally irregular fashion slow or brutal. The HIV-1 epidemic is mesoendemic in some parts of Zaire (e.g. Kinshasa and Shaba-major poles of economic development). Elsewhere the HIV-1 epidemic is at a low hypoendemic level and it attacks cities and rural areas equally. The first situation may be an exacerbated form of the second situation. It may be also the result of the beginning of an epidemiologic process already stabilized before the mid-1980s. HIV was in Kinshasa since the 1950s. The HIV infection rate in the Yambuku region of Zaire has stayed at the same level since the mid-1970s. Yet HIVs presence in other areas of Africa suggest a process before its spread. Two distinct forms of HIV-1 in Central Africa equally argue in favor of a prolonged presence of HIV-1. It is possible that the HIV-1 endemic has been present at low levels for a long time in the Atlantic watershed of Africa. Many persons believe that explosive urbanization and intense mobility gave rise to the epidemic. Social economic and cultural evolutions which affect communities and contribute to new behaviors especially sexual behaviors would have sparked the HIV-1 epidemic. Sexuality (especially sexually transmitted diseases) is at the center of the HIV-1 transmission system. HIV-2 is limited to the Atlantic coast of Africa (and Mozambique) the principal site of different types of SIV (simian immunodeficiency virus) which is close to HIV-2 while HIV-1 is most prevalent in central and western Africa. In conclusion many uncertainties on the endemic forms of the two viral human infections their history their geography and their relationships remain.