Between 1999 and 2000 more people died of AIDS in Africa than in all the wars on the continent, as mentioned by the UN Secretary General, Kofi Annan1.
The death toll is expected to have a severe impact on many economies in the region. In some nations, it is already being felt. Life expectancies in some nations is already decreasing rapidly, while mortality rates are increasing.
UNAIDS estimates3 for 2008 (which are latest figures available) there were roughly:
33.4 million living with HIV
2.7 million new infections of HIV
2 million deaths from AIDS
Approximately 7 out of 10 deaths for 2008 were in Sub-Saharan Africa, a region that also has over two-thirds of adult HIV cases and over 90% of new HIV infections amongst children.
AIDS affects different segments of society in different ways. For example, children may have to care for an ill parent. Schooling may suffer as a result. Other times, children become orphans as parents succumb to AIDS. If they are lucky, children may have grandparents or relatives to help who then face the burden of raising many children, as the London-based organization, Panos, highlights:
AIDS is exacerbated by other conditions such as TB. Addressing TB and HIV as linked infections is at the heart of the approach of the Desmond Tutu TB clinic in Stellenbosch in South Africas Western Cape, as UNAIDS highlights:
People talk of AIDS in Africa, but Africa is a diverse continent, and different regions have been attempting to tackle AIDS in different ways, some with positive effect, while others seemingly making little progress.
As many African countries have moved towards democratization, they have been rewarded with paying off the debts of their previously unelected regimes, often dictatorships backed by foreign nations, most of whom embezzled billions of dollars from their own country into private savings.
Obstruction by some major pharmaceutical companies (detailed further below) has also contributed to the hampered responses of many governments.
While poverty is undoubtedly a crucial factor as to why health problems are so severe in Africa (also detailed further below), political will of national governments is paramount, despite disheartening odds. Constraints such as social norms and taboos, or lack of decisive or effective institutions6 have all contributed to the situation getting worse.
In South Africa, a relatively wealthy African nation, during much of his term former president Thabo Mbeki had long denied that AIDS resulted from HIV. Only through public outrage and international pressure was he forced to admit that there was a problem.
For more details on this, see Bad Science, by Ben Goldacre, (Harper Perennial, 2009), chapter 10 in particular, also available on line7, where Goldacre describes a vitamin-pill entrepreneur, Matthias Rath, claiming anti-retroviral drugs were posionous, and Multivitamin treatment is more effective than any toxic AIDS drug. Multivitamins cut the risk of developing AIDS in half.
Goldacre also notes that Interestingly, Matthias Rath’s colleague and employee, a South African barrister named Anthony Brink, takes the credit for introducing Thabo Mbeki to many of these ideas that HIV is not the cause of AIDS, and that anti-retroviral drugs are not useful for patients. (p.185)
South Africa’s health minister at this time was also against medical drugs for HIV:
How did Rath get this view? Goldacre notes a study in which 25 per cent of those on vitamins were severely ill or dead, compared with 31 per cent of those on placebo. There was also a statistically significant benefit in CD4 cell count (a measure of HIV activity) and viral loads. These results were in no sense dramatic – and they cannot be compared to the demonstrable life-saving benefits of anti-retrovirals – but they did show that improved diet, or cheap generic vitamin pills, could represent a simple and relatively inexpensive way to marginally delay the need to start HIV medication in some patients.
Goldacre adds that Rath mentioned it in full-page advertisements, some of which have appeared in the New York Times and the Herald Tribune. He refers to these paid adverts … as if he had received flattering news coverage in the same papers. (p.191)
As Goldacre continues (p.192), It’s not just MSF who Rath has gone after: he has also brought time-consuming, expensive, stalled or failed cases against a professor of AIDS research, critics in the media and others. Goldacre then describes how Rath has gone after a local, poor, NGO, Treatment Action Campaign, fighting for available medicines. In 2007, with a huge public flourish, to great media coverage, Rath’s former employee Anthony Brink filed a formal complaint against Zackie Achmat, the head of the TAC. Bizarrely, he filed this complaint with the International Criminal Court at The Hague, accusing Achmat of genocide for successfully campaigning to get access to HIV drugs for the people of South Africa. (p.194)
Despite these problems, Goldacre notes that Rath’s adverts continue unabated. He even claimed that his activities were endorsed by huge lists of sponsors and affiliates including the World Health Organization, UNICEF and UNAIDS11. All have issued statements flatly denouncing his claims and activities. (p.191).
