An Alarming Story

By

Ifedigbo Nze Sylva

nzeifedigbo@yahoo.com

 

Probably the most celebrated health issue today is that of the scourge of HIV and AIDS. No day passes without our being reminded of the presence of this deadly disease either through radio/television commercials, public bill board, in the pages of newspaper, on the internet or by one rally or public enlightenment or the other taking place within our neighbourhood. Sadly we are told that some one gets infected with every passing second. For nearly a quarter of a century now, mankind has frantically sought ways and means of solving this deadly scourge yet experts say the pandemic is spreading rather astronomically with between 70 and 100 million people already infected world wide a fact that has been proven by available statistics.

 

A GLOBAL PANDEMIC.

According to the UNAID/WHO AIDS epidemic update of December 2005 more than 25 million people have died of AIDS since 1981 with Africa having over 12 million AIDS orphans. As at Dec. 2005 women accounted for 46% of all adults living with HIV worldwide and for 57% in Sub Saharan Africa. Young people of 15-24 years are said to account for half of all new HIV infections world wide, more than 6000 becoming infection with HIV every day. It is said that of the 6.5 million people in developing or third world countries who need life saving Anti retroviral drugs only about I million are presently opportune to receive them.

 

THE SUB-SAHARAN AFRICA PROBLEM.

Statistics of HIV/AIDS prevalence are no doubt scary figures but even more scaring is the information that the area in Africa south of the Sahara desert known, as “Sub-Saharan Africa” is by far the worst affected in the world by the AIDS epidemic. The region has just over 10% of the worlds population but is home to over 60% of all people living with HIV. An estimated 3.1 million adults and children became infected with HIV in the year 2005 alone. This brought the total number of identified people living with HIV/AIDS in the region to 25.8 million by the end of last year.

         

At present, HIV prevalence continues to rise because there are still more newly infected individuals joining the pool of people living with HIV every year than there are people leaving it through death. In sub-Saharan Africa, AIDS accounted for approximately 2.4 million deaths in 2005 and experts believe that in the coming years, unless there is far broader access to life prolonging therapy, the number of surviving HIV positive Africans can be expected to stabilize as AIDS increasingly claims the lives of those infected a long time ago.

 

Regional statistics for HIV & AIDS (2005)

Regional

Adult of children living with HIV and AIDS

Adult of children newly infected

Adult infection rate (%)

Deaths of adult and children

Sub-Saharan African

25.8

3.2

7.2

2.4

East Asia

0.87

0.14

0.1

0.041

South and South East Asia

7.4

0.99

0.7

0.48

Oceania

0.074

0.0082

0.5

0.0036

Eastern Europe and Central Asia

1.6

0.27

0.9

0.062

Western and central Europe

0.72

0.022

0.3

0.012

North Africa and the middle East.

0.51

0.067

0.2

0.058

North America

1.2

0.043

0.7

0.018

Caribbean

0.3

0.03

1.6

0.024

Latin America

1.8

0.2

0.6

0.066

GRAND TOTAL

40.3.

4.9

1.1

3.1

NB in millions

   Source: UNAID/WHO AIDS epidemic update of Dec. 2005 

 

WHAT MAKES SUB-SAHARAN AFRICA DIFFERENT.

Recently, the 14th edition of the International Conference on AIDS and other STD’s in Africa (ICASA 2005) held in Abuja, Nigeria. As usual, piles and piles of documents, strategies and resolutions on the way forward were circulated. Dozens of good will messages have been sent depicting the effects and contributions of well wishers and international donor agencies in support of the AIDS ravished sub Saharan African countries while funds running into several billions of us dollars have actually been spent trying to fight this disease, yet the figures have continued to rise unabated. The mind-burgling question therefore is this:

 

What makes AIDS different in Sub Saharan Africa?

In the early 1980’s AIDS research in Sub Saharan Africa was hijacked by an extreme hehaviouralist explanation instead of being addressed with the proper acceptable methods of scientific inquiry. This claim, which was motivated by a powerful racial bias, which saw Africa as a special case incorporated the assumption that behaviour explained the difference in HIV prevalence between Sub Saharan African countries and the more developed countries. This notion, as myopic as it sounds unfortunately dominated both research and policy on AIDS for sub Saharan Africa for over a decade. A prove however came through a 1999 UNAIDS publication which showed no correlation what so ever between rates of sexual behavour and prevalence of HIV.

