AIDS in Africa

...This means that Africans with AIDS suffer the most brutal excesses of the disease...

...Unlike in the West, where the epidemic has primarily affected gay men and intravenous drug users and their sex partners, HIV in Africa is overwhelmingly rooted in the heterosexual mainstream...

...When prevention fails and illness develops, AIDS is one of the most expensive and labor intensive diseases to treat in the history of medicine...

...While the urban health care systems of the developed world are overburdened by the costs of battling the disease, the less wealthy nations of Africa must do what they can with an average annual per capita health budget of ten U.S...

...Africa's immediate future is tied inextricably to the effects of HIV...

...This is particularly true for Africa, and the current plague is simply a foretaste of the calamity to come...

...a tiny fraction are attributable to other causes...

...Recently, at an international conference on AIDS in Africa, an official from Guinea remarked...

...Women must also cope with HIV-infected men who spurn condoms but insist on continuing sexual relations...

...The HIV-related condom campaigns aimed at men are reversing decades of public health practice, which encouraged women to take control of contraceptive decisions...

...tens of thousands of HIV-positive women face the possibility of infecting their infants through breast-feeding...

...The virus often takes ten years to cause recognizable illness, and virtually every asymptomatic HIV carrier will become sick and die...

...WHO epidemiologists predict that by the year 2000 an additional five million Africans will perish, a total of fourteen million will be infected, and ten million children will have lost at least one parent...

...These other infections often produce lesions in the skin and mucous membranes, allowing HIV to move more easily from one person to the next...

...Convincing men to use condoms is key to HIV prevention efforts in Africa...

...African governments, like most others around the world, responded lethargically to the threat, allowing the virus to gain a foothold and spread...

...Agency for International Development have contributed tens of millions of dollars to combat HIV in Africa...

...By some accounts, the economic impact is already being felt...

...best estimates suggest that one million Africans have already died of AIDS...

...Agency for International Development and the World Bank predict that fragile national and local African economies will be dealt a severe blow by the epidemic...

...Conversely, when it becomes apparent to SUMMER • 1992 • 397 AIDS in Africa a man that one of the women in his life is infected with HIV, he may leave her without support or shelter...

...Subsidized by the United States Agency for International Development, local authorities supply thousands of vendors with condoms, which they sell at affordable prices while making a small profit...

...The success of this approach in Zaire can be measured by the number of condoms sold, climbing from nine hundred thousand in 1989 to nine million last year...

...Michael Merson, Director of the WHO's Global Programme on AIDS, has warned that while the eighties were the decade of HIV, the nineties promise to be the decade of AIDS...

...More than a decade into the epidemic, Dr...

...Some African officials say that close to one-fourth of Africa's work force will be lost by the year 2010...

...The decade-old AIDS epidemic has already strained the social and economic fabric of African societies, taking an especially heavy toll on women...

...Some British epidemiologists go further and project that certain regions of Africa will actually suffer a decrease in population...

...In some African cultures, men routinely maintain simultaneous familial and sexual relations with several women...

...Similarly, the all-important mining industry is suffering an AIDS-related shortage of workers, and one study predicts a three percentage drop of Zambia's and Zaire's share of copper production in the world market by the end of the decade...

...AZT and other costly medications, which both extend life and moderate the effects of opportunistic infections, are out of reach for almost all Africans...

...Also, many men migrate for months at a time to find work or earn their living by driving long-distance truck routes, and it is customary for these men to avail themselves of prostitutes when away from home...

...In the cities of Central Africa, HIV has hit the economic elite particularly hard, killing thousands of professionals in their prime...

...The U.S...

...Uganda, for example, provides one nurse for every 12,332 people, one doctor for every 23,000, and one hospital for every 200,000...

...These figures represent only a first wave...

...In Zaire and the Ivory Coast, entreprenurialism has succeeded where public education and distribution efforts have not...

...The statistics are daunting: the World Health Organization (WHO) reports that one in forty Africans is infected with either HIV-1 or HIV-2, a second AIDS virus that predominates in Western Africa...

...dollars...

...In fact, the cost of a single test for determining whether or not an individual is infected with HIV is more than the average African spends on health care in a year...

...These women can't refuse sex with their partners or ask them to practice "safe sex" without placing their domestic security at risk...

...Even the most optimistic researchers don't expect a vaccine before 1998 at the earliest, leaving prevention as the only tool available to stem the spread of HIV...

...Grandmothers are raising tens of thousands of grandchildren orphaned by the epidemic...

...Eighty to 90 percent of all adult cases in Africa are tied to heterosexual relations and 10 percent to infection by blood transfusion...

...Most never even make it to a hospital, yet the rates of infection are so high and the number of hospital beds so limited that in some cities 80 percent of all the hospitalized patients have AIDS...

...Perhaps some little encouragement can be drawn from the fact that by 1992, every African government had developed a national response to HIV...

...If the spread of HIV across Africa is intimately tied to the movement of men, the impact of AIDS on African women is especially dramatic...

...Remember, a sick population will not be able to work, will not be able to pay its debts...

...Among those infected are six million adults and seven hundred fifty thousand children...

...Recognizing this threat to weak developing economies, the WHO, World Bank, and the U.S...

...The heterosexual nature of AIDS in Africa accounts for the fact that women make up 50 percent of adult cases and that at least half a million children have developed AIDS...

...In Uganda and Tanzania this year, coffee and other cash crops remain unharvested due to an agricultural labor shortage resulting from mounting AIDS deaths...

...In Zaire, which is hardest hit, 6 to 8 percent of the urban population and 3 to 4 percent of the rural population is infected...

...The transmission of the virus follows culturally specific patterns of family life and sexual relations, and it travels along the routes of economic migration...

...The enormity of the epidemic is made clear by these statistics, yet on their own they do not tell how HIV has spread among the people of Africa...

...Because the greatest number of AIDS deaths have hit the most economically productive segment of the population, fifteen- to forty-nine-year-olds, the already burdensome ratio of dependent elderly and children to productive adults has become even more imbalanced...

...The economic fallout is not limited to the cost of health care...

...In attempting to attract more foreign assistance for the fight against AIDS, African officials find themselves appealing to the economic selfinterest of the developed world...

...These pre-existing patterns have fostered the spread of HIV both by increasing the numerical likelihood of transmission and by creating a high prevalence of other sexually transmitted diseases...

...398 • DISSENT...