HIV and AIDS in Sub-Saharan Africa - Coursework Example

HIV/AIDS in Sub-Saharan Africa: A Growing Crisis for the Young and an Expanding Need For the Entire Population for Health Services Introduction The epidemic of AIDS has had a devastating effect on the world. The disease knows no boundaries, having affected males, females, children, and most countries across the globe. In 1993, the world saw 12.9 million people dealing with the HIV virus, but by 2007 that figure had risen to 33 million (International 2008; 11). “AIDS is the fifth major cause of death in middle-income countries, the third in low-income countries (WHO, 2007) and the leading cause in Sub-Saharan Africa.”(International 2008; 11). “In the year 2005, 2 million Africans died of the disease as it ravaged the population with horrific consequences” (Cole 2007; 3). Africa is the most affected region of the world, where in 12 countries the rate of infection is at 10% and in 6 countries in the region having HIV infections rates of more than 20% (Committee 2002). The effect of the epidemic of AIDS on Sub-Saharan Africa has had widespread effects, creating consequences that have challenged the culture across many social issues. According to Terry (2007; 137) 62% of those who are living with HIV in the world are in the Sub-Saharan region of Africa. The World Health Organization (2004; 3-4) reports that 57% of the cases are women and girls, and that the effects of the devastation, in the form of caretaking, income loss, and rising opportunities of violence and inequality that make females victims. However, it is the young that are seeing the biggest increases in infection, accounting for almost half of newly reported cases. Treatments that are available to help control HIV and AIDS are not widely available in developing countries, and the nature of the treatment as it requires a developed program that is consistent and regimented makes distribution difficult. Only 7% of those needing these treatments are receiving them on a regular basis. The effect that AIDS has had on Sub-Saharan Africa has reached beyond just the infected and into social and economic areas of concerns. The popular myth is that the disease primarily affects the impoverished, however the disease has affected all classes of people, affecting nearly one third of adults at their economic prime (Falola 2007; 386). “Indeed, in some cases infection rates are higher among highly trained workers, such as teachers, health-care workers, miners, and truckers, than in the general population”(Falola 2007; 386). The consequences on the economy is that the affects of the disease inhibit productive activity, which creates a stall in the advancement of the economic health of the regions. The economic health of the country becomes relevant to its capability to distribute and finance the health care of the individuals who are suffering from the disease, thus creating a downward cycle of damage that requires outside resources in order to manage the illness. Public Health The way in which HIV/AIDS has spread in Sub-Saharan Africa in such alarming rates puts into question the circumstances that have contributed to the epidemic. In looking at ways that the disease spreads, one must look at blood pathogen forms of contact between individuals. Sexual practices play a major part in the way in which the disease is spread. As well, drug usage contributes to passing the infection between people. Health care that includes transfusions of blood that is infected can create a transfer of the virus. Finally, the disease can be transmitted from mother to child when proper precautions are not taken during pregnancy and birth. One of the biggest problems in diminishing the spread of HIV/AIDS is that so much mythology has been created around its spread. In some instances within communities with underdeveloped education, the disease is considered to be spread through sources of witchcraft, creating retribution that has no bearing on the reality of the situation and, of course, having no affect on the infected (Committee 2002; 22). While problems of education create an ignorance in teaching many how to protect themselves, the disease continues to wildly spread and blossom through sexual contact from multiple partners. The most prevalent course of the spread of the disease is through sexual contact. One group that has been singled out as having contributed most to the spread of the disease are the sex workers within the country. Because of widespread poverty, many women are forced to use sex as a commodity in order to provide basic needs to themselves and to their families. “Women traders are often blamed for the ills of African societies, for high food prices, unsanitary markets, for fraud and capitol flight” (Gladwin 1991; 164). However, the promiscuity of sex workers is not the only area of concern. Many migrant working men create families in more than one city, creating a factor of spread from one community to the next. As well, violence against women which includes rape also accounts for a great deal of the problem. Other forms of transmission also exist. Transmission from pregnant mother to infant is a widespread issue. “The HIV prevalence among pregnant women attending antenatal clinics in South Africa was < 1% in 1990; yet by the end of 2000, the prevalence among pregnant South African women increased to 24%” (Shaw 2003; 2). The three ways that the disease can be spread from mother to child are: when the baby is in the uterus, during the actual birth, and during