Aids in Africa: Demographic Transition - Essay Example

Running Head: AIDS IN AFRICA: DEMOGRAPHIC TRANSITION Aids in Africa: Demographic Transition [The [The of the Aids in Africa: Demographic Transition Introduction Africa is the worst hit continent in the world by HIV/AIDS. Botswana has 35.8% of its adult population infected. South Africa comes second with 19.9% infected with HIV. Zimbabwe life expectancy has dropped from 65 to 43 years as a direct result of HIV/AIDS. In Zambia one quarter of the city population is infected and one in seven people are infected in rural areas (Feachem 2007:Internet). In contrast to this these tragic statistics, in Uganda, there is now a real prospect of an almost AIDS-free generation of high-school-age children (anon2 2006:Internet). This is due to the intense effort of government and non-government organizations to push large-scale media and education prevention programs since the mid eighties. Resulting in a drop of infection from 14% of the population in the early 1990s to 8% in 2000 (Feachem 2007:Internet). Africa is a beautiful continent with its many countries, animals and diversity. Despite these positive aspects, Africa is suffering from one of the worlds worst AIDS epidemics. Every Saturday, nearby cemeteries are busy with the arrival of people who have died from AIDS. It is said that in South Africa, one of every ten people has AIDS. Some 17 million people in Africa have died representing almost 80% of AIDS deaths worldwide. This is the equivalent of the combined populations of New York City and Los Angeles. There is a conspiracy of silence fuelling the spread of HIV in Africa. For example, in Johannesburg, it has one of the fastest growing infection rates for around. AIDS is now South Africas leading cause of death. By the year 2010, HIV prevalence in adults is projected to reach 25% of the total population. South Africa is projected to have the highest AIDS death rate until 2015. At that point, the population will have decreased to the point that the death rate will no longer be as high as in other areas. Demographics show that those most affected by AIDS are women and children. African women and children have been particularly hard hit by AIDS. When it comes to sex in Africa, the man is always in charge. Girls and women are often forced to have sex and are punished if they resist. There is a belief in some areas that having sex with a virgin can cure an infected man. As a result, 12-year-old girls become infected. Men rarely know they have AIDS, because males widely refuse testing until they fall ill. Many men who think they may have AIDS just embrace it as if nothing is wrong until they get sick. They take the attitude that "Im already infected; I can sleep around because I cant get it again." Meanwhile, they may be passing on the infection to unsuspecting African women. The women then unknowingly pass it on to their children. Currently there is much stigma attached to the use of condoms and to the subject of AIDS. Common myths, fear of social reprisal and old traditions inhibit much of the populations from using condoms (Dossier, 2005). Condoms are seen by many in Africa as the white mans means of keeping the black population down (Dossier, 2005). If condoms are requested in personal sex situations it is seen as a violation of trust and intimacy. In brothels the lure of financial gain and fear of client refusal, added of course to the ever-present fear of physical abuse from clients, are the primary reasons for not using condoms (Health Transition Centre, 2004). Success of these measures could be seen within two years, with STD rates in brothels falling steeply, and HIV prevalence among army recruits declined by two thirds (Health Transition Centre, 2004). Expected Prospective Response Against aids in Africa Nudging government along, complementing and sometimes substituting for official programmes, have been efforts by mission hospitals, churches, NGOs, community-based organisations and concerned individuals. This response has reflected a genuine outpouring of compassion and concern for fellow human beings as well as an attempt to channel anxiety in productive ways and gain some control over an unwelcome and frightening threat to well-being. The dynamics of these non-official or non-governmental responses bear some resemblance to those which occurred in North America and Europe during this same period. In the African context, however, community action was not so much a consequence of the vacuum left by governments, initially unwilling to acknowledge the threat of the crisis and to come to the aid of a section of the population already stigmatised by what some regarded as aberrant sexuality. There was considerable denial among the ranks of government officers in African countries, as elsewhere, followed by scapegoating and finger pointing. However, the fundamental problem was less unwillingness to act than lack of resources, exacerbated even further by the effects of structural adjustment directives. Collective action at community level has been encouraged in Tanzania and Zambia, as across much of the continent, precisely because of the limited capacity of governments to meet the needs engendered by the emergency. However, those at the ‘grassroots’ are also hampered by limited resources. Some initiatives have therefore drawn on existing organisations, informal networks or NGOs. Some have obtained assistance from the donor community. Several examples can serve to illustrate how early in the epidemic a range of specific interventions were devised and put in place. Another important feature of the prospective preparation