why is hiv more common in africa
A friend of mine recently asked me why HIV/AIDS is so much more prevalent in than anywhere else in the world. Seeing that this topic is something I am somewhat knowledgeable about, I thought the question would be relatively easy to answer. However, after several minutes of roundabout answers and maybes and I thinks, I realized that I really did not have a concrete response to her question. There are, however, several factors that account for Africa s high infection rate, so I decided to summarize a few of them briefly. The first, and most common reason, is the high rate of. Sub-Saharan Africa is currently home to over of the world s ultra poor people (just over 121 million individuals), and is seeing very little progress in terms of reducing the proportion of those suffering from severe destitute circumstances. Although HIV/AIDS affects both the poor and rich, it is a known reality that those affected by poverty, are more readily affected by the epidemic. There are several reasons for this, the first and most significant, being that poverty offers fewer defenses against the disease. By defenses, I am referring to medical defenses, educational defenses and financial defenses. As the lack of these defenses increases, the HIV/AIDS infection increases, in turn forcing more of the population towards poverty. The result is a perpetuating cycle of the epidemic leading to poverty, and vice versa. This leads me to another bi-causal relationship; the one between education and HIV. I will not spend too much time on this one, because the correlation between a lack of education and an increased HIV/AIDS rate, is an obvious one. The epidemic, unfortunately, has a crippling effect on Africa s infrastructure, particularly the education system. Education plays a vital role on both HIV/AIDS awareness as well as support for those affected by the illness. As th
e endemic worsens, a toll is taken on education systems as they lose teachers, faculty, staff and students. In terms of general HIV awareness and education, there has been a significant effort to spread the knowledge of the illness throughout the continent, however, due to a lack of infrastructure, funding and poor communication paths, there are still countless communities and individuals who do not fully understand the illness, how it is spread, prevention methods and treatment. Also concerning education and awareness, Africa also struggles with the added challenge of overcoming traditional and cultural beliefs regarding HIV/AIDS (as I explore this cause, keep in mind that this is something that affects primarily rural parts of the continent, much more than urban and developed communities). Traditional beliefs have long impeded not only the process of eradicating the epidemic, but also the process of enlightening educationally unwilling parties. There have been several psychological studies and surveys that have recently explored the relationship between people s cultural views and prevention efforts. One published by the University of Connecticut and the Human Sciences Research Council in South Africa, was particularly informative. It found that about 34% of residents in Cape Town, South Africa (a country with the most HIV/AIDS in the world), either firmly believed, or believed there was a possibility, that the disease is caused by spirits or some form of supernatural forces. These misunderstandings are not only about the causes of HIV/AIDS. Many communities and individuals are misinformed as to how the disease is spread, and are also plagued with falsities in regards to people living with HIV/AIDS; beliefs that are spurred by deep-seated traditional and cultural understandings.
There are several stigmatizing beliefs concerning HIV/AIDS sufferers, for example, that such individuals are the victims of witchcraft, voodoo, curses etc. , or that they are involved in culturally unacceptable homosexual activities. With such negative stigmas, people are deterred from getting themselves tested, fearing the stigmas that are attached to the disease, much more than the illness itself. In fact, 44% of individuals expressed that these stigmas influence their decisions to seek HIV antibody testing. This, of course, increases infection rates, as people who are unaware of their status, are engaging in unprotected sex and are unknowingly spreading the virus at disturbing rates. However, as widespread and popular as these traditional beliefs may be, I firmly believe that it is not a specific issue about traditional and cultural convictions, however, it is a general issue regarding the misinformation of HIV/AIDS and its facts and details as a whole. It is an issue of broad-spectrum education and the spread of accurate HIV awareness throughout all levels of society and geographic localities. These issues are certainly not all-encompassing, in terms of why Africa suffers from a far greater infection rate than any other continent, however they provide a basic explanation of some of the root causes. The high rate of prostitution, polygamy and promiscuity, sexual violence and rapid urbanization and mobilization also play a major role on high infection rates and the spread of the epidemic. I am well aware that each of these examples can be further broken down and dissected into hundreds of detailed, separate entities, however, I do not have the knowledge, expertise or time to do so. This is merely a basic exploration into a few possibilities and patterns. For more details, click on the hyperlinks