The problem of AIDS in sub-Saharan Africa is gigantic. It is difficult for Canadians to comprehend the enormity of the situation. Both adults and children can be infected with HIV, but if just adults are considered, the numbers infected in some of the southern African countries have reached as high as 30 or 40 per cent. Infection rates in East and West Africa are less than these figures but still remain very high. Canadians can only imagine how they would feel if a third of adults on their street or a third of their extended adult family were infected with HIV.
HIV/AIDS is by no means just a health problem. The socio-economic consequences of HIV/AIDS are found within the family, the community and the country. A good example is school education. If a parent is dying from or has died from AIDS, almost always the children must drop out of school because school fees can not be paid, the children must work to supplement family income or the children are needed at home to look after younger children.
This article draws in part on the situation in Kenya (East Africa), but even though the countries making up sub-Saharan Africa are diverse, much of what is written about the HIV/AIDS situation in Kenya is applicable to other African settings. The article will specifically discuss HIV/AIDS with respect to the church’s role, status of women, AIDS drugs, HIV/AIDS funds and what lies ahead in the foreseeable future.
These days the church in Canada may have a peripheral role in society, but this is not the case in sub-Saharan Africa. The church (composed of Pentecostal, Roman Catholic, mainline Protestant and indigenous churches) is a respected institution with a sizeable membership and has a significant level of influence on the general population and government on moral, social and political issues. Thus, the church could have taken a central role in positively addressing the HIV/AIDS issue. Up until recently, however, the church more or less reneged on its responsibility.
Back in the 1980s and the 1990s the church led the campaign of finger pointing towards those who were infected with HIV. Infection was often said to be equivalent to sin or a curse from God. At times some churches refused to carry out burials of people who had died from AIDS. The HIV/AIDS problem was thought of as a problem of those other people and not of church goers. Attitudes however started to change as church members began dying from AIDS and almost everybody in the church, laypeople and clergy, had members of their own immediate or extended families succumb to AIDS. The stigma of HIV/AIDS created by the church and others, however, remains today.
Opposition from the church over the use of condoms has resulted in HIV infections which could have been prevented. There was and still is a mistaken belief that the promotion of condoms leads to increase promiscuity. The fact is though that those wishing to have sex outside of marriage will do so with or without a condom. The church, however, did not just talk about condoms from a moral point of view, but also from a quasi-scientific perspective. Churches talked of the condom having pores through which the HIV virus could pass. The truth is that such pores are non-existent.
Today, many church leaders and members have acquired the correct basic information on HIV/AIDS and almost all abhor the lost of human life among children and young adults. The church still has a great potential to modify the HIV/AIDS situation.
In training sessions about HIV/AIDS one of the human rights that is discussed, is the right to remain healthy. This discussion almost invariably comes up with the question: what can a wife do if her husband is having sex outside of marriage? After a sometimes emotional discussion, the answer is always, nothing. For a wife to refuse to have sex with her husband in such a situation, just simply goes against what society expects of a wife. Further, few husbands would agree to the request of a wife to use a condom with her. Separation or divorce by the wife also is not a viable answer as most women are not in the position to become financially independent.
Unlike western societies, the majority of people infected with HIV are women. In part this is due to anatomical reasons (the large surface area of the vagina), but another major factor is older men having sex with younger women or girls. The difference in incidence of infection between males and females is particularly marked during the teenage years and the early twenties.
Rape of women and sexual abuse of girls are also contributing factors to the higher incidence of HIV infection in females. The violence involved in rape often results in genital lesions and bleeding in women. These lesions are open windows for HIV to enter.
Women involved in prostitution are at high risk to acquiring and transmitting HIV. The underlying dynamics leading women to practise prostitution has their basis in poverty and social status.
The overall situation of women in African societies however continues to advance. Future generations will see women in a more self-reliant position. This will be reflected in women having a greater control and say about sexual intercourse. Also at present within the general population and among women’s groups and politicians, the serious issues of rape and sexual abuse of girls are starting to be addressed in a more aggressive manner.
