March
2000
AIDS:
The Epidemic Rages as its Face Changes
By Mia MacDonald
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Young. Female. Brown. Poor. This is the face
of AIDS in the 21st century, as the pandemic churns through sub-Saharan
Africa and establishes a strong footing in Asia. Once thought of
as
the disease of gay men in developed countries, HIV and AIDS are now
more commonly found among the poor in the poor countries of the Southern
hemisphere. Indeed, 95 percent of people who are living with HIV
are
living in the developing world. There, the explosion of AIDS is often
a new and devastating burden, layered on top of other long-standing
privations like hunger, drought, environmental degradation and dislocation,
lack of education, limited resources and even more limited social,
economic
and political power. And in this world where AIDS has taken a firm
hold, it is the women, increasingly, who are most affected, due to
a combination
of biology and social mores that continue to accord less value to women’s
lives, and little attention to their rights and desires.
It’s the Women
Physiologically, women are more likely than men to contract sexually
transmitted diseases (STDs), including HIV, and statistics reveal that
adolescent girls are the most likely to be infected. The consequences
of this biological reality are plain to see. Nearly 70 percent of the
global HIV positive population resides in sub-Saharan Africa. This
is
an astounding figure given that this region is home to only 10 percent
of the world’s population. For the first time, the number of women
infected with HIV outnumbers the number of HIV positive men. At the
end of 1999, 12.2 million African women and 10.1 million African men
aged 15-49 were living with HIV, according to the Joint United Nations
Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO).
On a slightly more human scale, this means that in southern Africa,
for every five HIV positive men, there are six HIV positive women.
Among the critical factors contributing to the gendering of HIV/AIDS
are economic realities like migrant labor and scarce employment in rural
areas, common throughout Africa and Asia, which increase the likelihood
of multiple sexual partners and therefore risk of infection. In many
countries, including India, long-distance truck drivers have been identified
as the source of many HIV infections, and are, as such, a key target
for prevention efforts. In others, migrant laborers (like mine workers
in Western and Southern Africa) live away from their families in single-sex
hostels, returning to their homes and families only a few times a year.
Many begin new sexual relationships in the cities or settlements where
they work, running a high risk of infection themselves and, in turn,
often infecting subsequent partners and in many cases, their wives back
home.
Absolutely central to the tenacious spread of HIV is that, throughout
the world, and not only in poor countries, women—both married and
unmarried—often cannot protect themselves from HIV. They often
do not have the power, confidence, information or resources to decide
on or negotiate sexual matters, including condom use. And many segments
of society accept that husbands will have multiple sex partners, while
such sexual "liberation" is socially unacceptable for wives
and all women. Women must also bear the fact and consequences of their
partners’ behavior without protest. "People die here every
week from AIDS, but we pretend not to notice," an HIV-positive
mother of five in South Africa told the Chicago Tribune recently. Her
husband died of AIDS and left her with no means of support for herself
or her children. "We die lying to ourselves," she said.
And the Young People?
Those infected with HIV are also getting younger: half of all new
cases of HIV globally are among people between the ages of 10 and 24,
and, typically, they die before they turn 35. Gender is an increasingly
critical factor here, too. In sub-Saharan Africa, girls aged 15 to
19
are five to six times more likely to have HIV than boys their age.
Sex with older men who have HIV or AIDS is judged by UNAIDS and WHO
to be
a key contributing factor to girls’ greater vulnerability to HIV.
Such sex is often coerced or "transactional" in nature—girls
trade sex for money or food, often to support impoverished families,
some already disrupted by the consequences of AIDS, or to pay for school
or university fees. Young women throughout the developing world are
also prey to a common male myth which suggests that having sex with
a young girl or virgin can cure HIV or prevent infection.
AIDS is also claiming even younger victims. In sub-Saharan Africa alone,
over a million children are living with HIV. According to 1999 UNAIDS/WHO
estimates, nearly 90 percent of all children born with HIV or those
infected through breastfeeding ("AIDS babies") are in southern
Africa. In addition, more than 11 million children have been orphaned
as a result of one or both of their parents dying of AIDS. Many of
these
kids are now being raised by their grandparents, extended family, older
siblings or, in some cases, no one at all.
