Sub-Saharan Africa burden with HIV/AIDS
A World of Difference Part 2
By Winsome M. Hare The Afro News Port Coquitlam
Part 1 of this article talked about Sub-Saharan Africa’s burden with HIV/AIDS and the vulnerability of women and children to the outcome of the disease. Not only do mother-to-child-transmission, violence, cultural and sexual practices pose a threat to the spread of HIV/AIDS in the region, but two other older diseases have been associated with the infection rate of the disease. According to the Millennium Development Goals, Tuberculosis and Malaria have been associated with the HIV/AIDS pandemic in Sub-Saharan Africa. Part 2 of this article looks at issues surrounding HIV/AIDS in Sub-Saharan Africa such as mother-to-child transmission, cultural practices, social inequalities, structural inequalities, and the big three: HIV/AIDS, Tuberculosis, and Malaria.
Mother-to-Child Transmission
Reproductive health should be a right for HIV infected positive women who decide to bear children. Current trends in research has shown that transmission from mother-to-child can be minimized if HIV infected women adhere to Highly Active Anti-Retroviral Therapy (HAART) and medical care. In addition, HIV infected mothers who do not breastfeed have less chance of transmitting the disease. Birth delivery such as cesarean section also lowers the risk of transmission of HIV to the baby. However, in Sub-Saharan Africa, the mother-to-child transmission accounts for 1.5 million of the cumulative pediatric AIDS cases, which is considered to be the majority of the world’s cases.
Cultural Practices
Globally, every country has been affected by HIV/AIDS and its impact in Sub-Saharan Africa is problematic because of multi-factorial reasons. The complexities of African cultures with its multi-layered dynamics add to the trend where women are most at risk for being infected. In 2003, researchers found that young women between the ages of 15 to 24 years were 2.5 times more likely to be infected with HIV than men. The burden of AIDS is noticeable in the women’s population in Sub-Saharan Africa due to influences such as migration, violence, and poverty. A unique aspect of the HIV/AIDS transmission in Sub-Saharan Africa is the heterosexual transmission, where researchers have noted that 80% of the population is at risk. In African cultures, women play a subordinate role to men and this difference in gender structure relationship puts women at a disadvantage for exposure to the disease, for example, in intimate partner relationships. In this setting, women have no bargaining power and cannot negotiate to use any form of protection during sexual transactions. Some males have precarious work patterns and migrate to many locations across the region to pursue work opportunities. Taken together, male migration patterns away from home combined with sexual contact with non-primary partners without condom use raises the burden of HIV/AIDS for women. Another example where HIV/AIDS has an impact on women is the sex industry. Researchers have argued that the illicit nature of the sex industry in many African countries and the difficulty to access that community because sex workers and their clients are one of the most vulnerable populations to HIV/AIDS contribute to the spread of the disease in the female population.
Lack of knowledge also influences the burden of the disease in women living in Sub-Saharan Africa. The continuous migration of young uneducated women from rural areas to urban areas and trade centers raises the potential for HIV infection. These young women are not knowledgeable about HIV/AIDS and they are having sex with men who are infected with the disease, thus, a continuous cycle of sex and disease process elevate the infection rate among participants, especially for those women involved. Sexual transmitted diseases (STDs) also increase the burden of disease in women, as researchers have observed an association between HIV transmission and untreated STDs prevalent in Sub-Saharan Africa. In most cases, STDs in women are asymptomatic; hence the lack of treatment in that group. However, women living in rural areas who want to access medical care, have to deal with long lines in waiting rooms, long distances to travel to the clinic, lack of transportation, and family obligations that make it difficult to access medical care, which worsens their prognosis.
Social Inequalities
Sub-Saharan Africa is argued to be the region which is most affected by the outbreak of HIV/AIDS. Social and structural inequalities in intrapersonal relationships and the distribution of resources have an impact on the infection rate. Cultural traditions play a role in the rates of disease infections. Some of these cultural traditions operate under a veil of secrecy, such as the widow’s inherence and fisi (hyena), which have influenced females’ infection transmission rate. The widows’ inheritance is necessary to provide socio-economic support for her after the death of her husband, so remarriage to a member of her deceased husband’s family will solve the problem. However, if the new husband has HIV/AIDS the infection is passed on to his bride. Alternately, another cultural practice that places women at risk for HIV infection is the fisi. Children are highly valued in African society and it is important for males to have offspring. Infertility in males can occurs for many reasons and this can affect fatherhood. Therefore, the fisi is a substitute method used to provide infertile male with children. In the fisi, traditional leaders arrange for women in the infertile couple to have intercourse with another man who can impregnate her, which can result in either conception and or the transmission of HIV. These social inequalities in Sub-Saharan Africa culture where the male decision process have decided the life course action for females have infringed on women’s reproductive rights, which have resulted in the marginalization of women and put their health and physical wellbeing at risk for reduction in quality of life and potential years lived.
