AIDS in Africa

Although the West's battle with HIV/AIDS has been extremely successful, as the disease began to decline in Western countries, its prevalence in other countries began to increase. Although various countries in the world have dealt with outbreaks of HIV/AIDS to some extent in recent years, no one region of the globe has suffered more as a direct result of this disease than Africa. In particular, countries in Sub-Saharan Africa have become breeding grounds for this condition. The situation has reached almost pandemic proportions, threatening to wipeout an entire race of people sometime in the next 30 years. According to Rushing (1995), "AIDS has been increasing faster in Africa than in any other region of the world" (p. 59).

With the realization that the HIV/AIDS epidemic has been more controlled in developed nations, there is a clear impetus to examine why the epidemic of AIDS in Africa and, more specifically, Sub-Saharan Africa has become exacerbated to the point that an entire race of people may be decimated by this disease. Clearly modern science has given physicians and researchers the tools that they need to effectively combat this disease. Yet despite access to these tools, AIDS counties to consume the lives of millions of people in Africa, orphaning children and further plunging the continent into economic despair. Clearly, there are greater forces at work in this situation. If AIDS can be combated in developed nations such as the US and the United Kingdom, it can be combated in Africa.

Using this as argument as a basis for investigation, this research considers the development of the AIDS epidemic in Africa. In particular, this research considers the demographics of AIDS in Africa, the root causes for the epidemic and the impact that this epidemic will have on the development of the country in years to come. Through a careful analysis of what has been written on this subject, it should be possible to provide a more integral understanding as to why AIDS remains such a pervasive health problem in Africa. Further, by extrapolating the data, a comprehensive understanding of what will happen to Africa as a result of this epidemic will be gleaned.

The Demographics of AIDS

As noted in the introduction of this investigation, as the rates of HIV/AIDS have decreased in developed nations, they have increased in underdeveloped nations. Table 1 in Appendix A provides an overview of the number of reported HIV/AIDS cases by global region. As expected, AIDS infection rates in North America are among the fewest in the world. However this is not the case in Africa.

Arguably the situation in Africa has become a critical health issue for the development of the continent. However, while the macro data clearly demonstrates that Africa has become overwhelmed by the AIDS epidemic, a closer look at the continent and the statistical data that has been collected with respect to the AIDS epidemic shows that the e

Seeking to discern why women between the ages of 15 and 24 and 15 and 49 are so susceptible to acquiring AIDS, the UN goes on to report that individuals between the ages of 15 and 49 are typically the most sexually active, as these ages represent key childbearing years. For women, however, the situation of being sexually active is complicated by the fact that, women are more biologically susceptible to the disease: "Because of their reproductive systems, women's bodies are more susceptible to infection by the human immunodeficiency virus than are men's bodies. That is particularly true of sexually active young women, whose bodies are still developing" (Women: The face of...). As the number of women with the AIDS virus in Sub-Saharan Africa increases, so too do the number of children born with the disease. As such, increasing rates of AIDS among the female population only further exacerbates the devastation that occurs as a direct result of this disease.

In an effort to effectively summarize the AIDS epidemic as it is currently occurring in Sub-Saharan Africa, the World Bank (2005) makes the following observations:

Sub-Saharan Africa has just over 10% of the world's population, but is home to more than 60% of all people living with HIV-25.8 million. In 2005, an estimated 3.2 million people were infected with HIV. Declines in adult national HIV prevalence appear to be underway in Kenya, Uganda and Zimbabwe. But each of those countries remains saddled with a large, potentially ruinous epidemic. HIV prevalence remains exceptionally high in southern Africa and the epidemic continues to expand, notably in Mozambique and Swaziland. Very high HIV prevalence-often exceeding 30% among pregnant women-is still being recorded in Botswana, Lesotho, Namibia and Swaziland and there is no clear evidence of a decline in HIV prevalence (World AIDS Day).

Overall, the data demonstrates that while some countries in Sub-Saharan Africa have seen declines in the total number of AIDS cases being reported, for the most part the entire Sub-Saharan area faces a considerable threat when it comes to the spread of AIDS. The most vulnerable populations remain all individuals between the ages of 15 and 49 years of age. Further women will continue to struggle with this disease at a disproportionately higher rate than men (World AIDS Day, 2005).

