HIV -- AIDS

By Sarah Ruden,The Christian Century.

South Africa has the world’s second largest AIDS epidemic (in gross numbers). Its neighbor, Zimbabwe, ranks first. During the past ten years, while AIDS has come under control in central African countries with far fewer resources, the disease has gone out of control in South Africa, in the richest, most cosmopolitan nation in the whole sub-Saharan region. An estimated 10 million South Africans, out of a population of approximately 40 million, will die of AIDS during the next ten years.

In a recent article in the New York Times, author Nadine Gordimer expresses views about the disease that South Africa is eager to promote and that have wide acceptance in America. Gordimer calls for more money to develop a vaccine, for Third World debt relief, and for less military and more public health spending within Africa. She thinks that, given Africa’s poverty and social malaise, we cannot condemn the promiscuous sex that is spreading AIDS. And she concludes by warning of the epidemic’s economic impact, saying that "the bell tolls for thee, globally."

MONETARY AID LIKELY TO BE REDIRECTED TO THE MILITARY

A critical look at these ideas might help explain why the epidemic continues to rage in the part of Africa with the most resources for fighting it. With a unanimity that invites trust, the scientists working to develop a vaccine have said that the nature of retroviruses itself is the main factor holding up an AIDS vaccine. Third World debt relief would probably not have the intended consequences. The states receiving this relief would be likely to use the public money freed up from social welfare demands to expand their militaries -- and military spending is one of the things Gordimer deplores. That donor countries have been the enablers of Africa’s arms addiction has certainly been the pattern so far.

That the AIDS crisis threatens Africa’s economic development seems unarguable. In central Africa during the early ‘90s, AIDS threatened to become a disease of the middle and upper-middle classes, decimating the skilled trades and professions. The higher a man’s income, the greater his access to sexual partners, and traditions of polygamy encouraged him to take advantage of all his opportunities. The danger this posed for the region’s economic future -- a danger reported in the Western press and widely publicized locally -- contributed significantly to a rethinking of both public policy and private mores. Most important, this threat motivated the public to move beyond apparently inadequate "safe sex" campaigns to more difficult and effective changes. In Uganda, for example, an HIV test now is required before marriage, and the social pressure in favor of chastity has grown markedly.

South Africa is different. Its white and its thoroughly westernized black middle class are not very vulnerable to the disease. The case of Charlene Smith, one of the few white rape victims, became a media sensation. She was able to obtain the drug AZT as a precaution against the transmission of HIV, and to prosecute her attacker and see him sentenced to 30 years in prison to prevent his carrying out his further threats against her.

But destitute rape victims have no such protections. For this and other reasons, in South Africa AIDS remains almost exclusively a disease of the underclass. The prosperous here simply do not share the fate of the poor to the extent common in other African countries. The income gap is wider than in any other nation except Brazil, and the institutional divides left over from apartheid are immense. Consequently, most of the people on the favored side of the prosperity gap do not see AIDS as an eventual or indirect threat to their own well-being.

HIGH UNEMPLOYMENT

Almost 35 percent of South Africans are unemployed. These are the AIDS-vulnerable, uneducated black and "colored" (mixed-race) poor. Unemployment is a major reason for the country’s very high rate of violent crime. Up to 70 percent of the army is HIV-positive. But the military is being drastically cut back anyway; soldiers of the next generation will be both fewer and better skilled. Gordimer cites a prediction that 270,000 out of 1.1 million public servants will be infected by 2004. But nearly as many, mostly from the lower ranks, may lose their jobs through the privatization and rationalization already under way.

Losses of employees to AIDS are an expense and trauma to American institutions, but not to those in South Africa, where people who are HIV-positive hide their condition as long as possible for fear of persecution and die relatively quickly once they have AIDS, since few interventions are available to them. Private charities and extended families take care of the vast majority of AIDS orphans.

Finally, AIDS has been most common in the predominantly Zulu province of ZwaZulu-Natal. The Zulus supported the apartheid regime and are a thorn in the side of the new government, which is dominated by the Xhosas. Commercial interests covet the fertile ZwaZulu-Natal farmland now kept in small subsistence parcels through tribal allotment. Why would policymakers fear that AIDS would have an economic impact on the country? It can make economically superfluous and burdensome human beings disappear.

