AIDS in Africa
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economic consequences of the disease, it is important to study the relationship between poverty, the global response, and the effectiveness of AIDS prevention, both government and grass roots.The AIDS epidemic has reached disastrous proportions on the continent of Africa. Over the past two decades, two thirds of the more than 16 million people in the world infected with Human Immunodeficiency Virus (HIV), which causes AIDS, live in sub-Saharan Africa. It is now home to the largest number of people infected, with 70 percent of the world’s HIV infected population. The problem of this ongoing human tragedy is that Africa is also the least equipped region in the world to cope with all the challenges posed by the HIV virus. In order understand the social and
Half of the world’s cases are found in what is referred to as the AIDS belt, a chain of countries in eastern and southern Africa that is home to two percent of the global population. The main vehicle for spreading HIV throughout Africa is heterosexual intercourse. In contrast, this is the opposite compared to the U.S. where the virus is usually transmitted through homosexual intercourse or contaminated syringes shared by drug users. Besides heterosexual intercourse, HIV transmission through transfusion and contaminated medical equipment is common in sub-Saharan Africa. Africans infected with HIV die much sooner after diagnosis than HIV infected people in other parts of the world. In industrialized countries, the survival time after diagnosis of AIDS ranges from 9 to 26 months, but in Africa the survival time for patients is 5 to 9 months (UNAIDS 3). Factors, such as lower access to health care, poorer quality of health care services, poorer levels of average health and nutrition, and greater exposure to pathogens that cause infection all contribute to the shorter survival in Africa. It is difficult to stop the flood of AIDS cases in Africa because it is not yet known by researchers the factors that contribute to outstanding prevalence of the disease among heterosexuals. This diagnosis will help determine how likely it is that heterosexual epidemics will spread to Asia or the West.
Even though AIDS is heavily researched, its origin still remains a partial mystery. It is know that HIV is a zoonosis, a human disease acquired from animals. The virus evolved from a Simian Immunodeficiency Virus (SIV): a type of slow virus found naturally in monkeys and apes which, while not harming the host, produces diseases in other primates (Caldwell 97).
How the virus crossed species is still unclear, though. Researchers are unable to identify a specific origin, and if they were able to, they would automatically be accusing someone or something, which would be difficult to accept knowing that it was responsible for inflicting Acquired Immune Deficiency Syndrome (AIDS) on the world. Consequentially, the biological and geographical origins of the HIV virus remain vague. However, the virus still represents one the deadliest threats to human life in the developing world, where 90 percent of all infected person reside (Caldwell 98).
HIV is most well established in sub-Saharan Africa, where 23.5 million people infected with virus live (UNAIDS 4). Since this is the most unprepared place for the epidemic it makes it extremely difficult for people to receive care. It is becoming clearer that HIV threatens to wipe out fragile development gains achieved over many decades. The United Nations Development Program calculates that 50 percent of Africans will live to 60, compared with an average of 70 percent for all developing countries and 90 percent for industrialized countries (UNAIDS 6). As a result, it greatly threatens the development in Africa, impacting it on all levels. At the continental level, of the 23 million people living with HIV/AIDS, most will die in the next 5-10 years, joining the 13.7 million Africans already killed, leaving behind broken families and crippled prospects for development (Est. Death 60). The virus has already surpassed malaria as the major killer in Africa, but its structural impact threatens to be even more destructive. Across the continent, life expectancy at birth rose by 15 years from 44 years in the early 1950’s to 59 in the early 1990’s, thanks to AIDS the figure is set recede back to 44 between 2005 and 2010 (UNAIDS 6).
Economically, AIDS has taken its toll across Africa. Recent evidence shows that companies doing business in Africa are suffering as a consequence and are bracing themselves for far worse as their workers frequently become sick and die. According to a survey of commercial farms in Kenya, illness and death have already replaced old-age retirement as the leading reason why employees leave service (Tatum 12). On one sugar estate, a quarter of the entire workforce was infected with HIV. Direct cash costs related to HIV rose dramatically with company’s trying to keep up with spending on funerals and constant absentees causing productivity to fall lower every month, forcing many owners to sell their companies. Now, illness and death largely caused by HIV, is the number one reason for people leaving a company.
