Vocabulary
epidemic, transmit, suppress, impoverished, prematurely, sibling, rampant, orphan, succumb, dire, gross domestic product, stigma, condemnation, pharmaceutical, prevalence, acknowledge, consensus, viral infection, nourishment, alleviation, vigilant
AIDS in Sub-Saharan Africa
Top five countries with the highest % of adults (15-49) living with HIV/AIDS (2009)
1 Swaziland 25.9%
2 Botswana 24.8%
3 Lesotho 23.6%
4 South Africa 17.8%
5 Zimbabwe 14.3%
No region of the world is more affected by HIV and AIDS than Sub-Saharan Africa. About 22.9 million people are living with HIV in this part of the world. This accounts for about two-thirds of the total HIV infected persons on the planet, even though this region contains little more than 12 percent of the world’s population. In 2010, about 1.2 million people died from AIDS in Sub-Saharan African countries, while 1.9 million people became infected with HIV. According to the CIA World Fact Book, the first 23 countries on the list of adults living with HIV/AIDS are all Sub-Saharan African countries, and the percentage of people infected increases the further south you go. In no other country in the world are there more AIDS related deaths than in South Africa. In 2009, about 310,000 adults and children - about half of all those who died in this country - died of AIDS.
But what is AIDS? And what is the difference between HIV and AIDS? AIDS was first identified in the early 1980s, and has since caused a global epidemic of immense proportions. AIDS stands for Acquired Immune Deficiency Syndrome. This is a disease that makes it difficult for the body to fight off infectious diseases. It is caused by the HIV virus, which most commonly is transmitted from one person to another through unprotected sex. The virus gradually attacks immune system cells, and as HIV progressively damages the cells the body becomes more vulnerable to infections. A person is diagnosed with AIDS when he is too weak to fight off these infections in the body. If left untreated, a person can live with the HIV virus in his body for up to 10 years before the immune system collapses and AIDS develops. There is still no cure for AIDS. However, there are drugs on the market (ARV – antiretroviral drugs) which suppress the HIV virus.
Consequences of HIV/AIDS
HIV and AIDS have a widespread impact on many parts of African society, and the social and economic consequences of the AIDS epidemic are today widely felt. In the countries most heavily affected, it has become by far the most important factor in slowing down social and political development, and although no part of the population is unaffected by HIV/AIDS, it is often those in the poorest part of society that are most vulnerable and for whom the consequences are most severe. It is believed that the AIDS epidemic will continue to have devastating consequences for decades to come for virtually every sector of society.
AIDS affects segments of society in different ways and poorer households are often more severely affected than better-off households. The loss of a family breadwinner can for many families be financially devastating. Also, the medical costs may increase dramatically since there are many AIDS-related illnesses that have to be treated. Very often AIDS pushes households into poverty, and households that are already poor may become further impoverished.
Also, the education sector has felt the impact of the HIV/AIDS epidemic. In many Sub-Saharan African countries the epidemic has resulted in a shortage of teachers, which again has led to a decrease in the quality of the education offered. Moreover, many children in AIDS-affected households leave school prematurely, primarily as a result of lack of money and an inability to pay the required school fees. Moreover, many are needed at home to look after sick parents or siblings after the death of their parents. They are often forced into the role of being the main caregiver, and this will subsequently affect the child’s education. Too many children leave school, and the decline in school enrolment is one of the most visible effects of the epidemic. Schools play a vital role in reducing the impact of AIDS, through HIV education and support, and educating the next generation is essential if a country is to get the epidemic under control. As Peter Piot, Director of UNAIDS put it: “Without education, AIDS will continue its rampant spread. With AIDS out of control, education will be out of reach."
Another serious consequence of the epidemic is the still increasing number of children who become orphans as parents succumb to AIDS. In fact, in Sub-Saharan African countries about 14.8 million children have lost one or both parents to AIDS since the epidemic started. Long before the appearance of HIV/AIDS, child fostering was common in many African societies. However, even though fostering orphans is a common cultural practice, the rapid rise in the number of orphans is today overwhelming the traditional support system of the extended family. The burden of raising the children is often put on the shoulders of elderly grandparents or other remaning family. Many of the households that are taking in orphans are themselves poor, and taking in orphaned children represents a significant financial burden, leading them even deeper into povertry than they were before.
AIDS also affects the productivity and economic growth in the country. The vast majority of people living with HIV and AIDS in Africa today are in the prime of their working lives, between the ages of 15 and 49. It is in this group we find the main workforce. When the workers contract AIDS they become an expense for the company, productivity falls, and this eventually affects the economy of the country as a whole. It is difficult to measure the impact that HIV and AIDS has had on the economies of African countries, because the epidemic has aggravated an already dire situation in this region. However, it is believed that the impact of HIV and AIDS on the gross domestic product (GDP) of the worst affected countries is a loss of around 1.5% per year. This means that after 25 years the economy would be 31% smaller than it would otherwise have been.