breastfeeding. The three ways in which to prevent this transmission are: giving antiviral to the mother in the third trimester, giving antiviral during birth, and by using formula instead of breast milk as a form of nutrition (DiPentima 2007). Before the availability of antiviral medications, the rate of transmission was at about 26%, however with the new advancements and treatments that rate has decreased to 5% (DiPentima 2007). In 2001 the rate of transmission of mother to child in Sub-Saharan Africa was at 40% of all cases of the disease (Aids 2001). By 2006, the number of children with HIV topped 2 million, of which 90% were infected through mother to child transmission (WHO 2006). Lack of the availability of antiviral medications decreases the successful prevention of the disease. There are 44 countries in the Sub-Saharan region of Africa. Of those countries, in 2002, 31 had created a national plan for HIV/AIDS strategy, while the remaining countries had the objective of creating such a plan. However, the affects of the disease continue to ravage the resources and the development of the area. Whole communities are decimated which rolls back decades of progress in the development of social advancement (HIV 2009). The ability for the health care system to provide proper treatment has created a burden that countries that face economically impoverished circumstances cannot meet. As well, the number of orphans that are created by the disease overwhelm the resources to help those children, many of whom have the disease themselves. Health Care Availability The advancement of the public health care in Sub-Saharan Africa has been diminished by the impact of HIV/AIDS. Decades of progress in creating a longer life span has been depleted as the average life expectancy has now dropped to 47 years of age. However, not all areas are losing the battle to this epidemic. According to Avert (2009), “effective HIV prevention campaigns have been carried out in Senegal, which is still reflected in the relatively low adult HIV prevalence rate of 0.9%”. In Uganda, the rate of prevalence in the 1990’s was around 15%, but by 2001 had dropped to 5% by virtue of prevention campaigns. Declines of the disease have also been experienced by Zimbabwe, Zambia, and Burkina Faso. However, in Southern Africa, the increases in the contraction of the disease continues to persist (HIV 2009). The availability of anti-retroviral medication is stark and does not reach nearly as many people as would be desirable. “Botswana, the first country in Sub-Saharan Africa to develop a national anti-retroviral distribution program, is the only developing country where nevirapine is readily available”(Shelling 2006; 62). However, the ability and capacity to distribute the anti-retroviral medication is at issue. Qualified health care workers are in short supply. The need to create health care infrastructures in order to facilitate distribution is not being met. The need for adequate health care workers causes more problems in the treatment of children. Additionally, the needs of children are far more complex than those of treating adults. The lack of workers adversely affects the treatment capacity for adults, but is creating even more challenges in treating children. As it is in every other place in the world, health care is a matter of financial consideration. However, access also serves as an issue as the balance between long waits and long distances conflict between earning income and taking care of those who can’t travel. Because of the nature of the spread of the disease and the way in which it affects women more deeply and on more levels of experience, it is usually left to the women to provide access for the family to the health care that is available. According to Howson (1996 p. 28), “it is only common sense to assume that suitable clinic hours and reasonable waiting times, multiple and adequate services, courtesy, efforts to diminish social and cultural distance between providers and patients and clarity of communication would persuade more Sub-Saharan African women to utilize services appropriately”. Creating some availability for the proper treatment only begins the process. Creating a cultural understanding of the benefit of treatment and of the importance of the consistency of treatment must also be addressed in order to create effective change. Economic Issues The issues that impact the people of the Sub-Saharan in the way in which the economic stability of families is affected is in the way in which family members are taken by the disease or lay dying. In many cases, the main income earner dies and leaves the family without financial security. Others in the family may be ill with the disease, creating an issue of care for those who are afflicted as the others attempt to create a source of economic survival. In many areas, fields have gone unattended and have resources that would otherwise be available have disappeared because illness has created a situation where the work must be abandoned and the needs of the unhealthy must have preside over the needs of the economic health of an area. With so many sick, there are not enough workers to accomplish the needs and services of the country. Many times, this creates systems of abuse where women and children are victimized by virtue of their need. The issues of food and the shortages that are being experienced have been impacted by the epidemic. Maddox (2006; 159) discusses the multiple reasons that food has become an issue within the region. Population