of war against aids in Africa is to provide the patients with the best available resources and consultancy services even at their door step. The argument in favour of home-based care is partly financial, given the assumption that it provides a less expensive alternative to hospital care. It partly follows, as well, from the related problem of limited hospital facilities. Advocacy of home care is also related to the nature of HIV/AIDS, which may involve a series of crises interspersed with periods of relatively good health over months or years. Chikankata not only pioneered and publicised this type of programme, but also offers training to others wishing to adapt it to their specific needs. In Zambia, some home care programmes have been run by hospitals or health centres, and others by churches or community organisations, reaching a combined total of at least 500. Action around AIDS directed at both prevention and care involves the exercise of great compassion and creative utilisation of existing expertise and organisational capacity. It often reflects a process of learning, adapting and seeking more appropriate means of effective intervention. Although local initiative and ownership have been crucial to sustainability from the beginning, collaboration has also been an important hallmark of efforts. Patient Education Campaign as a Tool to Avert Demographic Transition The importance of education was seized on early in the epidemic and encouraged by external advisors on the assumption that it was ignorance which led to risky sexual behaviour and spread AIDS. Government as well as community based activities have included awareness campaigns, training of those otherwise involved in the spheres of health and education, incorporation of AIDS education in schools and development of peer education and collective learning initiatives. AIDS training has been extended to groups who deal with health and education matters in the hope that this will improve their own practice and enlist them in the teaching or advising of others. As well as those in the formal sector, attempts have been made to liaise with and offer training to traditional healers, traditional birth attendants and traditional educators, and to integrate them into government or NGO initiatives. The importance of work with traditional healers cannot be underestimated, given the extent to which so many, especially in the rural areas, turn to their services, by choice or in the absence of adequate local medical facilities. (Wohlgemut, 2004) For all the strengths and accomplishments of AIDS programmes in Tanzania and Zambia and their development of innovative techniques and new skills, there are many problems, with continuing gaps, and extensive unmet need. Despite recognition of the importance of co-ordination, pooling of efforts and utilisation of knowledge gained from experience; there remain instances of wasteful competition, uneven geographical coverage, duplicated effort, and repetition of strategies which have elsewhere met with limited success. Despite the relative success of awareness campaigns in increasing knowledge about AIDS, encouraging more open discussion about sexual behaviour and inducing some behavioural change, progress in these areas is far too restricted and at too slow a pace given the urgency of the situation. Lam Ideologies and orientations which have guided some partners, such as religious groups, have not always been helpful. While their assistance is critical, donor preferences have sometimes dictated a direction and substance of activities at variance with what local activists or government personnel might have preferred. Most fundamentally, problems of resourcing programmes have continued to dog efforts around AIDS and have led to the serial demise of many initiatives to the repeated frustration of both potential beneficiaries and local facilitators. Gender Issue and Demographic Transition in HIV Stricken Africa The argument that, women are placed in a disadvantaged position in the face of AIDS by cultural practices and by their economic dependence on men, are explicit in official documents and are broadcast through the media, but this insight rarely translates into official programmes, NGO activity or project work. If anything, there is a continuing tendency to focus on women rather than on gender relations and, in spite of apparently adopting a gender discourse, to continue to treat women as merely victims. Concern with structural bases for vulnerability has led to initiatives promoting income generation for widows or ‘rehabilitation’ of sex workers, and the need to ensure the education of girls as a means to forestall the epidemic has been recently highlighted. (Lancaster, 2006) However, it is rare for a link to be drawn in practice between income security and the ability of women to ensure protection against HIV, or to address the relationship between unequal power relations in public and private spheres. Tanzania’s third medium term plan asserts that the promotion of income-generating activities amongst sex workers ‘empowers them to negotiate for safer sex’, but there has been little attempt to assess the validity of the hypothesis that greater income security yields greater protection. Community-based actions around AIDS Community-based activity has been affirmed in official policy documents as necessary and crucial to the fight against AIDS, given limited resources and capacity of central governments. The logic in favour of more widespread participation, greater inclusiveness and indeed greater democratisation may be implicit in the very nature of the AIDS epidemic itself. Although