The above sketch is the only way I can explain the unusual feebleness of South Africa’s attempts to deal with the epidemic. "Sarafina II," the centerpiece of the Nelson Mandela regime’s anti-AIDS campaign, was a glitzy traveling musical that, because it charged admission, did not reach most of its target audience -- low-income black youth. The Health Department then tried to promote Virodene, an industrial solvent with no medicinal properties, as an AIDS cure, and this led to a vicious fight with and estrangement from medical authorities.

The new president, Thabo Mbeki, has become interested in the widely discredited Duesberg hypothesis that the HIV virus is a fabrication and that AIDS is really a set of symptoms of poverty or drug use. Mbeki has also disputed the safety of the widely esteemed drug AZT. He insists on exploring these issues thoroughly before providing rape victims and HIV-positive pregnant women with AZT treatment to reduce transmission of the virus.

Even those who at first appear more forthcoming tend to have an "all or nothing" strategy that suggests a basically dismissive attitude toward the disease. In a recent article in the Cape Argus, Dr. S. P. Reddy (a "health promotion practitioner and HIV/AIDS researcher") argued that AZT could save 50,000 to 100,000 babies a year from HIV. The virus means death before the age of five for nearly all infected infants. The new drug nevirapine’s effectiveness is similar to that of AZT, yet the cost is only a tenth as high, less than $5 per child.

The use of this drug might seem both humane and affordable. However, some children who survived HIV would die later anyway from poverty-induced ailments, Reddy wrote. Why bother with the drug unless South Africa can provide "housing, education, clean water, health clinics, health-worker training, and nutritional supplements" as well? Thus, the "full ramifications [of the drug treatment] must be carefully researched and costed."

Reddy’s rationalization is fairly representative of views popular with the government and the development elite, who strive to keep the international and local media’s attention on South Africa’s AIDS crisis in order to foster foreign aid and grass-roots projects. When I asked a community worker in Cape Town’s squatter camps what ordinary people were saying about AIDS, she replied, "They think it’s a way for people to get jobs." There is a breath of truth in this version of an AIDS conspiracy theory.

A subcategory of the "all or nothing" approach is purveyed by organizations like Planned Parenthood, which teach "life skills" in the hope that young people will become sexually prudent as part of an integrated improvement in their lives. Participants in programs get information, encouragement in self-esteem and training in social interaction, but no actual prescriptions for behavior. Also, community health workers distribute contraceptives and treat sexually transmitted diseases on the spot. The workers are carefully chosen as ethnically and culturally similar to the people they work with, and trained to communicate within their milieu instead of imposing alien ideas.

The planners seem to have imbibed from the study of population control (especially the notorious coercion used in China) a dogmatic opposition to "targeted" approaches. Their scruples are commendable, but whereas failure to promote contraception means unwanted children and overpopulation, failure to combat AIDS means mass death. Can organizations say with equal conviction in both cases that clients should simply be free to choose, with no pressure of any kind?

AIDS NOT LIKELY TO CAUSE ECONOMIC CRISIS IN SOUTHERN AFRICA

AIDS is not causing, nor is it likely to cause, an economic crisis in southern Africa. That is the real reason why the epidemic is not being dealt with effectively there. Perhaps half-consciously, certainly imperceptibly to Western media, a narrowly economic understanding of public welfare is allowing millions of people to die. What’s neeeded is a call to action based on what the epidemic actually is: a humanitarian catastrophe resulting mainly from irresponsible sexual behavior. Against South Africa’s cultural and economic background, the only hopeful efforts to mitigate and control AIDS that I see are coming from the churches.

Churches feel obligated to make spending money on medical care a priority, even if the only outcome is likely to be the temporary relief of suffering. The South African Council of Churches has helped to establish a number of home-based AIDS care groups. These relieve overcrowding in hospitals, allow for the dignified treatment of patients and help destigmatize the disease. The churches undertake unglamorous charity work such as collecting food for AIDS victims and their families and caring for children with AIDS and AIDS orphans, as in Cape Town’s Nazareth House, a Catholic outreach.

Education efforts are mostly in the early stages, but are growing rapidly. Many churches have fitted their traditional teachings about chastity and monogamy into programs to fight the disease. One example is the ZAP AIDS Project, under the auspices of Catholic Welfare and Development. ZAP AIDS does its work in public schools, prisons, churches of many denominations, and shelters for street children.

