AIDS in Africa -- Questions & Answers
Are there any differences between AIDS in Africa and AIDS elsewhere in the world?
AIDS in Africa is basically exactly the same thing as AIDS in the USA, Europe or anywhere. But there are big differences in the way it is affects people due to the poverty of Africa.
The African HIV virus is also a different subtype from those seen elsewhere in the world. This suggests that the HIV virus is spreading rapidly WITHIN but is not spreading from Africa, via airplanes or ships.
The opportunistic illnesses associated with HIV are different as well. TB is for instance, which was almost controlled before in Africa, is now rampant again as was in the early 1900s. Some studies suggest TB is even worse now then in 1900.
The time between contracting the HIV virus and getting full-blown AIDS is about 50% as quick. Without treatment it ranges from five to ten years. This is thought to do to malnutrition and the overall poorer health for all Africans than in the more developed nations of the world.
Is it really such a crisis?
Yes it is, the World Health Organization estimates Africa out of a population of one billion has 25 million people with HIV (about 2.5% of the entire population of Africa) Most of this, 24.5 million is located below the Sahara desert. About 2 million people each year die from AIDS.
Is it getting worse?
In the short term, yes. In the long term, no. Actually like in the United States, even before the introduction of antiviral drugs in the mid 90s HIV appears to be getting less lethal. However while the NEW rates of HIV and AIDS go down the over all number is growing higher.
What does all this mean for Africa?
The biggest part of AIDS in Africa is that it affects the young generation. In Africa many of these young people leave their villages and go to other countries and earn money. This money they return home is all that keeps some countries like Lesotho alive. With these wage earners gone the money dries up.
Furthermore these young adults become a "burden" because, not only do they no longer earn money, but they must be taken care of. Additionally most of these young people that go to other countries to earn money, to send home, themselves have children. Thus these children are orphaned causing additional problems for the villages and nations affected.
Most staggering is the life expectancy of some African nation has fallen below 40 years from time of birth. To have a life expectancy rate be cut from 60 years to 40 years is tragic.
Has AIDS always been in Africa?
It is possible that it existed in small numbers and was waiting to get the right transmission route. What is known in the late 1970s and early 1980s Africa already was having small pocket of what the Africans termed "The Wasting Disease."
Studies with Marburg and Ebola also suggest that it is very possible for a virus to sit dormant for decades, and then come back. For instance Marburg a hemorrhagic fever first came to Europe in the late 1960s via monkeys imported from Africa. It killed a dozen or so Europeans and then disappeared. In the mid 1970s a couple of more people in South Africa got Marburg. Then it disappeared.
In 1977 and 1979 a virus called Ebola (a close cousin of Marburg) showed up. Ebola kept showing up for awhile here and there in contained outbreaks. Then in the late 1990s Marburg appeared and killed over 100. Then in 2004 Marburg again came back and killed even more.
So it is quite possible for a virus to be confined to a small area until it finds the right "vector" to grow in.
Why is this more a problem in Africa than elsewhere?
No one can pinpoint it exactly but the most likely reason is poverty. Generations ago Africa was relatively rural. Big cities south of the Sahara desert were limited to such industrialized places like Cape Town and Johannesburg. In the 1970s cities like Kinshasa, Congo swarmed with rural people trying to find a better life.
Up until the mid 1970s Africa was mostly an area of sustenance living. Even during the Ebola outbreaks, the poor could be taken care of. This was because people lived simply and though they had little. Their lives consisted of living in simple huts, which were made out earth or other easy to get materials. They went hunting, fishing and grew crops. So even if they had next to nothing it was enough to enable Africans to live as they did for millions of years.
As the poor flocked to cities in hopes of finding a better life they demanded more material things and sustenance living didn't work. Newly urbanized women found they had to trade sex to get food. Moving entire families of people into flats meant for one person gave way to extremely unsanitary conditions. Rats and other disease bearing animals flourished in the new urban environment.
This is the same pattern that occurred in places like London and New York City before they were modernized in the early 1900s. Diseases flourished and grew in those cities in the poor slums much as it does in Africa today. So the pattern is not new.