There are no drugs that will cure an HIV infected person but there are drugs which will substantially prolong life. These drugs are called anti-retrovirals or ARVs. Much is discussed about these drugs in the news media, especially the price. In the past the cost of ARV drugs was well beyond the means of most Africans, but the price has now decreased allowing many but not all to afford the drugs. Some large donor programmes are also further subsidizing the cost.
The ARV drugs certainly do help individuals and the penetration of these drugs within the HIV infected population is set to increase. Among the general population the drugs are often perceived to be the answer. This, however, is not the case. The drugs must be taken daily for life, need to be medically monitored and still do have a cost (including the indirect costs of transport to the hospital or clinic and loss of income due to taking time off work).
It is the nature of people everywhere to forget to take their medications and this is even more so when drugs need to be taken over a long period. In the case of tuberculosis, drugs are often required for only six months, but after a few months many patients default on taking them. What is needed to contain the defaulter problem is a very good follow-up system, such that, if people do not come to collect their ARV drugs, someone will go to the home to find out why they did not come and to further re-motivate and educate them. In many African countries however the weak health infrastructure makes it difficult for intensive follow-up of ARV drug defaulters to occur on a large national scale.
A further concern of ARV drugs is that the concentrated focus on these drugs is in practice lessening the priority placed on HIV/AIDS education with respect to transmission and prevention.
Most people in Europe and North America are aware that Africa has a large and serious problem with AIDS. In response to the great need to address the problem different organizations and governments have donated funds to Africa. The United Nations has a special fund called the Global Fund, the United States has the President’s Fund and many other countries give bilateral assistance for HIV/AIDS to the individual African governments. In addition there are private secular organizations and churches raising money. These funds from the different sources are used to go towards ARV drugs, orphans and other vulnerable children, home-based care, preventive education and issues of human rights and stigma.
Certainly the need is great and if all funds given for HIV/AIDS were spent appropriately and efficiently by governments, secular agencies and churches, the problem would be lessened. Unfortunately, many funds are not spent appropriately and efficiently. The phenomenon of brief-case non-governmental organizations is large. In these cases, organizations with little infrastructure are formed with the main objective being to get hold of AIDS money for often personal benefit. On the other hand there are examples where outside funding given to governments, secular agencies or churches have proved effective in addressing the AIDS problem.
One of the fall-outs of AIDS funding is that the extent of volunteerism among local populations in addressing some of the AIDS problems has decreased. The perceived perception by many people is that there is lots of AIDS money which should be used to compensate them for performing AIDS related activities. The feeling is understandable in countries where unemployment and under-employment are high, but the lessening level of volunteerism in any type of health or socio-economic intervention is a real loss.
The problem of AIDS in sub-Saharan Africa is chronic; it is not about to be solved soon. Reports by the United Nations always seem to be saying that the problem is getting worse. Without the present-day programmes in place, however, the situation may very well have been far greater than what we are seeing.
It is important that Africa and the world do not get an HIV/AIDS burnout. If year after year one hears about AIDS or sees the consequences without noticeable improvement, an uneasy apathy to the problem can develop. People must realize that there is no quick fix and there must be commitment for many years to come. A local African church congregation that assists a destitute family because of AIDS this year but fails to continue with a follow-up plan in the future does not understand the chronic nature of the problem and the long-term commitment needed. Similarly, western donor countries or agencies contributing HIV/AIDS assistance this year but then abandoning their involvement in later years, also fail to understand the complexity of the problem.
down the road, it hoped that a HIV/AIDS vaccine will become available just like there is a vaccine for measles or whooping cough. Such a vaccine will not totally solve the HIV/AIDS problem but it will make the problem containable. The difficultly in developing the vaccine to date is that HIV is always mutating or changing shape. Present-day technologies require a virus to be stable in shape in order to develop a vaccine against that virus. In the early 1990s, scientists talked about a HIV/AIDS vaccine being ten years away; today scientists still talk about such a vaccine being ten years away.
The sad reality is that today in sub-Saharan Africa death due to AIDS is usually prolonged and painful. The families they leave behind are left with dire socio-economic consequences. Nationally the African states lose young and middle age adults, the very people needed to make the economy grow. The HIV/AIDS problem at family, community and national levels must be approached with a long-term commitment to findings solutions.