The six countries in southern Africa that are most affected by the epidemic are Botswana, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Within these countries, one in six adults is HIV positive and AIDS is expected to kill between 8% and 25% of today’s practicing doctors by 2005 (Est. Death 61). More than 2000 Zimbabweans die of AIDS each week and in Botswana an estimated 4.2 million people are infected and is expected to increase as the HIV prevalence rate has tripled since 1992. One in four adults living in Zambian cities is HIV positive and one in seven Zambian adults are infected in the country’s rural areas (Caldwell 98).
It is unknown why Africans are affected by the HIV virus more than others, but the large amount of people living in poverty could contribute to the increasing epidemic. In Africa, poverty has been increasing at a faster rate than anywhere else in the world making Africans account for one out every four poor people in the world. Within the continent, four out of every 10 Africans live in conditions of absolute poverty (Caldwell 98). Africa is also the only region in the world where both the number and proportion of poor people are expected to increase. The poverty is a result of weak endowments of human and financial resources, such as low levels of education, poor health, and low labor productivity. The poor health status can be attributed with existence of undiagnosed and untreated sexually transmitted diseases (STDs), which is a significant contributor to the transmission of HIV. Poor households often to do not have the financial basis to counter such diseases and as a result of these circumstances, it puts Africans at higher risk of contracting the HIV virus. This risk is even higher in rural impoverished environments where large amounts of mobile populations are isolated from traditional groups and in these new conditions engage in risky sexual activity with consequences of HIV infection and no way to treat it. In South Africa, throughout the past century, men around the southern African region were hired to work in Southern Africa gold, mineral and diamond mines. They leave their families behind, usually in rural villages, to live in all male labor camps and return maybe one a year. Since the men are not usually well-educated, they turn to home brewed alcohol and sex for leisure. Men that work in South African gold mines have a one in 40 chance of being crushed by falling rock, so the risks of HIV seem remote to them. Mining companies pay $18 million a year in wages to 88,000 workers in Carletonville, the center of South Africa’s gold industry. These wages usually go to purchasing sex, causing 22% of adults in Carletonville to be HIV positive in 1999 (Wohlgemut 485). When these men return to their rural villages, they often carry the virus into their communities. As a result, HIV infection often clusters in families, when both parents are HIV positive. Poor families do not have the means to deal with effects with HIV infection in a whole family and this lack of savings makes it very difficult to cope with the impact of illness or death. The poor already have to live within margins of survival that are unable to deal with health costs such as drug costs to treat infections, transport costs to health centers, and reduced household productivity through illness and funeral related costs. These poor families are never able to recover from the family losses and productivity, and a household’s chance of survival is greatly diminished.
The strain on the capacity of families to cope with consequences of illness causes them to disintegrate as social and economic units. With sole providers like parents gone, it further exposes the rest of the family members to poverty which in turn increases their chances of contracting HIV. This is particularly common with young woman, who are often forced to engage in sex as a means of supporting themselves or family members. Sometimes they become casual sex workers (CSW), but they usually work on an occasional basis just for survival. As a result, the risk of HIV infection is much higher for young women unable to support themselves by other means (Siedel 133). The reason that these young women are at higher risk for contracting the virus is the large amount of girls having unprotected sex. Today, this is not uncommon when anyone looks at teenage pregnancy statistics, but the governments in Africa ignore the problem the most, refusing to create sex education in schools. Woman in Kenya are three times more likely to contract HIV then men but conservatives and religious groups still strictly oppose putting sex education in their schools (Siedel 134). Another factor contributing to the high rate of HIV infection in young women is the amount of girls having sex with older men. Young women already sexually active are at an even higher risk than the prevalence rate suggests and girls that have recently become sexual active and are infected with HIV are more contagious because the virus replicates very quickly at the beginning of an infection (Milligan 5). Having unprotected sex with young women puts an older man at higher risk of contracting the virus then if he were to have sex with a woman his own age.