throughout this blog entry for links to detailed studies and reports. As always, feel free to comment or provide me with feedback, because TALK AIDS! Botswana seems an unlikely place for an AIDS epidemic. Vast and underpopulated, it is largely free of the teeming slums, war zones, and inner-city drug cultures that epidemiologists say are typical niches for the human immunodeficiency virus. Botswana is an African paradise. Shortly after gaining its independence from Britain in 1966, large diamond reserves were discovered, and the economy has since grown faster and for longer than that of virtually any other nation in the world. Education is free, corruption is rare, crime rates are low, and the nation has never been at war. Citizens are loyal: A visitor quickly learns that even mild criticism of anything related to Botswana is considered impolite. Yet this country, with all these advantages, has the highest HIV-infection rate in the world. The virus has spread extremely rapidly in Botswana. Two decades ago, virtually no one there was HIV-positive. By 1992 an estimated 20 percent of sexually active adults were infected. By 1995 that proportion had reached one-third, and today it is roughly 40 percent. In , Botswana s second largest city, nearly half of all pregnant women in the main hospital test positive for HIV. The picture in the rest of sub-Saharan Africa is nearly as dire. AIDS has killed Zulu nurses in South Africa, Masai teachers in Tanzania, Kikuyu housewives in Kenya, Pygmy elders in Uganda. HIV infection rates range from around 6 percent in Uganda to 39 percent in Swaziland. Such numbers are astronomical compared with most of the world. In the United States, less than 1 percent of the population is infected; in Russia and India the figure hovers around 1 percent. Even in Thailand, with its thriving sex and drug trades, the proportion of infected barely exceeds 2 percent.
The high rates come despite efforts in many communities to stem the HIV epidemic through educational programs, condom distribution, and treatment for such sexually transmitted diseases as gonorrhea and syphilis, which create genital sores and ulcers that make it easier for the virus to spread. In most cases these programs have had little effect. The growing disaster has forced AIDS experts to reconsider old theories about how HIV spreads in Africa. Outside of sub-Saharan Africa, many HIV-positive people are injecting drug users, prostitutes, and highly promiscuous homosexual men who may have hundreds of different sexual partners every year. But most Africans with HIV claim never to use drugs, engage in prostitution, or have large numbers of sexual partners. To explain the high infection rates, scientists have advanced theories ranging from nutritional deficiencies to more virulent HIV strains to different sexual customs. In the 1980s Australian demographer John Caldwell insisted that the virus was spreading rapidly in Africa simply because people there tended to have more sexual partners than people elsewhere. He pointed to the cultural desire for many children, the tradition of polygamy, and other aspects of African society that contributed to a greater tolerance of promiscuous behavior than in the West. Caldwell s views sparked controversy and for years received little attention. Recently, though, some experts, including epidemiologist James Chin of the University of California at Berkeley, have revisited the theory. Chin believes it s the only possible explanation: People tell me not to say it, but I strongly believe it. Some studies do show that Africans have more but not vastly more sexual partners, on average, than people in Western countries. For example, a study of sexual behavior in Zimbabwe, where roughly 33 percent of adults are HIV-positive, found that in a single year, most people have between one and three sexual partners. Of course, prostitutes in Zimbabwe may have more than 100 partners a year, just as prostitutes elsewhere in the world do, but most HIV-positive Zimbabweans are not prostitutes. In the early 1990s, Martina Morris, then a member of the sociology and public-health departments at Columbia University (and now a professor of sociology and statistics at the University of Washington in Seattle), tried to solve the mystery of HIV in Africa mathematically. She had helped devise a computer program to predict the spread of HIV in a given population based on such factors as the number of sexual partners people had and the duration of those relationships. At the time, Uganda had one of the highest HIV-infection rates in the world, so she flew there in 1993 to gather data on sexual behavior. Just after I arrived in Uganda, I had to give a lecture to Ugandan doctors at the medical school in Kampala, telling them what I planned to do, she recalls. At the time there was talk in Uganda about helicopter scientists whites from the United States and Europe who just parachuted in, took data, and didn t work with local African experts. I was the only American woman in the room, and it was a tough audience. The HIV rate was estimated to be 18 percent at the time, and here I was trying to explain how mathematical models were going to help. They listened, and then at the end, one man raised his hand and asked, Could your model handle more than one partner at a time? I said, No. The man walked out. The others sat down with me and said I had to include concurrent partnerships in my model. Otherwise it would be irrelevant.
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