Denominations are not unanimous in their definitions of sexual morality, but their disagreements are limited to questions that, in Africa, have little to do with AIDS. Homosexuality is a contentious issue within the Council of Churches, but in South Africa homosexuals are a relatively low-risk group for AIDS. (Arguing this, an actively homosexual man recently went to the Human Rights Commission and won the right to donate blood.) Another question is whether condoms should be available to those who do not accept monogamy. Even the liberal churches strongly urge monogamy, though not insisting on legally binding or heterosexual unions.

The "safe sex" controversy is perhaps the most unfortunate distraction in the fight against AIDS, not least because it has restricted cooperation among the churches. The more permissive of the mainline churches staunchly defend condoms, a resource that has been important in combating AIDS in the industrialized world. But the use of condoms is at odds with some aspects of African culture. In many regions of southern Africa, men prefer dry sex, and some women even take pains to dehydrate their vaginal canals. Without natural or artificial lubrication, condoms tear and come off.

HIGH RESISTANCE TO CONDOMS BY MALES

Though the Western myth is that the Catholic Church in the Third World is retarding public health measures for the sake of a theological nicety, that is certainly not the case on this continent. African men’s resistance to condoms is already considerable. Condoms are imported by the ton and given away by the double handful -- and hardly used. In TB eradication campaigns, the overreporting of people’s cooperation with medical advice is measurable (chemical tests show whether patients have taken their pills or not) and quite high. If appropriate adjustments were made to the statistics for reported condom use (in the few programs that actually follow up distribution with surveys), the already modest numbers would shrink to practically nothing.

Reasons for not using condoms vary in Africa, as they do everywhere, but one is particularly strong. African men, the decision-makers with most of the power, tend to believe even more than do African women that sex is for procreation. Activists paddle upriver in working against this belief, and they must work against it in promoting condoms, the most confrontational of modern birth control methods.

The churches would do better to forget about condoms and put their energies into what they do have to offer, which they themselves fail to appreciate fully. Their stance for chastity and monogamy, often labeled as "unrealistic," is actually much better suited to African culture, especially in its present troubled condition, than are modern Western teachings about sexuality emphasizing personal freedom and individual development.

For many women in southern Africa today, heterosexual intercourse is either coercive or deceitful in some way. Either a woman is actually raped (South Africa has the highest rate of rape in the world; the rumor of the "virgin cure" has sent male AIDS patients on the hunt for younger and younger girls to rape), or she is pressured socially and economically. Women do not believe they have the right to disobey men, and wives and girlfriends are desperately dependent on their men. Extreme poverty may force women to become prostitutes in order to survive. And many women do not know and are afraid to ask whether a man has other partners.

ANARCHIC SEXUAL PRACTICES

A nurse and midwife who routinely deals with AIDS in families lamented the effect of anarchic sexual practices on the spread of the epidemic. She was especially concerned about the attitude of young men. Xolisa, 15, said that she and her friends were regularly harassed, chased and grabbed, sometimes in public. "They try to drag you inside -- you have to get away," she said. As a veteran of Planned Parenthood education, she was fully aware of and articulate about the danger of AIDS, but she was facing that danger alone. The police were "useless," she said, as the media also assert.

Xolisa and other young people I spoke to confirmed that parents typically retain the traditional notion of choosing spouses for their children, but put it into practice only to the extent of refusing to meet boyfriends and girlfriends or even acknowledge that there could be any. (An alarming custom is for the parents of a teenage boy to build him a small, private hut behind the family home; girlfriends can meet him there, unseen by his family.)

Young people are thus left to negotiate their relationships without guidance from the people most interested in their welfare. Peer pressure, heavy-handed seduction and rape are the outcome, with predictable victimization of young girls by older boys and grown men. AIDS spreads more easily from men to women than in the opposite direction, and traumatic sex, with the tearing of tissues, is the easiest route to sexual transmission.

The most reassuring message to a typical African girl is that her community will protect her from early, chaotic sex and that she will be able to marry a man indoctrinated against adultery and raise her children in safety. Trying to get someone so powerless to "take responsibility for her sexuality" is a cruel joke. With family and tribal structures pathetically weakened by colonialism and apartheid, and the government inept and indifferent, the only institution even seeking to make these all-important promises is the church. Though these promises cannot always be kept, they are far more practical than projects to "foster every individual’s right to his or her own unique development" -- projects that make no sense in the African context.