Women are more likely to be exposed to HIV depending on were they live as well. When comparing West and Southern Africa it is easier to see how poverty can affect a women contracting HIV. In West Africa, infection rates have always been lower than Southern Africa. One reason for this is that women are more involved in the economic life in West Africa than any other part of the continent. They are less dependent on men for survival than East and Southern Africa, and they have more control when engaging sex, having more influence when it comes to protection. This more realistic attitude towards sex has helped tremendously with HIV prevention programs in West Africa.
After twenty years of trying to establish a strategy to counter the AIDS epidemic in Africa, actually employing a plan has been difficult as a result of three factors: the African governments lack of support in countering the virus, the pharmaceutical companies that hide behind patent laws that allow them to sell essential drugs at high costs, and World Bank and the International Monitory Fund (IMF) who decide public policy in Africa (USAID 47).
In many countries in Africa, poor economic management, high inflation, and corruption are common, and military spending often outweighs education. When AIDS is combined with an already deteriorating society it only falls further into a grim situation. This leaves little option for young people looking to survive. Instead planning for the future there is a strong emphasis for short term survival among young people in Africa (Milligan 5). This includes exchanging sex for money, schooling, a job, or just somewhere to sleep. The problem is that on a continent where HIV is so prevalent, short term strategies often result in premature death. This all creates a large developmental challenge, the AIDS epidemic must be countered with programs but developmental plans for the future also need to be reformulated to address the real threat of the HIV virus. The governments have a large responsibility in attending to these problems, only they can place AIDS at the center of the agenda and create a system where others can effectively address the situation. Right now, religious groups and non-governmental organizations lead in countering the epidemic, but with government support they can create the policy and legal environment to really be effective. Finally, only the governments can protect the poor and those who are particularly at risk of infection, by trying to reduce household poverty, keep women out of the sex trade, improve information about sexual education and encourage the use of sexual protection to prevent sexually transmitted diseases.
Most African leaders, until recently, have stayed indifferent in approaching the AIDS epidemic, with the exception of Senegal and Uganda. In Uganda, an early response to HIV prevention has cause the prevalence rate of the virus to decline noticeably. From 1985 to 1990, the amount of HIV infections rose 20%, but since 1993 the prevalence has declined 18% in Uganda thanks to an aggressive approach to AIDS prevention (UNAIDS 7). The numbers of HIV prevalence declination are similar in Senegal where they have also adopted HIV prevention programs. With the exception of Uganda and Senegal though, most African leaders are in a state of denial, simply ignoring the massive effect it has on their countries. Usually, they disregard the information that they receive about the epidemic claiming that the moral values of their societies would not allow transmission of an agent such as HIV that is associated with risky sexual behavior, homosexuality and drug use. President Thabo Mbeki of South Africa even questioned the scientific link between HIV and AIDS. Even where leaders have accepted that AIDS exists and is problem, the methods they use to counter it often makes it worse. In Malawi, President Bakili Muluzi instructed his police troops to do periodic raids on known brothels to slow down the spread of AIDS and gave his police authoritarian powers to restrict civil liberties of prostitutes and their clients. The case is similar in Swaziland where proposals have been made for a special place where people that are HIV positive can be kept so they do not spread the disease. Suggestions for HIV positive citizens to be sterilized and branded were even discussed. African leaders attempt at reducing the spread of AIDS through stigmatizing citizens makes the struggle against HIV even harder because people are less likely to get tested in fear for the lives (Zwarenstein 5). The strongest example of this is the story of Gugu Dhlamini, who was beaten to death in South Africa after admitting she was HIV positive.
