Initiatives of Change - Detailed view of For A Change Articles

BY YAW ADU-SARKODIE
A new commitment has been made by Western governments, especially the UK and US, to devote more resources to fighting HIV/Aids globally. The question on many lips, however, is why has it taken so long?

Since the world became aware of the first clinical case of Aids in 1981, the disease has affected 60 million people. Twenty million are already dead and 40 million are living with the virus or the disease. Over the next decade, without effective treatment and care, they will add to the death toll.

Africa is the continent hardest hit. About 30 million people live with HIV/Aids. This represents 75 per cent of those infected worldwide. Ten million people aged 15-24, and about three million children under 15 years old, have Aids. More than 20 per cent of the adult population in Botswana, Lesotho, South Africa, Namibia, Zimbabwe, Swaziland and Zambia is infected. The next decade will be far worse if effective treatment does not become available soon.

bankrupt
Reasons given for the level of the epidemic in Africa include: ineffective education about the disease; poor health services which still cannot screen blood properly before transfusions nor treat the victims effectively; cultural practices which continue to perpetuate the disease; HIV-infected men sleeping with children in the belief that this will cure them; and, most important, poverty.

Structural adjustment programmes carried out in the last decade by African countries at the instigation of the World Bank have left many of them bankrupt. Very little remains for these countries to undertake social programmes. Local industries in Africa have collapsed under competition with Western and Asian industries which have flooded African markets with cheap goods. Unemployment has risen, and many former rural people now live in urban slums. Unable to find jobs in the cities, many women have turned to prostitution to keep body and soul and their families together. The lack of effective political leadership in the face of Aids, with some countries denying its existence to protect international tourism, has also fuelled the spread of the epidemic.

aids orphans
Aids not only results from poverty, it is a major threat to development. The most productive members of society are, in general, the hardest hit. Family income is being hit by the loss of breadwinners, Aids orphans, and increased hospitalization of the sick. This has led to malnutrition, limited access to education and other social services, and a breakdown of family structures. A drop in the labour force due to disease has had an enormous impact on national productivity. The media tell us that the food shortages in Zimbabwe are due to its new land reform programmes. We are not told about the contribution of Aids. Classrooms in East Africa are battling with a lack of teachers due to this scourge.

What is the way forward? In the developed world during the last decade, the use of antiretrovirals (drugs which prevent the virus from further damaging the immune system) has dramatically improved the quality and expectation of life of HIV-infected patients. Aids is being increasingly seen in these countries as a chronic disease, like hypertension and diabetes.

Unfortunately, of the 30 million Africans with the virus, only 50,000 have access to these life-saving medicines. The signs are that this will soon change if the US, the UK and other Western countries stick to their recent commitments. The World Health Organization (WHO) plans to make the drugs available to three million people by 2005. The Director-General of WHO says that to make this happen, it should not be 'business as usual'. We should acknowledge Aids as a global emergency, big pharmaceutical companies should be more charitable, rich governments should 'walk the talk' and, above all, developing countries should put their health systems in order to make full and judicious use of committed resources.

Would antiretrovirals be the panacea for this global threat? Unfortunately not. We all have a moral responsibility to prevent infections in the first place. The truth is, in Aids as in all diseases, prevention is better than cure. As we propagate the ABC of Aids prevention (abstinence, being faithful to a partner and condom use), we must stress the importance of the A and B just as we do the C.

virgins' club
Most of the population in even the hardest hit countries is still not infected, and children under 15 years of age (except those infected at birth from their mothers) are largely free of the virus. And who says we shouldn't be telling them about the A, and, as they grow up, the B? Do we want the devil to find work for them as they grow? Africa is showing the way. Uganda already has a number of youth clubs addressing this. In Ghana I was recently invited to give a talk to a 'Virgins' Club'. Yes, Virgins' Club! If you think they do not exist for 15-30 year olds, come with me to Ghana!

Dr Adu-Sarkodie is a researcher on sexually transmitted infections and Aids. He is a specialist and lecturer in a teaching hospital in Ghana.