Thursday, May 31, 2012

HIV/AIDS: The First Step Is Admitting It

While no one has found a cure for AIDS, there are scientifically validated preventative and palliative treatments for it. Antiretroviral therapy (ART) significantly delays the onset of AIDS in people living with HIV and prevents HIV+ pregnant or breastfeeding women from passing the disease onto their children. Contraceptives greatly reduce the chances of transmission during intercourse, and infant circumcision has a similar effect in the long term. These interventions work. We know that.

Part of the problem in scaling them up in AIDS-ravaged countries, however, is cultural and political denial, a blank refusal on the part of societies and, less often, governments to acknowledge the severity or even existence of the HIV/AIDS crises. Unfortunately, because HIV spreads through sex, something very private, and then lays dormant for years after transmission, it is easier to reject the causal link between HIV and AIDS. Moreover, because AIDS destroys the immune system but does not finish its victims off, denialists try to attribute deaths from AIDS to tuberculosis or other common diseases, which set in with ease after AIDS has removed the body of its defenses.

For an example of a government’s refusal to accept HIV as a cause of death, take the South African government pre-2009. Though the AFCA does not happen to work in South Africa, in the 2000s President Thabo Mbeki took to the extreme a pattern of denial that persists on a smaller and somewhat tamer scale elsewhere in Africa, including in the four countries in which we work. In South Africa, despite the near doubling of children’s AIDS prevalence between 2001 and 2007, the 7.7% increase of the prevalence rate during the same period, and more AIDS cases than in any other country but India, Mbeki consistently renounced the link between HIV and AIDS. Spurning civil society groups such as the impassioned Treatment Action Commission, he refused to spend government funds on ART, maintaining that the medicine was a waste. One Harvard study concluded that his negligence cost South Africa 300,000 lives.

In 2009, things changed abruptly. Anti-AIDS campaigner Jacob Zuma won the South African presidency, reversing Mbeki’s policies soon thereafter.  Zuma actively and publicly sought to reduce the incidence of HIV. His efforts paid off. By 2011, 95% of HIV+ pregnant women were taking ART pills, preventing mother-to-child transmission. Moreover, Zuma’s government lowered the requirements for receiving ART—a moderate CD4 count (a measure of immune-system strength) of 350 rather than 200, at which point the prospective patient is already suffering in the clutches of the disease. Despite these changes, the tide of transmission still outweighs the government’s efforts. Prevalence rates continue to climb, but at a slower rate (3%) than during Mbeki’s presidency. In restricting, but not stopping, the spread of HIV, the South African government has saved many, many lives.

Obviously, as the case of South Africa demonstrates, lack of willingness on the part of African leaders to face AIDS does not fully explain why the disease persists. Another large part of the problem lies in the fact that, though the price of ARV has dropped in the last decade in response to loosening patent monopolies on the medicine, African governments seldom have the funds to provide treatment for all who need it. South Africa is by far the wealthiest country in Africa, and, even after election of Zuma, it still has not achieved full coverage. Nevertheless, denial is an important facet of this extraordinarily complex global health crisis. To understand why AIDS persists, we must understand why in some settings it goes unacknowledged and how we can work to encourage openness and educate Africans (and ourselves!!!) about this very real threat.

World Health Organization Statistics

Friday, May 25, 2012

HIV/AIDS: More Than Just A Disease

Without a doubt, the global HIV/AIDS pandemic is a multifaceted tragedy. Many Americans may view AIDS primarily as an unfortunate consequence of individual choice, a disease whose effects are regrettable but mainly limited to those who have ‘chosen’ to engage in unprotected sex. But AIDS has terrible consequences that reach far beyond the physical discomfort and subsequent deaths of immediate victims. In addition to causing extreme physical suffering for victims and severe emotional trauma for loved ones left behind, AIDS brings down the livelihoods of entire communities and the productivity of entire nations, especially in developing nations such as those in which we serve (Kenya, Uganda, Zimbabwe, and the Democratic Republic of the Congo). AIDS does not merely affect those who have it; it is bad news for everyone, and citizens of developing countries seldom have the resources to acquire adequate treatments for it. This means that we, as first-world citizens who possess a dramatically disproportionate share of the world’s resources, must make fighting AIDS around the world a strong priority.
To illustrate the destructive effects that HIV/AIDS has on communities, consider the timing of most deaths caused by AIDS. Most victims contract HIV in their teenage years, many well before the end of puberty. This means that, because HIV lays dormant for about six years on average, the virus begins to manifest itself as AIDS during the early-to-mid-twenties, which is probably the least fortunate age possible. Both in the countries we operate in and in many, many others, most men and woman of that age have multiple, young children and are at their zenith in terms of economic productivity. Their families’ well-being and survival often depend on them, and, if they were to stick around, they could lend decades’ worth of support to their communities.
But way too often, young parents cannot stick around. They succumb to a disease they contracted as teenagers, and when they die, they leave behind orphans who require care. In this way, AIDS not only deprives young ones of their parents; it drains resources from communities that are already economically strapped. Grandparents—grandmothers in particular—often take orphaned grandchildren under their wing, but these older caretakers have less energy and more responsibilities (including other kids) than their deceased sons and daughters had. Sometimes, the orphans have no new caretakers at all; no one local is willing to share enough resources to provide for them, and they are left to fend for themselves.
AIDS causes other, more immediate, but equally devastating resource drains as well. Because AIDS weakens the immune system, making normally tolerable diseases lethal but not technically killing its victims, families will often rush AIDS victims to health facilities to treat these diseases when they set in. (That is, IF they are privileged enough to have such care within reach. In Uganda, for instance, health care access is under 70%.) By paying for extensive treatment, both for AIDS and for the disease it has made life-threatening, families willingly throw themselves into poverty, going into debt in hopes of saving their loved one. Many families struggle to repay their debt for many, many years, especially if the AIDS victim died, thereby damaging the family’s ability to work it off.
Finally, funerals can have a similar effect. In many developing countries, such as Kenya, funerals have a much greater cultural importance than in America. Not to hold an elaborate—and expensive—celebration of the deceased’s life is often considered negligent on the part of surviving relatives. In some places, as in some areas of Kenya, religious beliefs reinforce the attitude that expensive funerals are necessary; an improper send-off jeopardizes the deceased’s position in the afterlife. To put together an adequate funeral, then, families will take on debt beyond their means and struggle thereafter to repay it, sacrificing their well-being in the process. Changing these embedded cultural practices is difficult, and in any case, asking people to curb these spending practices may imply a dubious judgment on the part of the West. Who are we to say they should not spend money on their loved ones in this way? The poor, after all, do deserve to be celebrated. In any case, whether they should or not, the fact is that in developing countries around the world, the poor willingly become poorer in order to pay for funerals of loved ones who die of AIDS.
Clearly, AIDS is not just a disease; it is a cause (or an amplifier) of terrible poverty. Delaying the onset and severity of AIDS through interventions such as antiretroviral therapy not only assuages the suffering of the victim, it prevents the family and the community from having to shoulder all of the intertwined emotional and economic burdens associated with the victim’s death. In this way, the AFCA’s work in providing such interventions uplifts entire families and communities. Our question to the reader is, what will YOU do? For more information on ways you can get involved with our work against HIV/AIDS, visit our website,, or email us at or