increases and a longer expectancy of life have created a greater need for food throughout Africa. After WWII, the availability of antibiotics, the clearing of areas for cultivation and grazing needs which diminished the prevalence of sleeping sickness, improved transportation, the availability quinine for malaria, and a certain level of improvement in public health care provided resources for extending life and creating more availability in quality food. However, with the HIV/AIDS epidemic, these improvements have created a large population for whom these systems are breaking down as the labor force is becoming increasingly diminished. This relationship that developed between the African people and nature has become akin to a war in which the human element is winning few battles. Violence, Conflict and HIV/AIDS The effects of the HIV/AIDS crisis should not be diminished in regard to the way in which men experience the issue. The way in which men are judged within a society is reflected upon certain behaviors that are adopted by the male in which he achieves a certain status that denotes him as a man. As in many cultures, one of the aspects of being considered a man in “Africa is attaining financial independence and then starting a family. In some of these cultures, not having the correct employment and not having a wife and children creates a scenario where they are not considered men, despite their age. Lack of work causes problems for young men as they long to be considered men” (Bannon 2006; 163). Military and police options become a way to assert manhood. However, these options are not universally available. “The role of civil conflicts in the spread of HIV/AIDS in Sub-Saharan Africa cannot be overstated” (Singhal and Howard 2003; 41). Because of the proliferation of conflict and the formation of militarized groups without a leadership that has respect for humanitarian rights, the proliferation of violence from groups such as the RUF (Revolutionary United Front) from Sierra Leone includes rampant sexual violence that result in increased spread of HIV. “Multiple rapes become routine whenever the rebel forces captured female civilians. And sex was frequently unprotected so contracting or transmitting infections , including HIV, was likely (Singhal and Howard 2003; 43). The way in which women are socialized creates a sense of resignation to victimization. “Studies of in-school youth in Ghana, Malawi, and Zimbabwe found that men’s and boys’ use of violence against women was accepted and even encouraged, while girls were largely socialized to be tolerant and to passively accept such violence” (Bannon 2006; 166). In a society that has been developed to allow violence to women and girls an acceptable practice, the ability for the female part of society to protect themselves from infection is greatly diminished and overly hazardous. The effects of low availability of employment coupled with the sociological needs to assert manhood creates a problem for young men as they seek out ways to establish their place within the society. In addition, many of these young men are pressed into service, some as children, and the development of the capacity for violence, including sexual violence, becomes part of an accepted part of life. Opportunities that lead them into lifestyles that promote violence can be associated to the spread of HIV as these violent environments can promote rape. As women are seen as usable objects, respect of their person treated with condescension and contempt, the increase of infected women who then infect their children will continue to be an issue without resolve. A method of transformation of the cultural attitude toward women would be needed to create a safe atmosphere that allowed for more control over the transmission of this disease and the terrifying consequences. The Impact on Children The way in which the epidemic of HIV/AIDS has affected children expands well beyond just the issues of infection. The disease has taken the lives of some 2 million or more children, but it has orphaned 11.6 million in the process (HIV 2009). These children find themselves seriously displaced within society and without adequate services from everything from food to education. Many of these children are left to take care of younger children in order to survive, putting them into harsh working environments and illegal trades, including the sex trade. Survival for these children is brought down to the very basic elements and they are often left without help or prospects, which lowers their probability of survival. As well, many have been left with the infection and having to find ways to deal with attaining proper health care. According to Jamison (2006; 155), the way in which to approach the epidemic of HIV in the Sub-Saharan is through aggressive plans for education and prevention. As in all countries, this seems to be the best policy for actively diminishing the effects of the disease until a cure can be found. According to a report filed for the Support for Analysis and Research in Africa Project (SARA) on the state of affairs in Sub-Saharan Africa in regard to children and HIV/AIDS Public intervention, the following weaknesses have been observed in countries that are not seeing marked improvements in child mortality rates in regard to HIV/AIDS. “1. Perceived low priority for child survival objectives, 2. Disconnected approaches, and 3. Inadequate attention to broader health system deficiencies” (SARA; 3). In addition, the following deficiencies have