A return to chastity would be a return to a workable African society. Gordimer states that "promiscuity is difficult to condemn when sex is the cheapest or only available satisfaction." That is an obstacle only insofar as human activity is a laissez-faire marketplace. That marketplace begins to turn into a community when people insist that all its members have a future to protect, so that it is unacceptable for any to behave irresponsibly.

RETURN TO MORAL BEHAVIOUR

Muslims as well as Christians have strict views on sexual conduct, and even animists are expressing their desire to restore older mores. (Credo Mutwa, a leader of traditional healers, appeared in the Cape Argus recently speaking of ancient practices involving voluntary quarantine, which he claimed defeated earlier waves of venereal disease introduced by colonial forces.) But the Christian churches are strongest and best positioned, and therefore bear the greatest responsibility for demonstrating what can be done.

What the churches are doing is not enough to contain the epidemic, but they are ensuring that many of their members survive it. Keith Benjamin of the South African Council of Churches reports that in a group of 25 clergymen interviewed, not a single one had had to deal with a congregant who was an AIDS patient. He sees the clergy’s distance from the disease as unfortunate, but I think that he has missed the good news. Among those who feel bound by it, what the churches say about sex is life-saving.

Ironically, a disproportionate amount of the credit goes to conservative black churches with no AIDS programs and no specific AIDS message -- the churches regularly accused of having their heads in the sand. Most black churchgoers belong to these denominations. (The Zionist Church alone has 3.9 million members; this single institution keeps nearly one out of ten South Africans relatively safe from the new plague.) Lucy is a 26-year-old who attends the Gospel Church of Power in Guguletu, a squatter settlement near Cape Town. She said her church had nothing to say about AIDS. No one in the church had AIDS. All its members were very strict about marriage.

Some churches do go too far, and ostracize the few AIDS sufferers they have to deal with. In the mainline churches, certain parishes have refused pastoral care to victims and their families. Some of the conservative black churches have an actual policy of exclusion, which extends to a ban on church burial. This is, of course, inexcusable for any people professing to follow the teachings of Jesus -- but it is somewhat understandable, given the churches’ own weakness and exclusion in South Africa. The apartheid government shut down mission institutions and defamed religious proponents of racial equality. Churches’ commitment to nonviolence (and in some cases refusal even to take sides) diminished their influence with the liberation movement, and consequently with the new government, if not the whole new polity.

But the absence of economic incentives to fight AIDS might make an observer feel, apart from any moral, sectarian or theological considerations, that a religious revival alone can save South Africa from eventually consigning perhaps a third of its population to death. This is my own conclusion, although I am a Quaker, a member of a sect that is liberal and tolerant almost to the point of being secular and that frowns on proselytizing. I simply see in this part of the world the greatest practical need for churches to do what they ordinarily do, and to do more of it.

[Sarah Ruden is a freelance writer living near Cape Town, South Africa. This article appeared in The Christian Century, May 17, 2000, pp. 566-570]

[Australian Foreign Press, Sun Nov 19, 2006]

Zimbabwe has the highest number of orphans in the world in relation to its population, mainly due to the HIV/AIDS pandemic blighting the economically ravaged country. This was revealed by James Elder, a spokesman for the UN's Childrens' Fund UNICEF.

Zimbabwe's HIV infection rates are currently at 20.1 percent, down from 24.6 percent two years ago. At least 3,000 people die every week from AIDS-related illnesses in the country of some 12 million people, which is grappling with four-digit inflation, huge shortages of food and fuel, and spiralling unemployment and poverty.

According to the latest UN report, southern Africa is home to 14.9 million people living with AIDS, or 38 percent of the worldwide total of 38.6 million people at the end of 2005.

The country's ailing health sector has meanwhile suffered a gigantic blow with more than half of key medical professionals seeking jobs overseas, according to a report in a state-run weekly earlier this year. "The economic crisis makes it much harder to look after these orphans, whereby 90 percent of these orphans are cared for by extended families," UNICEF's Elder said.