What Can Be Done?
There are different ways of fighting the epidemic and dealing with the disease. The best way is to reduce the number of people being infected with the virus. However, this is much more difficult than it sounds. The disease still carries a stigma and is something that many people will try to hide for as long as possible. Many HIV carriers don’t even know they are infected because they have never been tested, thus continuing to spread the virus. To get the disease under control, people have to be willing to get tested and to take the consequences if the test turns out to be positive. However, this is not likely to happen if people know that a positive HIV test will lead to condemnation and perhaps even exclusion from the community. The fight against AIDS is impossible to win if there is not sufficient openness around the disease. Education and information are key words in the battle against AIDS; it has to be dealt with in an open way to reduce the stigma and make people aware of the dangers.This is essential if the number of HIV infected people is to be reduced.
Uganda was one of the first countries in Sub-Saharan Africa to experience the devastating impact of HIV/AIDS, and it was also one of the first countries in Africa to address the AIDS issue. There was no money for drugs, but a high-level political commitment to HIV prevention and care was made to educate the population on how to protect themselves and their partner. Sex education programs in schools and on the radio became common, HIV testing was quick and confidential and advertisments for the use of condoms and safe sex became a common sight in the streets. As a result, they managed to reverse the tide of HIV/AIDS already in the early 1990s, and UNAIDS reported that the program was a success.
For people who are already infected by HIV, ARV drugs (antiretroviral drugs) are the best option. These drugs are not a cure, but can stop the HIV virus from developing into full-blown AIDS. Antiretroviral drugs are so far the only effective way to treat HIV, and they have been made widely available for many years in the developed countries. However, they are expensive, and therefore they have been denied to millions of people in the developing world. Many of the big pharmaceutical companies have been reluctant to lower the prices of their products, arguing that it would compromise their ability to research and develop new alternatives. However, international pressure has forced them to reconsider, and cheaper drugs are now being made available on the market. Still, many African countries struggle to afford the drugs, even at a reduced price.
South Africa
South Africa is regarded as having the most severe HIV epidemic in the world with one of the world's highest HIV rates. The country tops the list of people dying from AIDS, and it is on the list of the top five countries with the highest HIV prevalence in the world, with 17.5% of the population estimated to be infected. This counts for about 5.3 million people, including 220,000 children under the age of 15 years.
In spite of the severity of the problem, South Africa was for many years accused of ignoring it. Nelson Mandela came into office in 1987 just at the beginning of the epidemic. But his attention was not on the growing HIV/AIDS epidemic, but on the the huge challenge of taking over the political control of a divided country. He acknowledged after leaving office that his government had not acted swiftly or decisively enough to address the crisis.
His successor, Thabo Mbeki, turned his back on the scientific consensus that AIDS was caused by a viral infection. According to Mbeki, the cause of AIDS was not a virus, but poverty, bad nourishment and general ill-health. He also challenged the view that the disease could be combated, though not cured, by sophisticated and expensive drugs. The solution to the AIDS problem was not expensive western medicine, but the alleviation of poverty in Africa. He refused to provide medication for people with HIV, claiming that it had no effect and that the country could not afford it. Also, pregnant women were left untreated, in spite of the fact that treatment with ARV during a pregnancy reduces the chance of mother-to-child transmission with more than 50%.
Mbeki's views on the causes of AIDS, in particular the link between HIV and AIDS, and the treatment of AIDS were much criticised. His lack of response to the AIDS crisis is believed to have caused the death of more than 330,000 people. It is also estimated that 35,000 HIV-infected babies, who could have been protected from the virus, were born during his presidency. It was not until 2008, when Mbeki fell from power that the fight against AIDS was back on track.
In 2009, President Jacob Zuma introduced some radical changes to the country's AIDS policy, showing a political will to fight the problem. The number of people receiving ARV drugs today has more than doubled since 2008. Also, there is a 30% increase in the number of pregnant women receiving ARV, and the treatment starts much earlier in the pregnancy. The drugs make it possible for more HIV infected people to live normal lives and provide for their families since the infection never develops into AIDS. South African leaders have gone from ignoring the problem to playing an active role in combating the dicease, and the country now runs the world's largest anti-retroviral program.
Despite this positive development, AIDS remains South Africa's leading cause of death, mainly due to the fact that South African leaders were not vigilant enough from the very beginning. In the future it is important that the government stays committed to the AIDS program and that they are still willing to put in the effort and the money to fight the epidemic. Lack of commitment will again lead South Africa into a downward spiral.