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Fall 2001 (18:1)
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AIDS in Africa
The worldwide AIDS epidemic has already caused more deaths than the bubonic plague of the Middle Ages. Three-quarters of the AIDS cases and deaths today are taking place in Africa.
About 22 million people in the world, including more than a million children, have died of AIDS since the epidemic began in the early 1980s. Currently, the AIDS virus has infected 36 million individuals, who are likely to die because of its effects. The AIDS epidemic is most prominent in southern and eastern Africa, where about a quarter of the population is infected.
AIDS stands for Acquired Immunodeficiency Syndrome. It is caused by the Human Immunodeficiency Virus (HIV). HIV is transmitted through blood or other bodily fluid from an infected person. When HIV enters the body, it attacks the immune system, gradually weakening it. Diseases such as tuberculosis (TB) then overwhelm the weakened immune system. These secondary or so-called "opportunistic infections" actually cause the death of AIDS victims.
Unlike most other deadly diseases, such as the bubonic plague, AIDS takes a long time to kill. After a person is infected with the AIDS virus, he or she will not start to suffer the effects of "opportunistic infections" for another six to 10 years. Once this occurs, however, death usually follows in a year or so. Powerful drugs, called antiretrovirals, can help an AIDS victim live longer. But they do not kill HIV. There is no cure for AIDS yet.
HIV is one of the few viruses that have "crossed over" from an animal species to humans. Scientists believe that HIV originated in African monkeys or chimpanzees. They speculate that sometime in the 1930s the infected blood of one of these animals entered an open wound on an African hunter. The virus then spread slowly from person to person through sexual contact. The virus remained isolated in remote areas of Africa until the 1980s, when improved transportation and increased human migration caused the virus to spread rapidly throughout Africa and the world.
The most common way for HIV to be spread is through sexual contact. In some places, like the United States, the majority of cases result from male homosexual relations. Most cases worldwide, however, are spread through heterosexual intercourse. HIV is also spread through infected blood transfusions, use of infected drug or tattoo needles, and, rarely, in contact sports like boxing. In addition, mothers may pass the virus on to their babies during pregnancy or by breast-feeding. The best way to prevent HIV infections is to avoid risky behaviors like unprotected sex and drug abuse.
About 27 million Africans are currently living with HIV/AIDS. All may die of AIDS within the next decade. Why has the AIDS epidemic become so severe in Africa, and what can be done about it?
Why Africa?
Many African countries south of the Sahara Desert are very poor. To survive, workers often must travel long distances across national borders to find work. For example, a man may leave his wife in Botswana to work in a diamond mine in South Africa. For months, he lives in a dormitory at the mine. He begins to sleep with women, some of whom are infected with HIV. He refuses to use a condom, which many African males disdain as "unmanly." When he finally returns home, he is infected with HIV and may not even know it. When he has sex with his wife, he passes the HIV to her. If she later becomes pregnant, she is likely to pass on the virus to her baby. In a very real sense, all three are doomed.
Most women in south and east African countries have low social status, few rights, and traditionally submit to male demands such as having sex without a condom. Also, many males with HIV/AIDS persist in believing that if they sleep with one or more virgins, they will be cured.
African societies have strong cultural and religious taboos against openly discussing matters related to sex. This makes it difficult for health clinics, schools, and the media to educate the people about how to prevent AIDS. Until recently, most African countries have been in denial about the AIDS epidemic.
AIDS Infects Society
AIDS in Africa infects not only millions of individuals, but also society itself. The stigma of AIDS causes many victims to hide their illness for fear of losing a job or being shunned by relatives and neighbors. Moreover, the relentless funerals of those who have died of AIDS sap the will of the living to have hope for the future.
AIDS affects African economies. It is the young, the strong, and the most productive members of society who are most often struck down by AIDS. Many African countries are suffering from the loss of farmers, skilled industrial workers, teachers, health professionals, business owners, government employees, and university students.
The epidemic in Africa is also producing millions of orphans whose parents have died from AIDS. These orphans have overwhelmed African families, who traditionally take in the children of relatives who have died. Consequently, "child-headed" households and homeless "street children" are becoming much more common in African societies.
"Raise the Alarm Loudly"
African countries have responded in different ways to the AIDS epidemic. Zambia, with 100,000 AIDS deaths and 25 percent of its people infected with HIV, has done little. It doesn't even provide HIV/AIDS awareness education. Uganda, which has a sad violent history, is the surprising success story of Africa in combating AIDS.