Understanding the HIV/AIDS Crisis in Sub-Saharan Africa

With the realization that the AIDS epidemic has hit Sub-Saharan Africa the hardest, there is a clear need to determine why this situation has occurred. A precursory overview of the current literature on the subject seems to indicate that the rise of the AIDS epidemic in this region of Africa is due to a wide range of social, economic and political issues. As such, a review of what has been uncovered with respect to each of these issues is warranted in order to fully understand the complex nature of AIDS in Sub-Saharan Africa.

Social/Cultural Variables

Although the current research on the AIDS epidemic in Sub-Saharan Africa demonstrates that there are a host of reasons for the proliferation of this disease, researchers examining the cultural and social issues that have fueled this epidemic have noted that there are a number of social attitudes and cultural beliefs that have promulgated the further spread of the disease. For instance, Hickson and Mokhobo (1992) note that although traditional African culture teaches children that premarital sex is taboo, these taboos are note widely enforced in social discourse. "Such sexual practices and their consequences are not necessarily frowned upon. Sexual excesses, especially when practiced by urban men, are generally hallowed and viewed as prestigious" (p. 12). Hickson and Mokhobo go on to note that the idea that promiscuity is wrong, even if it leads to death-through the spread of AIDS-is not viewed as a reason to stop engaging in sexual activity. In most African countries the idea that promiscuity is wrong is thought to be a White belief that is used to impose some degree of oppression on those living in Africa.

Adding to the complexity of social attitudes about sex that have developed in Africa, Hickson and Mokhobo also note that many in Sub-Saharan Africa have not come to view AIDS as a disease that is caused by sexuality. According to these authors:

All too often AIDS is explained as a disease that affects nonsexual organs and other organs remote from the genital areas. Consequently, many Africans wrongly perceive that the disease is not linked to sexual organs. Accordingly, the connection between AIDS and sexual activity is not acknowledged by many Africans and will not be until AIDS can be effectively linked to sexual activity in the African mind (p. 12).

Thus, the inability of Africans to understand the connection between AIDS and sex is one that continues to limit the ability of health officials working in Africa to reduce the spread of the disease. Hickson and Mokhobo note that this issue will remain a pervasive challenge in Africa because AIDS has no symptoms that directly affect either the male or female sex organs. Because Africans cannot see the manifestation of AIDS, they simply do not accept its existence.

Finally, Hickson and Mokhobo report that African rebuke of Western medicine in lieu of using traditional "healers" is also increasing the overall incidence of AIDS. "Many Africans believe that there are some diseases that have African experiential causes and cannot be treated by allopathic and western approaches. [...] Consequently, the indigenous healer plays a key role in the health of the individual and his or her family as well as in the social cohesiveness of the group" (p. 15). As such, even when medical treatments for AIDS are available, there are those who will not access these treatments because of their dislike or fear of Western medicine. Thus, until changes in the stereotypes of Western medicine can be brought about many that need treatment will not receive it.

Because Africa is such a wide-reaching continent, there are many different sociological reasons for the spread of AIDS. In Baylies & Bujra's (2000) study, one of the main arguments the authors provide is that women have become more economically autonomous in recent years, especially within the Rungwe district, and the youth of the culture, both male and female, having been rebelling against parental/elder control. The authors claim that such behavior has led to increased HIV/AIDS cases while, in the meantime, the balance of power within both the household and society is being challenged.

This has placed a tremendous stress on the families, forcing women, men, and even children into prostitution. Baylies & Bujra (2000), in a study they conducted within Rungwe, found that "women, both married and unmarried, had turned to sex work. An index of the poverty of many, it also provided the means to prosper for the few. Poor married, divorced and widowed women looked to exchange sex for food as well as money. Rather than objectify women as sinners for engaging in sex work, many people viewed the conditions which forced women to take such steps, as beyond their control. They were the consequence of drunken husbands who neglected their wife(ves) and spent whatever money they had on alcohol and commercial sex, or of in-laws who deprived widows of their land and homes, and sometimes their children" (p. 83). This is a situation that does rely on economic variables, but it also built upon social constructs as well. As was noted previously, the changing nature of domestic relationships is pushing all of the family members out of the household to search, by whatever means necessary, for money. And there is no need to emphasize that prostitution will greatly increase the chance of spreading the HIV/AIDS virus.