"The (economic) crisis makes it harder to provide for basic services which children need, such as education, nutrition and health care." Meanwhile, an alliance of local child rights group Sunday expressed concern on the growing incidence of child abuse. The Child Protection Working Group (CPWG) said there were 8,600 cases of child abuse in Zimbabwe last year.

"That is 24 every day, or one every hour," the CPWG said in a statement. "More than half of all cases reported involve sexual abuse of children."

The statement said the rise in child abuse could in part be attributed to prevalent myths such as the belief that AIDS and sexually transmitted diseases could be cured by having sex with a virgin.

"This is the most repulsive of myths," Betty Makoni, director of Girl Child Network, one of the members of CPWG, said. "The time has come for all Zimbabweans to speak out and act against the abuse of country's children."

During the first nine months of this year, Childline, another rights group, reported 34,000 calls, "or more than five every hour, on children's issues." Childline said in a statement that 70 percent of the calls were related to child abuse.

Rachel Tongoona, an official with the Girl Child Network, meanwhile expressed concern on judicial delays in dealing with child abuse cases. "Some cases take two years to start and at times the child ends up giving conflicting information in court and the case is dismissed," she told AFP. "Most of the cases we handle -- 93 percent relate to the girl child and seven percent for the boy child. There are also cases of sodomy reported."

UNICEF's representative in Zimbabwe Festo Kavishe said in a statement that community leaders should help stop child abuse. "Fears of reprisal and families' willingness to reach settlements deepen a culture of silence and enable the problem to fester undetected and unreported. For the sake of Zimbabwe, this cannot simply continue."

UNITED NATIONS - Although some real progress has been made to reverse the HIV/AIDS epidemic in Latin America and the Caribbean, experts say huge gaps persist in the actions taken by governments in the region.

"There are countries like Brazil and Argentina, where there is a high HIV/AIDS incidence but also a positive government response to the issue. And you can find countries like Bolivia, where there is neither legislation nor money available in the federal health budget to address AIDS," Gracia Violetta Ross Quiroga, a Bolivian civil society representative from the group REDBOL, and who found out she was HIV-positive in 2001, told IPS.

Quiroga was in New York attending the 2006 High-Level Meeting on HIV/AIDS, which took place at U.N. headquarters. She said she was disappointed that there were so few Latin American government representatives at the summit."My country, for example, didn't send even one official," she said. "They need to understand that there are other important issues beyond coca." Luiz Loures, associate director of the UNAIDS Global Initiatives Division, told IPS that, "This low presence of Latin American representatives shows its low commitment to the HIV/AIDS epidemic." However, he emphasised that some Latin American countries are making sincere efforts to deal with the disease and "we must recognise the strong presence of countries like El Salvador or Brazil, which sent to New York, respectively, its national president and its minister of foreign affairs."

Haiti and Cuba offer a stark example of the paradoxes seen in the Latin America and Caribbean region. Although they are less than 50 miles apart, the two islands are completely different worlds. Haiti has the highest prevalence of HIV/AIDS in all of Latin America and the Caribbean. According to the UNAIDS latest report on the pandemic, 3.8 percent of adults aged 15 to 49 are infected. This adds up to 190,000 Haitians living with HIV.

"Haiti's prevalence represents 60 percent of all Caribbean infections, and if you add to that the Dominican Republic, which shares the same island, it's about 80 percent of HIV in the entire region," Evan Lyon, a doctor working with the group Partners in Health, which assists people living with HIV in Haiti, told IPS.

"On the other hand, Cuba has one of the lowest HIV incidences in the world," he said -- less than 5,000 thousand people, or 0.1 percent of the population. According to the UNAIDS report, while 100 percent of Cubans infected with HIV get antiretroviral therapy, only 20 percent of HIV sufferers in Haiti have access to life-saving drugs.