Structural Inequalities
The policies of resource rich countries and the development of structural agreements have long reaching consequences on wealth distribution. These policies can affect the ability of resource poor countries to meaningfully manage and access resources for them to be economically viable and support their population. In a 1987 comparison of the spending habit of the United States to Sub-Saharan Africa on the spending pattern for HIV/AIDS it was observed that the health expenditure average per capita differs in Sub-Saharan countries where it was U.S. $3.50 per year, compared to U.S. $1000 in the U.S. HIV/AIDS progress follows the same disease trajectory in either resource rich or resource poor countries, yet Sub-Saharan Africa has so little money to care for a large proportion of their population who is living with a chronic and serious disease. The inequality between the resource rich and resource poor counties will continue to deepen as an estimated 22.5 million people are living with HIV/AIDS in Sub-Saharan African with an incident rate of five million per year. Lack of adequate care for HIV/AIDS patients is resulting in many social problems such as an increase in orphans, low crop yield as there is no one to farm and economic downturn due to factory closure because of a diminished labour force due to death from the disease.
The Big Three: HIV/AIDS, Tuberculosis, and Malaria
HIV/AIDS remains a challenge in Sub-Saharan Africa to treat. Adding to HIV/AIDS, the Millennium Development Goals have identified Tuberculosis and Malaria as related diseases that adversely affect the progression of HIV/AIDS and pose an emerging threat to the wellbeing of individuals in Sub-Saharan Africa. Before, diagnosis poses the most risk for the infection as most individuals remain infectious but display minor symptoms. However, researchers have found that in Sub-Saharan Africa, among those individuals diagnosed with tuberculosis, the HIV infection first appears to be present in this group, which leads to death among the HIV infected and thus, lessens the chance of infection transmission. Tuberculosis further depresses the immune system. The Directly Observed Therapy Short Course (DOTS) program is used in the treatment of tuberculosis and needs to be increased to meet the needs of millions of other Africans who urgently require treatment. The DOTS program targets those individuals with smear-positive tuberculosis and interrupts the continuing transmission cycle to disrupt the progression of tuberculosis. In 2003, tuberculosis related deaths in the region were 1.7 million and that was from an estimated 8.8 million new cases of tuberculosis.
For Sub-Saharan Africa, when malaria is concurrent with HIV/AIDS the outcome is grim. Malaria is caused through parasitic infection from the mosquito, Anopheles gambiae. One of the results of malaria is anemia and this has been observed as the leading cause of co-morbid conditions in the region which is charged with a huge burden for the disease. The risk for clinical malaria is higher among those individuals whose immune system is compromised by HIV. One of the mechanisms through which malaria induced anemia may occur is with the destruction of parasitized and non-parasitized red blood cells. In instances of severe anemia, malaria affects women, children, and persons with HIV. In pregnant women, anemia is associated with maternal morbidity and mortality, shock, and cardiac failures. Research done in Sub-Saharan Africa has revealed that in the presence of HIV, malaria infection increases.
In the Final Analysis
Sub-Saharan Africa needs assistance from the global community to assist them in this fight to preserve life. Helping to reverse some of the damage that HIV/AIDS, tuberculosis, and malaria have done need money to provide human capital and resources to help lessen the threat and impact of these diseases. This is why universal access is a key component in the struggle against the spread of these diseases. Providing financial contribution through universal access would open the door and make a world of difference, allowing all individuals, especially those living in regions such as Sub-Saharan Africa, an opportunity to be connected with much needed services that provide HIV prevention, treatment, and care. In fact, universal access would also provide much needed monies to help support the care and treatment for HAART, DOTS program, and effective pharmacological therapy for malaria treatment that would help to alleviate the suffering of millions of individuals living in Sub-Saharan Africa. If the future Sub-Saharan Africa is expected to be viable and sustainable, the present generation has to be healthy to promote growth. This is not happening. The ongoing health issues of HIV/AIDS, tuberculosis, and malaria have presented one of their biggest challenges and the outcome is causing the population to diminish. We all have a vested interest to help those who are most vulnerable. It is time for universal access to become a reality.
Winsome M. Hare Registered Psychatric Nurse (RPN) Undergraduate Student/Health Sciences SFU whare@forensic.bc.ca