this societal crisis frequently elicits denial and initially repressive responses, it has the capacity to engender greater openness. By creating dilemmas which cut across class and interest group solidarity and threaten development, it necessitates the involvement of existing networks within, but also co-operation across, countries, potentially leading to greater justice and equity. In Africa, the context of demographic transition is very different, given that all sexually-active adults are potentially at risk. However, professionalisation is again at issue, this time more clearly exposing class relations. Activism in Africa often begins as self-help, like gay activism in the West. In confronting the unprecedented and ever-expanding crisis of AIDS, the voluntary self-help group is quickly overwhelmed. In seeking funding, devising ways to approach benefactors and recruiting paid workers it is forced to routinise its operations. For some, this expansion becomes an additional or even alternative motive for action, an opportunity for income, for a career, for class mobility. The question is whether the professionalisation it embodies also creates a disabling distance between those who suffer and those who ease suffering: the former becoming ‘clients’ and dependants rather than fellow human beings at risk. Women are disproportionately drawn into this work as stereotypical carers of the sick, but now they too are drawn into the professionalisation process. Becoming involved in helping those who are moral outcastes might be contagious, putting their professionalisation in question. The transgressive nature of the work may jar with what women are supposed to know and how they are supposed to behave. Evaluation of the activities of AIDS organisations needs to be set in this critical moment of change—in an international climate where civil society is promoted against the state, and locally, in ongoing struggles around class and gender. All of these contested developments are manifest in AIDS activism in Africa. (De Cock, 2005) Despite the seemingly obvious association between AIDS and poverty in Dar es Salaam, AIDS activism was not generated in such contexts. It came rather out of the leafy suburbs and the campus, the social milieu of the educated and comfortably-off, those whose world was shattered by the realisation that their income, their modern knowledge and familiarity with scientific facts could not protect them from this invisible killer. Accounts from two activists, both children of University teachers, illustrate the compelling impact of personal affliction on the decision to become involved. In both cases a sibling died of AIDS—these were amongst the first recorded cases in the capital. The bereaved were still struggling to make sense of how the victim had become infected. In one case they blamed socially unacceptable sexual liaisons—adultery, but in a context of oppressive family relations that had led to a forced marriage. In both cases their misfortune brought them cruelly into the public eye. People had just begun to hear about AIDS and they were overcome with a morbid curiosity, which quickly turned into stigmatisation of the sick and their relatives. ‘In Africa…when you hear somebody is sick you must go and see the person. So they will come at home to visit us and you welcome them with ‘soda’ (soft drinks) and maybe they are afraid to use your glasses—and then you feel bad’. The speaker was still at school and she found school friends avoiding her: ‘they don’t want to study with me because I have a brother who has HIV. It has been written that governments in sub-Saharan Africa do not want to be actively involved in the fight against AIDS, fearing the possible consequences of official involvement to be worse than that of the AIDS epidemic itself (Health Transition Centre, 2004). Global pressure and growing evidence of the destruction caused by HIV have caused global meetings to occur however, where solutions have been sought and proposed to the world arena (anon2 2006:Internet). The best prevention of HIV transmission is abstinence and condoms. As sub-Saharan Africa is a largely polygynous group of populations, the question of not having multiple partners in order to slow the rate of infection is not a realistic or immediate approach in fighting HIV. Therefore attention must be focused on condom use. It has been suggested to support indigenous manufacture of condoms, thereby creating jobs whilst supporting safe sex (Barton, 2001) This would also help change the perception of condoms as foreign. Many religious groups are constantly slowing down progress against HIV, due to condemnation of the use of condoms. However, it is clear that people are not using condoms, yet still having sexual encounters with multiple partners. In order to work together in the fight against HIV/AIDS, religious differences must be put aside, including the push not to use condoms. Sub-Saharan Africa has consistently exhibited the highest mortality in the world, and the lowest educational level (Health Transition Centre, 2004). Education is an extremely important aspect in the reduction of the prevalence of HIV/AIDS in sub-Saharan Africa. As shown by results in Uganda and practically any country where bold education programs have been set up, simultaneously casting aside the fears of talking about sex and AIDS without shame and promoting a healthy and safe attitude toward sex, and health in general, HIV has been slowed and in some cases reversed (Feachem 2007:Internet). By using leadership in these areas, children and adults are not only empowered by their acquired knowledge to protect