U.N. Secretary-General Kofi Annan noted at a press conference earlier that HIV/AIDS rates are directly related to poverty. Because of that, he stressed, "The Millennium Development Goals (MDGs), the eight goals, including the goal of dealing with HIV, are focused on poverty." Haiti ranks number 153 in the U.N. Development Programme's Human Development Index, while Cuba is number 52. Lyon pointed out that Haiti's high HIV/AIDS rate is also rooted in its history of political and economic instability, just as Cuba was spared in part because of its relative isolation. "HIV arrived in Haiti by tourism and sex tourism. That didn't happen in Cuba. Because of the U.S. embargo, not so many U.S. and European tourists used to visit Cuba in that time (when the disease was taking root)," he said. Even Haiti has seen some progress over the last decade. "HIV infection levels have decreased in urban parts of the country... and the percentage of pregnant women infected in Haiti declined by half from 1993 to 2003-2004, notably in urban areas where prevalence fell from 9.4 percent in 1993 to 3.7 percent in 2003," UNAIDS said.

However, the report shows that more than 40 million people around the world are now living with HIV. The epidemic is responsible for over 20 million deaths and the toll is growing each year. About 1.8 million people live with HIV in Latin America. In 2005, 66,000 people died of AIDS and 200,000 were newly infected. Among young people 15û24 years old, an estimated 0.4 percent of women and 0.6 percent of men were living with HIV last year.

The Caribbean is the second most-affected region in the world after sub-Saharan Africa, with an HIV rate of 1.6 percent. More than 330,000 people live with HIV there, and half of them are women.

"The region has been doing a good job in regards to treatment, but needs to break taboos ands stigmas to start to deal with prevention," Loures told IPS. In recent years, the number of women infected in Latin America and the Caribbean region has been rising. "This increase means that we are not doing what we need to do," Raquel Child, an HIV/AIDS prevention specialist at the U.N. Population Fund, told IPS. "Investigations show that the main reason for this is informal relationships and bisexual relationships. But many countries keep insisting on the idea that heterosexual relationships are still the main problem," she said.

Loures offered a starting solution to the epidemic in Latin America. "What is needed is a combination of three things: governmental decision, availability of resources and social mobilisation -- which may be the most important one -- for an open discussion in society and the implementation of real measures."

HEALING THE DIVIDE

Visit the website: HEALING THE DIVIDE

[Washington Post, February 1, 2007]

01, 2007] The US House of Representatives on Wednesday approved by a 286-140 vote a $463 billion spending resolution (HJ Res 20) for fiscal year 2007 that includes a $1.3 billion increase for international HIV/AIDS, tuberculosis and malaria programs, the The resolution would bring the total for the President's Emergency Plan for AIDS Relief to $4.5 billion.

PEPFAR is a five-year, $15 billion program that directs funding for HIV/AIDS, TB and malaria primarily to 15 focus countries and provides funding to the Global Fund To Fight AIDS, Tuberculosis and Malaria. The $4.5 billion for PEPFAR includes $3.2 billion for the State Department's Global HIV/AIDS Initiative, $712 million for USAID's Child Survival and Health Program, and $494 million for CDC and HHS global HIV/AIDS activities, according to a House Appropriations Committee summary.

Of these amounts, $724 million would be allocated for the U.S. contribution to the Global Fund, with $625 million coming from the State Department and USAID, and $99 million from HHS. In addition, $248 million would be allocated to expand programs under the President's Malaria Initiative, an increase of $149 million. The resolution also allocates an additional $75.8 million in funding for the Ryan White CARE Act, which provides care and services to people living with HIV/AIDS in the U.S., to bring its funding to $1.2 billion (Kaiser Daily HIV/AIDS Report, January 30).>/I>

"With the increase ... the U.S. is much better placed to go to other countries and urge them to increase their contributions" to the Global Fund, the Global AIDS Alliance said. According to GAA, there were 4.3 million new HIV/AIDS cases worldwide last year, and outbreaks of malaria and drug-resistant TB continued (Cowan, Reuters, 1/31). "Given the incredibly difficult budget situation, the U.S. Congress made a bold decision to help those affected by AIDS, TB and malaria around the world," Natasha Bilimoria, executive director of Friends of the Global Fight, said (Friends of the Global Fight release, January 31).

"What House and Senate leadership have proposed on HIV/AIDS is nothing short of heroic," Pamela Barnes, president and CEO of the Elizabeth Glaser Pediatric AIDS Foundation, said, adding, "We were facing a nightmare situation where treatment for hundreds of thousands of people was seriously threatened" (EGPAF release, 1/31). The Senate must pass the continuing resolution by Feb. 15 to prevent a "partial government shutdown," the Post reports. The White House has indicated that President Bush will sign the measure if it is approved.