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

Sunday News (Zimbabwe) - - Big Read - Stan­ford Chi­wanga

“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.

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