The current and future generations are thus paying for this with their own lives.
However, other nations in Africa have shown a more proactive response to the crisis.
Some nations in Africa have shown a more proactive response to the crisis. Though it is one of the world’s poorest countries, Senegal has been a success story when it comes to fighting HIV/AIDS12. Reasons are many, including that
Problems were recognized early;
Resources were poured into fighting HIV/AIDS; and
Courageous steps were taken to deal with the religious and cultural taboos head on, using mass media to raise awareness effectively.
Both prevention strategies and reactive approaches such as condom use have also been promoted.
Universal access to anti-retroviral drugs was found to be more effective than user fees, for example and by monitoring and responding, they were able to increase health coverage and access to essential medicines, as USAIDS reported in its World Report 200413
UNAIDS, reporting years earlier on Senegal’s success did, however, admit that
Uganda has also been another success story in fighting AIDS. UNAIDS warns that even when there are successes, complacency must not seep in, as there are signs that in Uganda young people today may be less knowledgeable about AIDS than their counterparts in the 1990s15.
A variety of additional approaches observed include
Governments working with NGOs and their own people to deal with gender issues;
Recognizing the role of grandparents in high cases of orphaned children;
Using the mainstream media to raise awareness;
Providing universal health access in many cases;
Improving children’s access to education.
Botswana, Ethiopia, Tanzania, Senegal, and Zambia, have also tried to provide free HIV treatment as user fees have prevented people from receiving health services16. Some of these free treatments are funded by a combination of government resources and donor contributions, showing partnerships at work.
There is still a long way to go, as prevention programs reach fewer than 1 in 5 in Africa, for example, as the UNAIDS World Report 2004 mentioned above notes (p.70). Despite the incredibly difficult challenge still facing most countries, there are important reasons to be optimistic.
The Center for Global Development think tank notes a number of conclusions in Saving Millions17:
Major health interventions have worked even in the poorest of countries;
Donor funding has saved lives;
Saving lives saves money;
Partnerships between governments, NGOs, and private companies can be powerful;
National governments can get the job done;
Health behaviors can be changed; and
Successful programs take many forms.
This has required a number of elements:
Predictable, adequate funding from both international and local sources;
Political leadership and champions;
Technical innovation within an effective delivery system, at a sustainable price;
Technical consensus about the appropriate biomedical or public health approach;
Good management on the ground; and
Effective use of information.
UNAIDS’s strategy is a three-pronged approach:
Decreasing the risk of infection to slow down the spread;
Decreasing vulnerability to reduce risk and impact; and
Global funds help, global financial crisis hinders
As noted above, international donors have tried to help tackle this problem. While there have been many success stories, there have also been some obstacles from the international community.
The Global Fund to Fight AIDS, TB and Malaria was created at the urging of UN Secretary General, Kofi Annan, in 2001. It was supposed to be the largest fund set up to tackle these global health issues.
However, it has suffered from poor funding, slow distribution, and other political obstacles from some of the richest countries such as the US that would prefer to have their own initiatives (such as PEPFAR—the President’s Emergency Plan For AIDS Relief) so they have more control over where the money goes.
On initial thought, this sounds reasonable; a nation such as the US has the resources and ability to determine where that money should be spent. However, the concern is that the decisions become political, rather than health/need driven. The Global Fund is supposed to be a fund where countries donate without any strings attached.
