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March 2000
AIDS: The Epidemic Rages as its Face Changes

By Mia MacDonald

 


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."

 


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