         

The UNAIDS report can be buttressed by this example: African societies are generally credited globally as being the custodians of the best moral values in the world which abhores promiscuity and treats premarital sex and adultery as abominations, doesn’t it sound rather ironic that sexual behaviour in the absence of other factors would produce a prevalence of HIV in a country like south Africa that is over fifty times that of the United States and eighty times that of France?

         

Serous epidemics of other STDS in the United States and Europe confirm that there are quite significant levels of unprotected multi partnered sex in these countries. In spite of this level of unprotected sex, the HIV/AIDS pandemic is not considered a major problem in these otherwise “rich countries”. Statistics show that among the otherwise healthy, well nourished people of developed “first world countries”, sexual transmission of HIV is relatively rare, just about one in one thousand contacts between a HIV positive female and a HIV negative male and about one in 300 contact between a HIV positive male and a HIV negative female. This figures are obviously so low when compared to those of sub Saharan Africa clearly showing that there is something peculiar and different about our case.

         

This thus raises a big socio epidemiological question of how poverty in Africa contributes to the maintenance of high HIV/ADIS prevalence.

 

POVERTY AS THE CULPRIT.

 

The World Bank defines extreme poverty as living on less than I dollar a day. Among the 50 poorest countries of the world of 2004, 33 where Sub Saharan African countries notable among which are Somalia, Tanzania, Rwanda, Congo DR and Senegal. It is interesting to note that the region of the world said to be home to over 60% of the world HIV patients happens also to be home to the poorest peoples of he world. What an obvious relationship. With very low incomes, people in this region of the world are unable to avail themselves of the basic necessities needed for the maintenance of healthy living. Such people are less opportune to have safe drinking water, have poor nutritional intake, are less likely to have good health facilities at their disposal, are less likely to fight disease due to serious immune suppression. Such people are also not equipped enough to make informed choices and are less capable to change their behaviour.

         

For example it is more likely for a youth in Nigeria to have unprotected sex (say with a sex worker) because his meager income cannot handle such rather extraneous expenditures or even when he cares,

his finances can not provide him with good quality condoms for better protection than it is for a youth of same age say in the United States. On the other hand, the prostitute who is driven by unemployment and societal pressure into the trade just to raise money is less likely to question the use or not of condoms in her escapade with her customers. Prostitution it self we must note is a poverty induced and sustained trade.

         

The high prevalence of the disease in women (57%) can be linked to marriage practices which are poverty motivated. With most of the women being low income earners, they often get married in search of social and financial security rather than for love or convenience (as is the case else where) and are less likely to question their husbands infidelity or his polygamous status especially in an situation were the women is considered “opinion less” in issues as such.

         

Over and above all these, a well feed healthy looking child is more likely to withstands the effect of invading disease pathogen than an immune suppressed, undernourished Sub-Saharan African child.

         

It thus goes without saying that AIDS problem in Africa is purely a problem of poverty. The staggering AIDS casualty figures in Africa is a server indictment on the various governments and economic planners in Africa. It confirms the unacceptable levels of poverty and palpable neglect of the primary needs of the masses.

Worse still is that the high prevalence within the region is creating more poverty. It is making children hungry, in poor health, traumatized and less likely go to school or to learn a trade.

 

THE WAY FORWARD.

I am of the strong opinion that the fight against HIV/ADIS in Sub Saharan Africa will work best only when adolescents and young people can control their health and their future, are empowered to make informed choices and possess the skills needed to change their behaviour. This they cannot obviously do with less than dollar in their pockets.

         

It would therefore do our various governments, African union, NEPAD, the United Nations and international donors much good if their efforts are channeled more towards the eradication of poverty in the region rather then at the provision of free condoms and payment for endless television jingles which often do not reach the target audience, the poor.

 

African governments should become less pre occupied in retaining themselves in office and concentrate more in improving the heath and well being of their people which is the only viable way the HIV/AIDS scourge can be contained in Africa.

 

The time for action is now. I find it appropriate to end this piece with a quotation drawn from

Marius Nyoyergo’s Africa is Sinking “--------- Shall it be wisdom or smartness of man that there exist quantum surplus and obscene opulence for a few side by side with total look or unspeakable poverty for the majority who strike, claw and bicker at one another for the pleasure of that few”. Africa and Africans must find the answer to this.

 

Ifedigbo Nze Sylva

UNN