HIV/Aids – closing the tap impossible without drying the dam of poverty

“CLOSING the tap” — that’s the new aphorism in the fight against HIV/Aids. It is a war cry that is motivating the world to prevent new infections in an effort to ensure that by 2030 there will be an HIV/ Aids free generation. However, in Africa achieving this target will be a Herculean task if poverty is not eradicated.

Why? You may ask — because poverty and HIV/ Aids have a correlation and a study of this relationship is the key to understanding the reason why new infections keep happening in a world where almost everyone knows about HIV/Aids.

The association is cyclical in that HIV/Aids is a key driver in the existence and creation of poverty and in the same way poverty is a key factor in the transmission of HIV/Aids which can impoverish people in such a way as to intensify the epidemic itself.

From the first it must be stated that all factors, which predispose people to HIV infection, are aggravated by poverty which creates an environment of risk. According to UNAids poverty is linked to HIV infections through deep-rooted structural poverty, which are a result of such factors as gender imbalance.

These gender inequalities have been linked to higher HIV prevalence in sub-Sahara Africa. In this region, gender inequalities have been associated with unprotected sex and increased risk of HIV infection among women and are responsible for fuelling Africa’s HIV epidemic.

“The failure to enshrine the reproductive rights of women, not guaranteeing gender equality, and lack of access to reproductive health services for women and continued economic isolation and lack of autonomy in women has seen women being unable to negotiate safe sex.

This has resulted in risk of HIV infections being increased. In addition, the structure of persistent gender relations and ensuing power dynamics mean a significant number of women are not empowered and capable of negotiating protected sex,” said Mr Prosper Mupa, the Matabeleland South Provincial National Aids Council Monitoring and Evaluation Officer. .

Furthermore, the limited opportunities afforded to women to earn a livelihood compels them to choose survival sex as a resort.

In sub-Saharan Africa it is not only commercial sex that is a means to a living, even women and girls not commonly viewed as prostitutes find themselves exchanging sex for money and other basic goods.

This they do through early marriages, polygamy and eloping. The social inequalities in Africa see young females having early sexual debuts and in most cases they will be sleeping with older men for money.

The danger with transactional sex is that it is associated with sexual coercion and HIV risk behaviours. This type of sex places women and young men at increased risk of HIV infection.

Transactional sex is associated with increased sexual risk behaviours such as inconsistent condom use and multiple concurrent sexual partners of varying ages. Both sexes are equally vulnerable to risks associated with survival sex precisely because they are impoverished and less likely to take seriously the threat of an infection.

Migration in sub-Saharan Africa is an underlying factor in the spread of HIV/Aids and studies have shown that most people in Africa migrate to escape poverty.

According to the Zimbabwe Demographic and Health Survey, migration of youths, the married and unmarried from poor rural areas and poor countries to urban areas and economically powerful countries such as South Africa and Botswana, where some live in crowded hostels, which are targeted by sex workers, has resulted in high-risk behaviours which have increased the rates of HIV.

Males separated from their wives and girlfriends for long periods end up giving in to sexual temptation, the women end up engaging in sex work. The HIV infections, acquired from these areas of economic refuge, are then rapidly spread back to the homes of the migrant workers.

It is no wonder poor countries and rural areas carry the cost of their migrants contracting HIV/Aids, both through the loss of income remitted by the worker who has fallen ill and through the cost of supporting the ill family member if they return home once they are ill.

“In Zimbabwe and Africa in general, new infections are a result of spousal separation, age mixing, inconsistent condom use and multiple sexual partners. Spouses move to greener pastures and come back infected or they get infected by the remaining spouse who fails to handle the separation and indulges in sex for survival,” said Mr Mupa.

At the micro-level, the experience of HIV/Aids leads to an intensification of poverty and pushes the well-to-do into poverty. In turn, poverty accelerates the onset of HIV/Aids and tends to worsen the impact of the epidemic.

The increase in mortality, morbidity and the reduction in life expectancy and population growth have seen HIV/Aids having a direct impact on poverty. Most of the lives lost are adults between the ages of 25 and 45 years, the very people who support families.