However, the US’s PEPFAR approach has come under criticism from organizations such as the international HIV and AIDS charity, AVERT. They argue that going it alone in this way allows the US to avoid supporting countries perceived to be hostile (a political stance), or those who may support programs it currently does not like—such as abortion and condom use during the Bush Administration (a social/religious stance), or use of generic drugs that are cheaper than the ones from their pharmaceutical companies (an economic stance).
Prescribing social, political and economic conditions are not necessarily the best way to deal with a massive public health issue, although PEPFAR has claimed to have some successes in Africa.
For a good overview about the challenges and obstacles for the Global Fund, see The Global Fund to Fight AIDS, Tuberculosis and Malaria19 by AVERT, last accessed June 22, 2009.
It is not just direct international actions that affect Africa, but also other seemingly unrelated issues.
The global financial crisis20—a problem largely caused by rich nations—has led to some African countries cutting their health and HIV budgets. Their health budgets and resources have been constrained for many years already, so this crisis makes a bad situation worse:
And it is not just poor nations’ health funds at risk. IPS adds that even international donor organizations have started to feel the financial crunch:
Belated International/Western Media Attention to AIDS in Africa
While AIDS in Africa has now been on the agenda in many first world countries and often receives reasonable media attention, it has taken a long time to get to that position and report on the crisis and reflect the concerns of citizens in those countries to help address this problem.
What is also disturbing is how the situation in Sub-Saharan Africa only become real western mainstream media news headlines around the time HIV and AIDS was declared a national security threat to the United States. While it it understandable that a media may reflect concerns in its own nation, it is another example of the mainstream coverage and their priorities, especially when there is a lot to report in terms of western economic policies seen through the various international institutions that have increased poverty, an important factor in the spread of AIDS.
Major western media outlets also claim to be the best sources of world news, yet the items covered seem driven by the agenda of rich nations, not of the actual events around the world. (See this site’s section on mainstream media24 for more on that angle.)
Western politicians were concerned about the plight of Kosovars leading up to the Kosovo crisis, but there was not a similar concern for people on the continent of Africa, where far more have died from AIDS (already in the millions—approximately 11 million people around the beginning of 1999—by the time concern for Kosovo was raised. This is not to belittle the situation in Kosovo, but to help put it in perspective).
Now that it is a direct concern for some western countries as well, there is increased reporting on the situation in Africa as well. Could the same interest in African affairs earlier helped raise awareness and the urgency for help earlier?
Western Pharmaceutical Companies’ Reaction to AIDS in Africa
Accompanying the concern of the belated western media attention is the action of the multinational pharmaceutical companies and their lobbying efforts in first world countries and international forums, which reveal they are more worried for their profits27 than the plight of African nations, for they have resisted African nations’ attempts to use generic versions of their expensive drugs or pursue other related policies.
Currently, treatments, which Medicines Sans Frontiers describe as having transformed HIV/AIDS from a death sentence to a chronic disease in developed countries, are expensive and affordable by mainly the wealthier people in western countries. However, poor people—including those in industrialized nations—are the major victims of HIV and AIDS.
On July 19, 2000, the Export-Import Bank of the United States offered $1 billion per year for five years in loans28 to Sub-Saharan Africa to finance the purchase of U.S. HIV/AIDS medications and related equipment and services from U.S. pharmaceutical firms. However, three southern African countries, Namibia, South Africa and Zimbabwe
rejected the offer because the loans would further the dependency and debt of African countries
29, while American pharmaceutical corporations would benefit. Another criticism such motions have received is that this ends up benefitting those companies who, in effect, get a free subsidy. In this way, U.S. corporate interests are advanced.
Oxfam went as far as accusing some corporations of contributing to human rights violations by trying to prevent access to the needed drugs:
Numerous pharmaceutical companies took South Africa to court31 at the beginning of March 2001, over language in the Medicines Act which would allow for generic production and parallel importing of affordable AIDS drugs.
However, the public outrage around the world that resulted from these companies trying to do such a thing while people were dying led to them drop their case32 in April, 2001.
