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Subject: [AfricaMatters] AIDS in Africa linked to poverty
November 1, 2000
AIDS in Africa linked to poverty - analysis
By Marjolein Harvey
Siyaphila!
We have had poverty, TB and malaria for centuries - all conditions that
compromise the body's immune system - but never before have people been
decimated like this: in sub-Saharan Africa alone, an estimated 25 million
people are now living with HIV/AIDS and more than 15 million others have died
from it so far.
It is commonplace for HIV/AIDS programme managers to acknowledge poverty as a
causative factor, but to then say that "poverty" is beyond the scope of their
programmes.
President Thabo Mbeki, amid public outrage and media hype, goes a step
further by maintaining that poverty, not HIV, is the root cause of the
growing AIDS epidemic in sub-Saharan Africa.
"The world's biggest killer and the greatest cause of ill health and
suffering across the globe, including South Africa, is extreme poverty,"
Mbeki said at the opening of the International AIDS Conference in Durban in
July.
He added "As I listened and heard the whole story about our own country, it
seemed to me that we could not blame everything on a single virus."
It's therefore no wasted effort to help understand the links better. The
Africa Policy Institute's Joe Collins and Bill Rau provide an excellent
albeit lengthy analysis.
Sub-Saharan Africa has four times as many poor people as non-poor;
worldwide, 1.2 billion persons are forced to live on less than R7 a day;
95% of the more than 34 million people in the world with HIV live in
countries that are too poor to pay for HIV/AIDS drugs;
an estimated 25 million people are now living with the disease and more than
15 million others have already died in sub-Saharan Africa.
The relationship between poverty and HIV/AIDS is "bi-directional", say
Collins and Rau: poverty is a factor in HIV transmission and exacerbating the
impact of HIV/AIDS on the one hand, while the experience of HIV/AIDS by
individuals, households and even communities that are poor can readily lead
to an intensification of poverty and even push some non-poor into poverty.
"Thus HIV/AIDS can impoverish or further impoverish people in such a way as
to intensify the epidemic itself," say Collins and Rau.
They point out that the extent of impoverishment in the world today is truly
staggering. According to an internationally adjusted standard of absolute
poverty, sub-Saharan Africa has four times as many poor people as non-poor.
1.2 billion persons are forced to live on less than R7 a day.
Collins and Rau also point out that poverty and gender are inextricably
intertwined. Women and girls are disproportionately represented among the
poor. Seventy percent of the world's poor are women. It is poor women who are
most susceptible to HIV infections, for gender alone does not define risk.
They quote the United Nations Development Programme as saying: "A lack of
control [by poor women] over the circumstances in which the intercourse
occurs may increase the frequency of intercourse and lower the age at which
sexual activity begins.
"A lack of access to acceptable health services may leave infections and
lesions untreated. Malnutrition not only inhibits the production of mucus but
also slows the healing process and depresses the immune system."
They point out that poverty is not a natural phenomenon, or something innate.
"When we call people 'poor' we are in danger of forgetting that they are made
poor. Poor people are really impoverished people. They are impoverished by
inequitable socioeconomic structures on the household level, on the village
level, on the national level, and on the international level of trade and
commerce," says Collins and Rau.
The two authors argue that as a socioeconomic process, HIV/AIDS is just one
more problem for impoverished people to deal with, on top of many others.
They highlight the work by Tanzanian social scientist Gabriel Rugalema, who
investigated the impact of AIDS in a village in the severely affected
northwestern part of his country.
He wrote of people's views of the epidemic: "In general, they did not think
of AIDS as something terribly new. Rather, they saw it in the wider context
of other crises predating it," including famines, drought, war, and economic
downturns which affect poor people disproportionately.
With 95% of the more than 34 million people in the world with HIV living in
countries that are too poor to pay for HIV/AIDS drugs, some of which cost
more than R70 000 per year per person, there is little doubt that AIDS and
poverty are linked.
Perhaps a poverty approach to AIDS does provide some opportunities, in a
"bi-directional" way, and allay the miserable failure of decades of
"development". While poverty has been around so long it seems a natural part
of humanity, AIDS is approached with a sense of urgency. Perhaps linking the
two will be to the benefit of both ills.
go to the full article by Collins and Rau - note that it is very long, so
download may be slow
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