been reported throughout the system of public intervention: 1. Lack of child survival programming and reporting requirements, 2. Procurement processes that slow down implementation and contribute to programming gaps, 3. Personnel policies that do not sufficiently strengthen the staffing needed to design and implement programs, 4. Lack of close collaboration between mission funded programs and centrally funded NGO grants, 5. Lack of integration with complimentary programs and 6. Weak emphasis on program experience exchange. (SARA; 5). As seen in the above information, the gaps that are most prevalent are those concerning with organizational difficulties that can be seen as education is difficult to pass forward to new workers and programs are do not overlap in the way in which they share information. As well, stronger statistical information through more strict reporting could reveal the gaps with a possibility of filling them in and creating a more stable system of public intervention. According to Van Dyk (2008; 197), children in Africa have a far more sophisticated view of AIDS than expected. In questioning 646 adolescents in Africa, the understanding of HIV/AIDS and the methods of prevention were educated, with some normal instances of mythology that are prevalent in most adolescent cultures on the issues of sex and prevention. However, this study was done within the education system which does not have a broad capacity for service within the region due in part to the epidemic. The effect on education has caused a great concern in the African region. Because of the pressures of the disease that are put onto the children in families that are affected by this epidemic, a marked decrease in performance has been observed within the education system (Omolewa 2006; 130). With so many children displaced, sick, or needed to earn income or act as caretakers at home, the decline in enrollment has shown a decrease in schools. As well, in 1999, a recorded loss of 860,000 teachers to the epidemic within Africa created a void of teachers in order to provide educational opportunities (Omolewa 2006; 132). It is probable that similar losses have been seen in subsequent years, declining, however, as the development of education for teachers has diminished. The impact that HIV/AIDS has had on the population of children is far more widespread than in just the losses when the disease is contracted. Children have been orphaned and forced into more adult roles because of parents who die and are dying from the disease. Other children have restricted access to resources, which include basic resources such as food and shelter, as well as educational resources such as teachers and school facilities. As well, the violence that has proliferated in the region because of civil political difficulties has created dangers to children as they are often victims of sexual violence (Singhal and Howard 2003; 43). With a lack of organized reporting and the way in which the importance of the needs of children are not always considered in local cultures, a focus from outside public intervention resources will need to be utilized to support the local populations of children. Conclusions There has been some increase in the capacity for growth in the prevention and treatment of HIV and AIDS in Africa. The nations have come to realize that the epidemic is diminishing the capacity for economic and social growth and are therefore instituting strategies to combat the disease. However, the efforts are well below the limits of what is necessary to significantly slow the advancement. Without controls put into place that can create a serious dent in the advancement of infection, the countries will continue to lose ground in advancement and development. The control of this epidemic does not just affect the individuals with the disease, but it has a larger impact on the way in which the economy can serve the people and provide for safety and security in all levels. Aggressive plans for prevention education must be in place to affect the behavior of the cultures that are affected, which in essence is all cultures. However, the devastation in Africa requires a strong, concerted effort. Reducing the likelihood of risky sexual behavior is central to addressing the issue. Intensive education will provide a foundation for this effort and help to reduce new infection cases. Promoting the use of condoms and further education in birth control for those already infected will help in decreasing the spread and the infection to infants. Male circumcision will decrease the likelihood of the virus finding a place on the body to remain in between sexual encounters and help in overall hygiene matters. By addressing issues that are central to the issues of the spread of the disease a decrease in new cases will be seen. As the governments address the issues of infrastructure for health care, providing better services for those who are infected will help the quality of life, providing a health that can create a source of energy to conduct labor that creates income and economic stability. Creating an aggressive plan to fight the infection will provide a foundation on which stronger nations can be built to serve their people and create thriving communities. Bibliography AIDS ACTION. (January 2001). “Policy Facts” Aids Action. Viewed 17 March 2009 at www.aidsaction .org/legislation/pdf/mom2child.pdf AVERT. (20 February 2009). “HIV and AIDS in Africa” Avert: Averting HIV and AIDS. 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