Twenty years ago, Uganda started an HIV/AIDS prevention campaign. It consisted of sex education in the schools and an improved health care system. Uganda President Yoweri Museveni has said, "When a lion comes to your village, you must raise the alarm loudly." As a result, HIV infections have dropped from 15 to 8 percent of the population.
South Africa has a large population that is relatively well educated and economically well off compared with the rest of Africa. Yet, HIV has infected 20 percent of its people. South Africa could lose more than 6 million of its citizens to AIDS by 2010. After democracy replaced the racist apartheid system in South Africa, the people were much freer to travel. Tragically, this increased mobility helped spread the AIDS virus to all races, classes, occupations, and locations in South Africa.
The response of the South African government has been mixed. Prevention information is widely available, but the government has been slow to approve certain anti-AIDS drugs. One of these drugs reduces the chance of a mother passing HIV to her baby. President Thabo Mbeki has even publicly doubted that HIV causes AIDS.
In 1997, South Africa passed a law that allowed importing generic antiretroviral drugs that can prolong the lives of AIDS victims. These generic drugs are much cheaper ($600 per person per year) than the antiretrovirals originally developed and now sold by American and European companies ($10,000-$15,000 per person per year).
In March 2001, the American and European companies went to court in South Africa. They sued to stop the sale of generic antiretroviral dugs. The lawsuit claimed that the companies that made the generic drugs violated international patents. These patents granted the original developers of the drugs the exclusive right to own and sell them for 20 years.
The American and European drug companies argued that they had the right to charge high prices to recover the high cost of developing the drugs. To deny them this, they said, would take away their motivation to do further research. They explained that research will be needed to keep up with the ever-changing AIDS virus and to find a cure for AIDS itself. The companies also pointed out that generics sometimes have safety and quality problems.
After many protest demonstrations against the American and European drug companies, they withdrew their lawsuit and cut their prices. At least one company has licensed a South African company to distribute its antiretroviral drugs generically. The drugs now cost from $200 to $800 per person per year in Africa.
This price cut, however, will not solve the problem. Considering the huge number of people involved, AIDS prevention programs and anti-AIDS drugs cost much more than most African countries can afford. The annual health budget for the poorest African countries amounts to about $10 per person. A special U.N. session on the HIV/AIDS crisis was held in June 2001. The nations of the world set a goal of raising $7-$10 billion per year to stem the AIDS epidemic in Africa and the rest of the world.
So far, many countries, companies, and individuals have pledged money for the U.N.'s Global AIDS and Health Fund. The United States pledged $200 million, which Secretary of State Colin Powell called a down payment. The Bill and Melinda Gates Foundation pledged another $100 million. Even so, the U.N. fund had pledges of only $1.4 billion by midyear 2001. Meanwhile, at a single South African funeral parlor, relatives and friends mourn 50-100 AIDS victims each week.
For Discussion and Writing
- What causes AIDS?
- Why has the AIDS epidemic hit Africa so hard?
- What can African countries do to prevent new HIV infections?
- What were the arguments, pro and con, over drug companies suing to stop the sale of generic antiretroviral dugs?
For Further Information
Death Stalks a Continent From Time magazine.
AIDS, Drugs, and Africa From Washington Post.
AIDS: Africa in Peril From CNN.
AIDS in Africa From BBC News.
AIDS & Africa Updated news.
AIDS in Africa From PBS News.
A C T I V I T Y
What Should the United States Do About This Crisis?
Imagine that the U.S. Department of State is holding a meeting to decide on its recommendation to the president about what to do about the AIDS crisis in Africa. The three main choices are:
A. Send unilateral foreign aid from the United States to the affected African countries.
B. Let the United Nations handle the problem and increase the U.S.'s contribution to the United Nations for this purpose.
C. Let the nations of Africa handle the problem.
Divide the class into small groups. Each group will role play a State Department meeting on the question of what to do about AIDS in Africa. Each group should do the following:
- Discuss each of the options.
- Add additional options if the group thinks they are necessary.
- Vote on which option is the best.
- Be prepared to report to the class on the option the group chose and the reasons why the group believes it is the best option.
After each group decides, have the groups report their choices to the whole class and hold a discussion. Close the activity by taking a class vote on the options.
Links to Additional Lessons
AIDS in Africa From CNN.
South Africa's AIDS Crisis From CNN.
