FREE ESSAY ON AIDS AND AFRICA

AIDS AND AFRICA

The following are facts cited in "Acquired Immune Deficiency syndrome" by Gerald J. Stine.
Worldwide, about 9,000 persons a day become HIV-infected. The majority of all HIV
infections worldwide occur in people ages 15-24. Over 1 million people die of AIDS each
year. The number of HIV-infections worldwide has tripled since 1990! It is estimated that
there will be a 20% decline in population in East Africa by the year 2001 due to AIDS
(Stine, 360). "AIDS is the leading cause of deaths among adult men and the second leading
cause of deaths among adult women in Africa" (Bethel, 135). The first for women is
pregnancy and abortion related.
"It is extremely difficult to judge the exact extent of AIDS in Africa, either
geographically or in the population" so rather than focusing on Western Africa alone, it
is most feasible to acknowledge modes of transmission across the African continent as a
whole (Bethel, 138). Also, "we can assert that AIDS cases do not occur on the African
continent in a uniform fashion but rather form an "AIDS Belt" in central, southern, and
eastern Africa" (Bethel, 138). 
First, by mentioning the fact that the Third World contains three fourths of the Earth's
population, and combining that fact with that of those worlds having an overall lesser
knowledge upon transmission, prevention, and AIDS in general, it is not surprising that
these countries populations are greatly impacted by mortality. "Africa, with about 12% of
the world's population, is now reporting about 25% of the world's AIDS cases. It is
estimated to have over 65% of the total number of HIV-infected adults and 90% of the
world's HIV-infected children" (Stine, 364). An astonishing fact that further allows the
realistic comprehension of the diseases' dominance in Africa is that 6,000 Africans
become HIV-infected each day which is 250 persons per hour or four per minute. 
"Between 20% and 30% of sexually active adults between the ages of 20 and 40 are believed
to be infected with HIV in some urban areas of sub-Sahara Africa, where the disease is
most prevalent. In rural areas, where the majority of the population lives,
seroprevalence remains much lower but is still increasing. Stine also mentions that
available evidence suggests that it is unlikely that the spread of HIV will be brought
under control in the near future, unfortunately (368). "The WHO estimates that one in
three of the 40million people in Southern Africa will be HIV-infected by the year 2010"
(Stine, 366).
Before discussing how AIDS is transmitted, it is quite relevant to discuss who is
transmitting and being infected by the disease. About 66% of HIV infections occur in
those under age 25. The ratio of men to women AIDS cases in Africa is 1:1 which is
comparatively abstract from that of Western society at 8:1, males to females. This 1:1
ratio is said to be the result of the African men's mentality of "taking" their women in
a more violent style of sex, where as white civilized men in the West express a more
gentle form of sex says Bethel (46). 
In Africa, the highest incidence of AIDS has been found among sexually active
heterosexuals. The women tend to be younger than men and a high percentage are thought to
be prostitutes. Women in Africa contract AIDS much more often than in North America.
Also, it appears that AIDS can be transmitted across the placenta from the infected
mother to the fetus so there are many more children with AIDS in Africa than in the US.
"In fact, children constitute almost one-third of all AIDS cases in Africa (Bethel, 139).
As in the US, AIDS in Africa appears to occur much more frequently in large cities than
in the rural areas, though this may be a reporting bias. And finally, those who are
discovered to have the AIDS virus frequently have a past history of venereal disease and
are found to be more sexually active than those without the infection.
Major routes of HIV transmission in Africa are heterosexual, mother-to-child, and
transfusions with unscreened blood. In addition, prostitution and cultural sexual
practices greatly influence the increase in transmission rates. Transfusions, though, are
now being screened in most major urban areas and therefore are not as threatening as they
once were. Homosexuality and i.v. drug use are not associated with AIDS or considered
factors in the transmission of the virus. This, however, is not to imply that they are
not factors in transmission but rather, at this time, not much is known about
homosexuality in African countries. However, we do know that anal intercourse is
considered abhorrent for a variety of reasons, including its connection with witchcraft,
and is almost completely suppressed in much of sub-Saharan Africa. Without considering
i.v. drug use as a factor primarily because injected opiates are too expensive, we can
not reject transmission by needles in general. African patients often prefer needle
injections to oral medication because they believe it to be more effective. With that in
mind, and the common re-use of needles due to lack of adequate supplies, one can see the
danger and high risk associated with the practice. In addition, it has apparently been
common to reuse needles in vaccinating children. And finally, ritual scarring may play
some part in the spread of the virus.