That was only part of the battle that South Africa won, and at some cost:
As Oxfam and other organizations have charged, due to negative publicity in recent years, the large pharmaceutical companies are also using corporate philanthropy to push their products at prices that would still be higher than generics, which poorer countries would be able to afford:
Furthermore, while pharmaceutical companies pour research into cures, and the way that they are doing it is raising appropriate criticisms and concerns, this attention also diverts the much needed emphasis on prevention as summarized by the following:
Africa Action, an organization looking into political, economic and social justice for Africa looked at the impacts of IMF and World Bank structural adjustments and its impacts on health in Africa, and is worth quoting at length:
The article also comments on recent increases in funds to tackle HIV/AIDS and other problems and concludes that because some underlying causes and issues are not addressed, these steps may not have much effective impact:
There is also the phenomenon of brain drain39 whereby the poor countries educate some of their population to key jobs such as medical areas and other professions only to find that some rich countries try to attract them away. The prestigious British Medical Journal (BMJ) sums this up in the title of an article: Developed world is robbing African countries of health staff (Rebecca Coombes, BMJ, Volume 230, p.923, April 23, 2005.) Some countries are left with just 500 doctors each with large areas without any health workers of any kind. One third of practicing doctors in UK are from overseas40 as the BBC notes.
UNICEF’s Progress of Nations, 1999, has a section on the AIDS Emergency48.
Deadly Conditions? Examining the relationship between debt relief policies and HIV/AIDS.49 A report by Medact and the World Development Movement.
UN Development Program’s report, Poverty & HIV/AIDS in Sub-Saharan Africa50
AIDS and the World Bank: Global Blackmail?51 looks into some of the global politics at play and the effects of some reactions from South Africa’s president, Thabo Mbeki.
The XIII International AIDS Conference52, Durban, South Africa provides information on the 13th conference on AIDS, that occurred in July 2000
Durban 2000 March53 for HIV/AIDS treatment is a march against pharmaceutical giants and governments—planned to coincide with the opening day of the 13th International AIDS Conference in Durban, South Africa in July.
AIDS in Africa; The Orphaned Child54 is a BBC special report. It contains various facts and case studies, as well as a look into the role of the drugs companies involved.
From the Democracy Now! radio show, the July 2000 archives55 have a number of talks about the AIDS issue.
AIDS in Africa56 from the Washington Post provides a number of articles of interest. In particular check out The Belated Global Response to AIDS in Africa
UNAIDS59, The Joint United Nations Programme on HIV/AIDS, provides a lot of informations, statistics and reports.
The Epidemic and the Media60 from the MediaChannel.org provides a collection of articles looking at the role of the media in this issue.
AIDS and the Poverty in Africa61, from The Nation Magazine, May 21 2001, looks at the relationship between poverty, and the lack of consideration of such aspects that has gone into current scientific research to explain the causes of the AIDS epidemic in Africa.
Around the world, large numbers of people suffer unnecessarily and die from often easily preventable illnesses and conditions. For example, an estimated 1 billion people lack access to health care systems while millions die each year from diseases such as malaria, Tuberculosis and AIDS.
While health service provision is a desire for most people, nations struggle to find sufficient funds as they face high drug prices (sometimes with drug companies challenging countries—especially poor ones—that may legally try to create cheaper generic ones when faced with urgent health issues) while changing lifestyles are contributing to deteriorating health.
Updated the AIDS statistics (replacing the 2007 statistics)
Embedded two videos showing impact of AIDS on children and how AIDS is linked to other illnesses such as TB. Also added some additional background on the South African government’s inappropriate resistance to HIV drugs, global funding, the impact of the global financial crisis, and drug company approaches.
Updated the AIDS statistics (replacing the 2006 statistics)
Updated the AIDS statistics
Update to AIDS impact, the effects of brain drain, and addition of a few success stories. Else, remainder remains untouched from May 15, 2002.