One reason most African leaders are reluctant to approach the HIV virus more effectively is the anticipated economic trouble on African economies. In Africa, countries are constantly under pressure from the IMF and World Bank to maintain financial discipline under a number of Structural Adjustment Programs (SAPs). Basically, the IMF does not allow countries in Africa to run massive deficits like a country such as the U.S., so there is not enough money to spread over all of Africa to start up programs to combat AIDS. Even though these adjustment programs have been employed for two decades, no African country has been able to achieve a sound macroeconomic policy. World Bank claims this is a result of African countries not following the adjustment policies correctly, and African leaders say it because policies are impossible to implement successfully. Either way there is nothing being done to try to fix the problem and create a policy that is effective. What is known is that these adjustment programs is that they often affect the poorest people in society, impacting food prices, costs of education, and payment for medical services for the worse (Tatum 12). Many believe that the SAPs are part of the problem mainly because across the continent they have done little help social, political, and economic conditions that could help construct an effective strategy against the HIV virus.
There is no cure for the HIV virus, however, over the past ten years there have been many breakthroughs in anti-retroviral drugs that slow down the course of the HIV infection. The problem is that these drugs have fallen into the hands of powerful pharmaceutical companies that use their ownership over these life sustaining drugs to make huge profits. The multibillion dollar pharmaceutical companies in the U.S. and Europe are rivals on the market place, but issue they agree on is copyright laws that allow them to control the manufacturing, distribution, and pricing on the drugs. They have fought hard to protect their privileges because they say if they infringed on the copyright laws to allow poor countries cheap access to AIDS drugs then there would be pirating of the drugs causing global business to suffer. Representatives of the pharmaceutical companies simply stated that if the copyright was not protected then no one would bother to invest the time and research to continue developing drugs to fight AIDS. Unfortunately, this argument has given rise to a situation where all AIDS drugs in Africa are more expensive where the need it the most. Recently, at a conference held in Nairobi on ‘Improving Access to Essential Medicines’, delegates were told that the potent antibiotic, Ciprofloxacin, the most successful antiviral drug on the market, was twice as expensive in Uganda than in Norway. Similarly, Fluconazole, a treatment for AIDS related meningitis is thirty cents in the U.S. where in Kenya the same drug costs eighteen dollars, where it is patent protected. It is the same for many treatments across Africa, other drugs show that 10 out of 13 commonly used drugs are more expensive in Africa than anywhere else (Chossudovsky 17). That means in order to pay for these drugs people in Africa have to work 215 days to afford them where someone in Canada would have to work eight days. The position of these pharmaceutical companies to capitalize on a grim situation and their ability to make these drugs as expensive as they want is even more devastating to the people that need it most.
In an effort to counter this reality, some of the largest pharmaceutical companies agreed to cut prices the prices of their AIDS treatment drugs for Africa. At first this seems to be a huge step forward in combating the HIV virus, but all the agreement states is how the drug companies might proceed to improve access and availability to the drugs, but does not say how much the drugs will cost. So there are still may unanswered questions concerning if this proposed reduction in cost will actually be effective. It is also unclear that if this move by the drug companies is an authentic effort to make life-saving drugs available to the largest amount of people or just a ploy to protect their worldwide monopoly on the manufacturing and distribution of these drugs.
Across the continent of Africa the HIV epidemic has presented overwhelming challenges of survival and development to communities and societies. There is no way to tell what exactly will be the long term effects of the epidemic. In order to counter the virus effectively, action must be taken on a national and international level in order to have an impact. In Africa, the spread of HIV is a devastating contribution to already bleak problem of poverty, food shortage and famine. These issues make the consequences of the epidemic even more crucial. With a disease that claims more lives everyday and growing and no way to properly treat them, it makes the effects of the virus damaging on many levels. Because of the poor economic situation, it causes citizens to take risks that greatly increase the chance of contracting HIV. Particularly, women have very few options for supporting themselves or their family and are forced to engage in activities that leave them unprotected against HIV infection. Low standards of health, unequal power structures, and the lack of HIV protection and prevention all contribute to the ongoing spread of AIDS and further the problems of the people affected by it. The situation of the Africa AIDS epidemic creates a viscous cycle where it continues to change the environment to one that increases the spread of HIV. Unless aggressive action is made to respond to the threat of the AIDS, the growing epidemic will weaken more people already suffering.