Africa has an incredible high prevalence rate among prostitutes in all countries.
"Prostitutes are at high risk for HIV-1 infection and are recognized worldwide as
transmitters of HIV-1" (Bethel, 149). Prostitutes, having large numbers of partners, are
naturally at greater risk, but this pattern fits the following larger social model in
addition to providing the explanation for HIV and AIDS cases migrating out from rural to
urban locations. Many unmarried rural women saw no means of adequate support for a family
in addition to family conflict leading them to migrate to the city at a young age. With
women's desire to survive in an environment where they are rarely employed in wage labor
or other "legitimate" jobs, they become prostitutes in order to earn a living. "AIDS
first struck the labor concentrations in Uganda and then moved outward to the labor
reserves, carried by migrant laborers and prostitutes as they return to their birthplaces
for care and assistance with illnesses consequent to infection with this virus" (Bethel,
151). Consequently, the virus is then spread throughout small villages and urban
communities. In studies of prostitutes in the town of Rakai, an area of major labor
concentration, nearly 86 percent were HIV-1 positive. One study tested 535 Nairobi
prostitutes in January 1985 and found that 348, or 65 percent of them were HIV-positive.
Of remaining 185, by 2 years later 120 of them had become HIV-positive. Thus of the
original 535 prostitutes in 1985, 504 or 94 percent, were HIV-positive by 1987. Condom
use among prostitutes in infrequent. Only 23 percent of prostitutes say they have ever
used condoms. The customers are said to refuse to wear one and there is a lot of
competition from other prostitutes who will not require it. 
The AIDS belt mentioned earlier as the area of highest prevalence of AIDS cases on the
continent, is also the area where a system of migrant labor was historically developed in
Africa. "The migrant labor system provides routes of infection and transmission which
radiate out from the labor concentration to the labor reserve areas throughout the
country which provides not only a vulnerable population but also an efficient mode of
spread and transmission" (Bethel, 152).
"It is clear that traditional sexual practices by African men, as well as the widespread
custom of genitally mutilating a large part of the female population, are responsible for
the different pattern of AIDS transmission" (Bethel, 46). However, "the complex mesh of
factors associated with the disease means that currently there is no way to ascertain the
relative importance of the various methods of transmission" (Bethel, 49). For example, it
is difficult and unknown whether a prior history of sexually transmitted diseases is a
risk factor because genital lesions facilitate the transmission of HIV or because of
exposure to unsterilized needles for treatment of sexually transmitted diseases. 
Altogether, 2.7 million children have died of AIDS since the beginning of the epidemic.
By the end of 1997, an additional million were estimated to be living with the disease,
half of them were infected that year alone. There is certainly a gap between rich and
poor countries and their mother-infant transmission rates. For example, in France and the
United States, fewer than 5 percent of children born to HIV women were infected. While in
developing countries, the average is between 25 percent and 35 percent. Breastfeeding
practices and access to drugs for reducing mother-to-child transmission are the two major
reasons for this difference. "In developing countries, between one-third and half of all
HIV infections in young children are acquired through breastmilk" (WHO, 48). There are
three reasons for this. First, the mother generally has no idea that she is infected.
Second, a woman may choose to breastfeed her baby regardless of knowing in order to
protect the infant against a whole range of other infections. Also, it is convenient,
approved by most cultures, and free. And third, if artificial feeding is chosen, the
mother must take chances on the water-supply that may expose her child to other deadly
diseases. Fortunately though, developing countries are providing information about sage
infant feeding to HIV-infected woman who are pregnant. 
In developing countries rather than Western society, they have a mentality much more
diverse. Western societies have the luxury of preventing illness and death, the
knowledge, and reason with a life expectancy of 75. In developing countries, the worry
more about survival of the present moment which can mean that they face death from AIDS
in five years from prostitution or death from starvation tomorrow from lack of money. In
many cases, if the wife is persistent in condom use, she is threatened with the husband
leaving her for another female. In which case, the wife would then be put out on the
streets to face starvation or begin prostitution. This cycle can only be broken by
education, which may not be enough still. 
Works Cited
Baer, Hans., et al. "Medical Anthropology and the World System." A Critical 
Perspective Ch. 8: p159-269.
Stine, Gerald J. "Acquired Immune Deficiency Syndrome...