This creates inter-generational poverty by impoverishing orphans, dissolving households and decimating the fragile asset base of the poor.

The experience, according to UNAids, is made worse by the rise in discrimination and marginalisation of the poor who lost relatives to HIV/Aids or are living with HIV/Aids.

This is worse for women who are often blamed for transmitting the HIV virus.

Furthermore since HIV/Aids deaths increase the prevalence of poor female headed households, often young widows and grandmothers, it can be said that the epidemic is largely responsible for the feminisation of poverty.

HIV/Aids is reversing decades of development in sub-Saharan Africa at the macro-level as well. In individual countries and in the region, HIV/Aids is impairing economic growth through reducing the labour force thereby affecting production, scaring away investment and having a negative impact on trade and national security. Countries in sub-Saharan Africa are spending huge amounts of money that could be used for development to fight the epidemic. All this leads to more widespread and extreme poverty.

Poverty then exacerbates the challenge of living with HIV/Aids. Lack of a good and reliable income and access to quality health care makes it difficult for many in sub-Saharan Africa to manage what has increasingly become a manageable disease.

In Sub-Saharan Africa the cost of life-sustaining ARV drugs ranges between $10 000 to $15 000 per patient a year and most countries cannot afford these costs because their economies are struggling. It is left to NGOs and international donors to fill the gap. As a result millions of people in sub-Saharan Africa are languishing on long waiting lists for help.

According to Dr David Wilson, a Zimbabwean doctor who heads the World Bank’s global HIV and Aids programs, 79 percent of HIV positive people in West and Central Africa and 59 percent in East and Southern Africa are not accessing ART.

More over 75 percent of adults in sub-Saharan Africa who are accessing ART have not achieved viral suppression.

This clearly proves that individual, household and national poverty increase the prevalence and impact of HIV/Aids in this region.

According to UNDP, people living in high-poverty countries, south of the Sahara Desert, face a number of other challenges including high rates of violent conflicts, social isolation, poor infrastructure, poor national governance and lack of HIV and sexual health literacy, all of which contribute to the epidemic in distinct and overlapping ways.

An inability to meet basic health and nutritional needs worsens HIV in Africa, increasing the risk of contracting other infections and hastening the onset of full-blown Aids.

And as viral loads increase from lack of access to care, so does the risk of infection to sexual partners, thereby further fuelling the epidemic.

However, it must be said that HIV/Aids does not only affect the poor countries, even the rich countries feel the impact of the epidemic.

Countries such as South Africa, Botswana and Nigeria have the biggest economies in sub-Saharan Africa, but they experience the highest rates of infection, while poor countries like Mozambique, which experienced 16 years of devastating civil war, have low infection rates.

The reasons why such countries have high rates are unclear but researchers such as Mr Mupa believe that it is because of migration and the uneven distribution of HIV/Aids in the region.

That said the argument that poverty drives HIV/ Aids and vice versa has been challenged by recent studies that show that in many African countries, such as Tanzania, Uganda, Ghana, Kenya and Cameroon, the prevalence of HIV infection correlates directly with wealth.

In Tanzania HIV/Aids indicator surveys show that there is a strong positive relationship between household wealth and high infection rates. However, it must be said that the relationship between wealth and HIV/Aids is not direct, but structural factors lead to situations of risk or non-risk in a given situation.

In other words, wealth is associated with risks and protective effects in different contexts. Wealthy men, especially men who have come into new wealth, in Africa tend to use their newly found status to engage in risky sexual behaviours such as practicing polygamy and having many concurrent sexual partners.

On the other hand, wealthy women tend to reduce risky sexual behaviours since their wealth protects them from transactional sex.

Moreover, while wealthy people may initially engage in risk behaviours, trends show that wealth becomes a protective factor as the epidemic matures.

The wealth will use their socioeconomic status to fight HIV/Aids — they will easily have access to treatment, a privilege that the poor do not have. Wealth also allows people to negotiate safe sex as their socio-economic clout gives them power to negotiate safe sex, refuse sex and determine the kind of sex they will have.

In short, infections will keep occurring and chances of an HIV free generation by 2030 are as high as the survival prospects of an ice cube in hell if we try to close the tap without drying the dam of poverty.