themselves, but also to inform and protect others. Questions of morality and shame are foolish when considering the amount of people infected and unarmed of knowledge that can prevent them from an early grave. It is for the individual to decide their attitude toward HIV/AIDS. To deny knowledge or misinform people of the existence, prevention and treatment of HIV because of moral, traditional and religious issues is, an obstruction of the human right to live. Therefore education programs need to be in place from early childhood and throughout the workplace. The source of Aids education needs to be trusted by the people that are receiving that education, and denial of HIV/AIDS must be overcome before education has a chance of working. Knowledge of the HIV pandemic is just not enough. However, awareness that one can become infected with HIV and that one has the power to decrease their chances of becoming infected, greatly increases the possibility of one taking measures to protect oneself, such as employing safe sex methodology. This awareness is tapped into mainly by employing fear. Hence educators need to understand people’s fears in order to access those fears to promote behavioural change (Dossier, 2005). Living standards and medical standards play a major role in prevention and treatment of any infectious disease. The Organization of African Unity (OAU) launched an appeal for international support. Africa needed to do this because it is a developing continent. This brings us to the difference in living standards evident throughout the world and, the correlation between poorer living standards to the prevalence of infectious diseases, which, is extremely strong. The only way to address the spread of HIV is through lifting the standard of living. This is only possible with the abolition of third world debt (Anon2 2006:Internet). Sub-Saharan Africa now has 40 countries with national HIV/AIDS strategies (anon2 2006:Internet). Yet the fruit of these strategies may not be fully seen for decades. Because immediate results may not be evident, world politics has a tendency to forget pledges and programs that have been set up, thus slackening them or abandoning them, totally ruining previous hard work. Money spent on vaccines (anon2 2006:Internet) must come second. For the cure does not rid the world of the problem. Vaccines played only a minor part in the epidemiologic transition in developed countries. Medicine on its own has not helped the epidemiologic transition in sub-Saharan Africa, rather it has doubled the burden. For now the poor are still dying of infectious diseases and the rich also dying of chronic diseases.( Eckert, 2003) Steps Taken to Avert this Demographic Transition Various African governments have made numerous attempts to control this devastating and destructive disease. Major Rubaramira Ruranga, of Africa, was one of the first HIV/AIDS virus activists in Africa. He started an HIV/AIDS virus rally; this was a brave act in Africa, where few activists, let alone army officers, ever admit to having the HIV/AIDS virus. He also set up a network for people living in Uganda with the HIV/AIDS virus. Many new approaches are being taken to battle the HIV/AIDS virus by Africans now as well. The idea of abstinence is being further stressed to women as well as men in Africa. Safe sex by means of condoms is also a widely taught method. Using condoms once thought of as a sign of mistrust or intent of adultery is now more extensively accepted by the African culture because of the severe reality of this disease (Hunter, 2003). The Zulu, also promote that young African girls pass a "virginity test" and are rewarded if they do with a certificate (Hunter, 2003). The Kenya Aids Intervention Prevention Project Group, which is based in Kenya Africa, also hopes to make a difference in the HIV/AIDS virus battle. The Kenya Aids Intervention Prevention Project Groups philosophy is to help people help themselves, which seem to be working, because of their immense achievement of helping 30,000 individuals and families per year (Kalipeni, 2003). It is great organizations like this with their admirable intents that will help Africa start to put an end to the war of the HIV/AIDS virus. Countries outside of Africa are also taking different approaches to help the African countries slow down the rate of HIV/AIDS virus cases. Awareness is the biggest tool in the prevention of the HIV/AIDS virus. Many organizations try to pass their knowledge of the brutal effects of the HIV/AIDS virus in Africa. Another commendable organization is the Grassroot Soccer association. "Grassroot Soccer is composed of former and current professional soccer players who have played around the world including Zimbabwe. The aim of Grassroot Soccer is to reduce the spread of HIV & AIDS by training well-known soccer players to educate at-risk youth about the dangers of HIV infection and about the most effective ways to protect themselves. The pilot study has begun in Bulawayo, Zimbabwe and will run for 7 months. Professional soccer players from Zimbabwe are being trained as HIV educators and will meet with children twice weekly for two-week sessions at a number of schools in Bulawayo (Grassroot Internet)." Despite the outrageous number of deaths due to the HIV/AIDS virus in Africa, life-saving drug cocktails are still being withheld from the majority of Africans infected with the HIV/AIDS virus (Kuadey, Internet). This is because few Africans can afford the drugs needed to fight AIDS, which can cost between $500 and $1,000 a month. Furthermore, many African governments do not have the funds to import these drugs. The