Even still, there are other risky behaviors the study found, including promiscuity among youth (mentioned by older women and men); and men (as noted by women); multiple sex partners among husbands (as reported by married women); and widow inheritance. Risky places included local beer clubs, weekly or shifting markets, local dances, and the highway, which loomed large as the route by which outsiders entered and the means by which women went outside (Baylies & Bujra 2000, p. 86). These are claimed to be a result of the erosion of values and tradition. There is no sexual education for young girls and the traditional patterns of marriage are no longer followed.

Further complications arise in the misunderstanding of protection. Specifically, the people within these communities view contraceptives such as condoms as a "vehicle of Western decadence" (Baylies & Bujra 2000, p. 89) even within professed Christian communities. Nationalists within Christian churches in African communities, supporting the tradition of African society have advocated the disposing of contraceptives, especially the ones used in the West, because of this distorted view. On a lighter note, the researchers found that the women of Africa are starting to demand that there is a supply so that they can protect themselves from the disease.

Before closing on this segment, it should be noted that another social construct which obstructs effective treatment of the Sub-Saharan region of Africa is the stereotypical notions that the West has about Third world countries, a point which Treichler (1999) pointed out in his concise study on AIDS in Africa. It is often thought, for instance, that Third World peoples are incapable of understanding the complex Western scientific formulations or explanations of AIDS and how to combat it. "Only in the Third World, the logic continues, can sufficient numbers of subjects who meet these criteria be assembled for testing: too ignorant (or mired in "tradition") to change their behavioral practices (and thus lower rates of infection), too poor and unsophisticated to seek alternative treatments, compliant and dependent enough to follow orders, Third World people are definitely a promising population" (Treicler 1999, p. 210). Though the thought is obviously erroneous, it is also destructive and thwarts the main goal of reducing the percentage of AIDS infected people.

Economic Variables

While the social and cultural issues impacting the spread of AIDS in Sub-Saharan Africa are critical for healthcare professionals working in Africa to alleviate the effects of this epidemic, researchers examining the spread of AIDS in Africa have noted that there are a host of macroeconomic issues that have contributed to the development of AIDS in Sub-Saharan Africa. In particular, the widespread poverty that is endemic to this region has been noted as the most pervasive reason for the proliferation of AIDS. Although researchers note that a direct relationship between poverty and the spread of AIDS is difficult to demonstrate, data on the spread of AIDS in Africa clearly demonstrates that the regions that are the most poverty stricken are those that have been hit the hardest by the spread of the disease.'

To illustrate this point, one only needs to consider the economic conditions in Sub-Saharan Africa to see that some connection between AIDS and poverty exists. Cohen (2001) reports:

In the case of sub-Saharan Africa, the World Bank estimates that in 1998 some 291 million people lived on less than US$1 a day, and that between 1987 and 1998 the percentage of the total sub-Saharan African population living at this level remained constant at 46 percent, implying a significantly increased absolute number of poor people. [...] Between 1990 and 1999, real GDP per capita in sub-Saharan Africa increased at an annual rate of 0.1 percent, compared to 2.8 percent in the years 1965 to 1980 (p. 54).

Cohen goes on to argue that in the last decade there has been zero growth in income for most countries in Sub-Saharan Africa. When placed in context with the spread of AIDS, Cohen argues that the poverty that exists in Sub-Saharan Africa limits the ability of the government to provide basic social services and healthcare to citizens. This issue has been noted as key for reducing the spread of the disease in any country.

Although the issue of poverty, in and of itself, is one that has been noted to impact the spread of AIDS, Cohen goes on to argue that the proliferation of poverty only further exacerbates the spread of AIDS, by reducing the ability of individual countries to become more economically independent. Cohen notes that in many countries in Africa, the AIDS infection rate is as high as one in every three people. As the number of individuals with this disease increases, the number of able bodied individuals capable of work decreases. With fewer people in the workforce, governments in countries such as Botswana or Zambia do not have the human capital infrastructure to build the economic stability needed for income growth in these countries. As such, the epidemic of AIDS in Sub-Saharan Africa has created a cyclical pattern of economic devastation that continues to perpetuate itself over time.

The economic conditions facing many of the countries in Sub-Saharan Africa has other impacts on the spread of AIDS. Because governments of countries in Sub-Saharan Africa are so poor, these governments are unable to acquire the necessary medications to help those with the disease live healthier lives. At the present time there are a wide range of drugs that can improve the lives of those with HIV/AIDS. However, if the government cannot afford to purchase these drugs, the quality of life for individuals cannot be improved. Until steps are taken to reduce poverty in countries located in Sub-Saharan Africa, the epidemic of AIDS will only continue to grow.