Out of Africa
Even though the current face of AIDS is mainly African, it is not
the only face. According to the UNAIDS report, the world’s steepest
curve of new HIV infections were caused by intraveneous drug use in
the Russian Federation and Ukraine, where the proportion of the population
living with HIV doubled between 1997 and 1999. In Central Asia and Eastern
Europe, the number of people infected with HIV increased by more than
one-third in 1999, to an estimated 360,000. In Moscow alone, reported
HIV cases (and many more go unreported) rose three-fold in the first
nine months of 1999 when compared to all previous years’ records
combined. Towns near Moscow had even sharper rises in HIV infection—five
times the rate of previous years combined.
India, with a population of over a billion people, has an estimated
four million people living with HIV, more than any other country in
the world. However, prevention efforts have, so far, kept the number
of infections below what had been projected. In addition, over a million
and a half people have HIV throughout Latin America and the Caribbean,
and nearly a million people are living with HIV or AIDS in North America,
where reports of complacency about safe sex are on the rise.
Dowsing the Fire
Must the AIDS epidemic continue to ravage and rage, destroying individual
lives, communities, countries and even whole regions of the world, with
impacts well into this newborn century? According to international experts
and activists, the answer is, and must be "no," given what’s
known about HIV/AIDS and the material and financial resources that exist
and can be drawn upon. "Two decades into the AIDS epidemic, we
know better than ever before about prevention—how to persuade people
to protect themselves, make sure they have the necessary skills and
back-up services, and remove social and economic barriers to effective
prevention," Peter Piot, Executive Director of UNAIDS, keenly observed
in 1998. "[Each of the] new HIV infections represents a prevention
failure—our collective failure." Given the nearly six million
new HIV infections in 1999, the scale of the failure is stunning. And
in many ways, the response of the "First World" has been shameful.
President Clinton trumpeted an increase of $200 million in his latest
budget to fight HIV/AIDS in developing countries, a paltry sum given
the scope of the epidemic and the riches in the U.S. Treasury; he has
also asked for $2 billion to increase on-line security, in the wake
of the recent monkey-wrenching attacks on e-merchants. It is clear where
priorities lie.
Money, and numerous nonhuman primate lives, are being spent in efforts
to develop an AIDS vaccine and new forms of anti-retroviral drugs, but
equity issues remain largely unaddressed. When and by what means will
people in Asia, Africa and Latin America benefit from these methods
to prevent or slow HIV’s spiral into full-blown AIDS? Will the
drug companies and their shareholders forego billions of dollars in
profits to make medications available to those who cannot afford them?
Recent evidence, such as the drug companies’ lawsuit against South
Africa for daring to consider manufacturing low-cost, generic versions
of drugs used to treat HIV/AIDS, suggest not. Whether or not the West
decides to provide monetary, professional or pharmeceutical aid, Third
World governments are obligated to launch or invigorate their HIV prevention
and treatment efforts. "What governments don’t seem to understand,"
says David Heymann, Executive Director of WHO’s program on communicable
disease, "is that the window of opportunity is closing…if
they don’t tackle the gigantic problem now, they’re just endangering
their own survival." Impassioned words, but at the same time as
they are being spoken, World Bank and International Monetary Fund (IMF)
technocrats, backed by First World legislatures, call for massive cuts
in developing country health budgets, health staff, while encouraging
the privatization of health services, with user fees a major component.
Even some of the plans to reduce the debilitating debt of many poor
countries insist on such cuts in social spending and the liberalization
of economies, including privatization, as conditions for debt reduction.
In many countries that have undertaken health system privatization,
rates of use of available services have plummeted—people simply
don’t have the money to pay. "It’s true that there are
no queues [at Zambian health centers], " Dickson Jere, a Zambian
journalist, recently told a writer for The Nation, "but
that’s because people are simply dying at home."
Along with these structural gaps are individual, less tangible and therefore
harder to address facets of HIV experience: denial and stigma. Sbongile
Shabane, a South African AIDS activist, works to raise awareness of
HIV/AIDS in the province of Kwazulu-Natal, which has a population of
two million. Yet, as she told the Chicago Tribune, her group
doesn’t even have 25 members. "To be HIV-positive is to be
less than human," she said. "I have seen people turned out
by their families. One woman was carted out of her house in a wheelbarrow
when her family found out she had AIDS." Of course, the true face
of AIDS is the individual face, which is often hard to see within the
welter of statistics and depressing news images. Yet perhaps that is
the key: how to comprehend, to really see the 15,000 men, women and
children who are infected with HIV each day—the individual faces,
the individual burdens and the individual traumas? This is only one
face: "My crime is that I’ve told people I have HIV,"
the AIDS widow in South Africa interviewed by the Chicago Tribune
said. "That has made me an outcast."