drugs used to fight HIV/AIDS are manufactured by pharmaceutical companies usually based in Europe and North America. These companies spend billions of dollars on research and development of HIV/AIDS drugs. Subsequently, they must make a profit from these drugs by charging more, or the research would be impossible unless the government paid for their extensive research. South Africa, Kenya, and Uganda have attempted to produce generic versions of these HIV/AIDS drugs to help fight the disease in their individual countries (Kuadey Internet). However, because these drugs are patented the drug companies have been strongly fighting the South Africans, Kenyans and Ugandans practices. Although the drug companies arguments are substantial, it is hardly a rationalization for allowing 25.3 million HIV/AIDS patients to die in Africa (Kuadey Internet). Conclusion In conclusion, the brutal effects of the HIV/AIDS virus have taken a great toll upon the massive continent of Africa. The HIV/AIDS virus is quickly depleting the already diminutive funds of the African people and African governments. Although this HIV/AIDS crisis in Africa is seemingly not affecting other countries, this genocide of Africans will have drastic effects on the people of other countries in the near future in many different ways, including many western nations economies that depend on Africas natural resources and goods. The only way for these extreme and harsh effects to be prevented is for countries around the world to try to stop the outbreak of the HIV/AIDS virus in Africa. Promoting awareness among African people, as well as people of different countries, is the most useful key to manage and plan this prospective demographic transition that would harm Africa in the coming years. In order to lengthen the lives of the African people already infected with the HIV/AIDS virus, money must be donated to either the African people or African governments to be spent on these expensive drugs. Generic drugs should also be allowed to be produced by these governments, if they are still unable to obtain the money to buy the drugs needed for HIV/AIDS virus treatment. These actions should be taken not only to save the African people, but to also save the people of other countries from experiencing the same terrible circumstances the African people endure from the immense amount of HIV/AIDS virus cases. The scale and depth of the AIDS crisis has prompted calls to enlist women’s organising capacities and collective energy in campaigns for protection. Women have been targeted partly because they themselves have lined up to assist as primary carers within families, through religious groups offering compassion to those who are sick or bereaved, via informal networks providing mutual support around rites of passage, and through more formal charitable and service organisations, NGOs and community-based organisations. While men are also involved in such activities, their numbers are dwarfed by women fulfilling roles as carers, volunteers and educators, whether in the domestic sphere or the informal and formal sectors of the public sphere. Understanding the ways in which sexuality is constructed and gender relations configured is crucial for strategies of protection against HIV. The subordination of women’s needs and desires in relations of intimacy came through in all of our case studies, expressed in a variety of ways. Understandings of sexuality and the content of sexual practice are embedded in specific cultural histories and are the products of particular experiences of social and economic change. As they evolve, such understandings apply differently to those in different social locations defined by age and marital status, as well as gender. They form the backdrop through which AIDS is experienced and its ramifications felt. However, the epidemic in its turn has influenced the ongoing construction and reconstruction of sexuality and the beliefs and behaviours which constitute it. References Anon2 10 January 2006: Press Release SC/6781 Security Council Holds Debate On Impact Of Aids On Peace And Security In Africa. Accessed from http://www.un.org/News/Press/docs/2000/20000110.sc6781.doc.html Barton, Thomas George, 2001: Sexuality and Health in sub-Saharan Africa. African Medical and Research Foundation, Nairobi, pp.13 De Cock, Kevin M., Mbori-Ngacha, Dorothy, and Marum, Elizabeth. "Shadow on the continent: public health and HIV/AIDS in Africa in the 21st century." Lancet 360.9326 (2005): 67 Dossier, Panos 2005: AIDS and the third world. New Society Publishers, Philadelphia, pp.54, 56, 57s Eckert, Erin 2003: Diseased Societies, in The World & I (vol. 13), 166 Feachem, Richard G.A, May 12, 2007: AIDS Hasnt Peaked Yet -- and Thats Not The Worst of It in Washington Post http://www.globalpolicy.org/socecon/develop/aids/2003/0112peak.htm Grassroot Soccer. Accessed on May12, 2007 from . Health Transition Centre 2004: Towards the Containment of the AIDS epidemic. ANU printing service, Canberra, pp.42, 152, 154, 156 Hunter, Susan. Black Death: Aids in Africa. New York, NY: St. Martins Press, 2003. Kalipeni, Ezekiel. HIV & AIDS in Africa: Beyond Epidemiology. New York, NY:Blackwell Publishing, 2003 Kuadey, Kwame. The Politics of Aids Drugs in Africa: Accessed on May12, 2007 from. . Lancaster, Carol. Aid to Africa: So much to Do So Little Done. Chicago: The University of Chicago Press, 2006. Wohlgemut, Joel Pauls. "AIDS, Africa and indifference: a confession." Canadian Medical Association Journal. 5.167 (2004): 485 Appendix THE IMPACT OF HIV/AIDS IN AFRICA Source (http://www.uwmc.uwc.edu/geography/Demotrans/demtran.htm) Read More