Political Variables

Political problems in various countries of Sub-Saharan Africa are also having an impact on the spread of AIDS in this region. Politics is, of course, a practice that is legitimatized by the culture and socially validated (Lewis 1998). Accordingly, it is "rooted in a community's habits, customs and symbols regarding power, authority, participation and representation, its mores are readily accessible to elites and ordinary people alike. Moreover (and this is a critically important point), a given culture of politics may be altered over time through a process of political learning. A culture of politics is thus the product of a polity's distant and its more proximate political past" (p. 331).

In the Sub-Sharan region, the efforts to deal with AIDS were further strained by the political circumstances, especially within the time frame when the HIV/AIDS virus arrived. Specifically, within the 1980s, there was widespread political turmoil and violence. There were a number of groups rallying for the overthrow of the government and, as a result, the situation became extremely volatile.

There were a number of specific examples that can be used as cases in point, but as Van Der Vliet (2001) finds, "a major feature of black resistance was the school boycott, which saw children in some areas out of school for years at a stretch, or the schools themselves turned into "sites of struggle" for political education. "Liberation before Education" was the call. In 1986, pamphlets appeared proclaiming "The Year of No School." Youth activists--the "comrades" or "Young Lions"-- played a central role in the politics of 1984-1986, often in conflict with township adults, who felt they had lost control over their childrenBetween 1984 and 1986, it is estimated that three hundred children were killed, one thousand wounded, eleven thousand detained, and eighteen thousand arrested on protest charges. As Saths Cooper, a clinical psychologist and activist, has remarked, there was "very little normality in the lives of politicized children. No good familial relationships, no normal schooling, no integrated existence. Norm restraints were non-existent." Whatever fragile social fabric had survived the apar heid years was torn apart by the politics of the 1980s. In the chaos that followed as an unintended consequence of the political struggle, as the sociologist Steve Mokwena has observed, "all forms of control were challenged. Some argue that it was the strategy of 'ungovernability,' preached by sections of the political movement, which is directly responsible for the breakdown of control in the townships." (Van Der Vilet 2001).

As the author further notes, the children of those years, who are now within their twenties and thirties, bore the brunt of the epidemic. Naturally, the government could not have foreseen the possibilities and consequences of their actions, as the realization have the effects of AIDS had not been known. However, today it is. While AIDS is inevitably politicized, [15] the superheated political climate between 1984 and 1994 ensured that people of all ideological persuasions interpreted, manipulated, or ignored it to suit their own political agenda. In the words of Refiloe Serote of the Township AIDS Program: "Political and racial divisions, created and inflamed by apartheid, make everything to do with AIDS political" (Van Der Vilet 2001)

There were no methods of educational reform at the time, at least in regards to incorporating sexual education and AIDS. Some of the countries were conservative, some traditional, and therefore the cultural elements of the society would not allow political officials to implement such a system. In any case, the politicians themselves would not see any pressing issues to introduce such a program. Thus, while the rest of the nations were seriously concerned with the issue of AIDS, Africa's political system would not allow it to become a concern until it was too late. The affects of the neglect issue still linger today, and it is still a major problem in the Sub-Saharan region.

In another study, Swidler (2003) in her examination of the political issues that surround the spread of AIDS in Africa note that while some countries in the Sub-Saharan African region have been willing to work cooperatively with the United Nations and other NGOs (non-governmental organizations), many have been unwilling to change authoritarian polices that significantly impede the ability of Western organizations to improve health outcomes for people living with AIDS. To illustrate this point, Swidler notes the case of Senegal. In this country, the government's willingness to cooperate with Western agencies and the UN has lead to a dramatic decrease in AIDS cases. At the present time, HIV infection rate in Senegal currently less than 1 percent.

The unwillingness of may governments in Sub-Saharan Africa to work with Western agencies has created a significant problem for those seeking to create change in this region. As governments bar or limit the ability of Western agencies to provide care and relief for AIDS patients, the scope and magnitude of the problem only continues to grow. This situation is further exacerbated by the corruption that exists in many of the governments in Sub-Saharan Africa. Widespread corruption has made it difficult, if not impossible, for some Western aid agencies to provide citizens with the resources they need to reduce poverty, improve their quality of life and decrease the spread of AIDS. The various problems that have developed with government leaders in Sub-Saharan Africa have prompted many Western governments to provide very few resources toward combating the AIDS epidemic in this region.

The Impacts of HIV/AIDS on the Future Demographics and Economic Well-being of Africa

At the present time, the current situation that has evolved in many countries of Sub-Saharan Africa is one that only continues to become more exacerbated. As the number of individuals living with AIDS increases, the economic devastation that occurs as a result of this disease continues to perpetuate itself. This is troubling when one considers that few steps have been taken to reduce the spread of AIDS in this particular region. Although the economic devastation of AIDS in Africa has become quite extreme, researchers have noted that this impact has not been felt outside of the region: "Africa'sAIDS catastrophe is a humanitarian disaster of world historic proportions, yet the economic and political reverberations from this crisis have been remarkably muted outside the continent itself" (Eberstadt, 2002, p. 22). This author goes on to argue that:

The explanation for this awful dissonance lies in the region's marginal status in global economics and politics. By many measures, for example, sub-Saharan Africa's contribution to the world economy is less than Switzerland's. [...] The states of the region are thus not well positioned to influence events much beyond their own borders under any circumstances, good or ill-and the cruel consequence is that the world pays them little attention (p. 22).

Unfortunately, when framed in these terms, it is evident that even though the AIDS epidemic will continue to have a negative impact on the development of Africa, it will not impact the global economy. For this reason, developed nations will have no real reason to interfere or help reduce the impact of the epidemic. Therefore, it is plausible to argue that the AIDS epidemic in Africa will continue to worsen and further cripple the economic development of all nations on the continent.

Given the realization of this pressing issue, many organizations, both governmental and non-governmental, have rallied together to stop the spread of HIV and AIDS. There are a number of campaigns run to advocate the use of contraceptives and to show that it is not an evil Western product, but rather that it is meant to help save lives. The United Nations has rallied around this cause, more than 10 years ago, by offering affordable contraceptives to all people. According to Philipson & Posner (1995) "it [The United Nations] defines "ready and easy access" to contraceptives as the state in which "the recipient spends no more than an average of two hours a month to obtain contraceptive supplies and services," and that "a one-month supply of contraceptives should cost less than 1 percent of a month's wages" (p. 835). Moreover, in 2005, the United States government has shipped over a million condoms to the African region, but critics rightly claim that more can and should be done (Donnelly 2005).

On a lighter note, there is progress being made. Ben Barber, a State Department correspondent quoted an official from the AIDS Bureau of Global Health who noted that, "Uganda has been a success, and Zambia looks like it's going the same way. The epidemic went down when prevalence rates went down in young girls. Behavioral surveys show a delay in the onset of sexual activity by two- and-a-half years on average" (Peterson quoted in Barber 2002, p. 62). Moreover, social work that aims to decrease the likelihood of sexual partners among women and men has been working well in that particular area. The difference between Uganda's successes as compared to other nations is that they have support of the government. Therefore, social workers and governmental agencies work in conjunction with one another instead of against one another. Hopefully, the Uganda model can be implemented and change the unnecessary amount of death per year (2.2 million alone died in 1999). In addition, this short success story should not overshadow the severity of the situation. If AIDS is not dealt with, it will keep destroying people, families, and lives. As Nelson Mandela once stated, "In the face of the grave threat posed by HIV/AIDS, we have to rise above our differences and combine our efforts to save our people. History will judge us harshly if we fail to do so, and right now" (Van Der Vliet 2001, p. 172).

Conclusion

In summary, there are clear implications of AIDS in Africa and there are a host of factors that negatively affect the region from successfully establishing an efficient program to deal with the disease. These factors include political, economic, and social factors as discussed previously. Lack of money and scarcity of jobs forces women, men, and, perhaps most unfortunate of all, the children, into prostitution. Thus, the rate of HIV/AIDS increases. Cultural and political issues prevent the countries of Africa from fully understanding the consequences of AIDS and measurements that can protect them from contracting the disease are wrongly viewed as something 'evil from the West.' By working together, these negative affects and erroneous believes can be erased by education. The countries economy and underdeveloped infrastructure can be maintained through the help of non-governmental organizations, the World Bank, and the United Nations. Africa has neither the means nor the methods to deal with the problem by itself. There needs to be continual development in order for the HIV/AIDS problem to be under control.

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