Is all of Africa affected?
No, it varies widely. Whether this is actual or rather a failure to represent statistics accurately is not known. It appears from random sampling that countries NORTH of the Sahara desert have a lower HIV infection rate, than in North America. As does Somalia in the "Horn" of Africa, which has been torn with war for 20 years. It may be that Muslim cultural practices slow it down. Most notably is circumcision among Muslims.
The worst affected countries are South Africa and Botswana. Curiously they are also countries with huge populations of migrant workers. This lends credibility to the theory that HIV is being spread among the poor due to rape, sexual favours and simply unsanitary conditions.
Any other differences between AIDS in Africa and the West?
Yes it is quite apparent that women are effected vastly more so. Sampling indicates 60% of African AIDS victims are women. The World Health Organization estimates about 8 million children (of both sexes) are orphaned do to AIDS. It also appears the subtype of HIV in Africa is more virulent than in North America or the subtype of HIV seen in Europe.
Are most people tested for HIV in Africa?
No, and this is the real problem that gives HIV alternative theories credibility. The World Health Organization estimates less than one half of ONE percent (0.5%) have been tested. The rest of HIV or AIDS is diagnosed by taking a "sampling" of the local populations.
This is extremely problematic because different cultures react differently. For some even the mere test for AIDS is taboo and they refuse the tests. So how random is the sampling one has to ask?
The World Health Organization relies on autopsies and "death certificates" to complement their "sampling." Also in Africa many people are diagnosed with HIV simply due to their symptoms. In the United States this is not standard. In Africa it is, so there is much potential for error.
Most samplings occur in Africa from Women who attend prenatal clinics. The data from these clinics is roughly the same throughout sub-Sahara Africa, so it's considered somewhat reliable. However for most Africans medical clinics are only for sickness and pregnancy is considered a "normal" condition. So the vast majority of African women don't seek any medical advice from clinics if there are no apparent problems. So we really don't know how many we're AIDS victims we are missing.
So as you can see this lack of scientific standards causes some people to believe the AIDS rate is over inflated. But it could really just as easily be under inflated.
I've read the AIDS prevalence is stable in Uganda. That is that is good thing right?
Probably not, what it most likely means is the rate of new infection isn't exceeding the number of people dying from AIDS.
Do unsafe injections cause many HIV infections in Africa?
The World Health Organization denies they are a large part, but it is not supported by a lot of backup. For instance Africa as a continent produces about five million needles for injections a year. The World Health Organization estimates AT LEAST one BILLION needles are needed per year. It doesn't take a rocket scientist to see you're going to have a huge shortage of needles.
Africa doesn't come close to providing the needles for safe injection. Unless the needles are cleaned properly after each use they can spread infections. Outbreaks of Ebola and Marburg in the past indicate that improperly cleaned needles was a cause of the epidemics. While HIV is a lot less durable than Ebola or Marburg, it surely must be part of the problem.
IV drug use doesn't occur for most Africans basically because of the cost of such "street" drugs. Also many Africans have herbal alternatives to "getting high."
Does male circumcision have any effect on rates of HIV transmission?
Yes it does appear to. In Uganda and Tanzania, in closely controlled studies it indicated uncircumcised males have about 40% more HIV infection than circumcised males.
Do any other African "cultural" rituals spread AIDS?
Certain rituals certainly don't help. For instance the drying of the vagina before sexual intercourse is a common ritual. The vagina has natural lubricant's and by drying them out that makes cuts in the vagina much more common and provides an additional way to get infected.
Most reports of African rituals, try to focus on the "exotic" aspect of culture in Africa. People forget no matter what the practice is, if it involves the transmission of blood HIV is spread. This would include tattooing, branding and bodily cleansing of the dead.
The goal of the World Health Organization is not to stop this culture but rather to explain how it can be done safely. But many Africans fear the rituals will be stopped all together.
This for example occurred in the Ebola outbreak of 1979. The women and children would ritually cleanse the dead body of all intestinal contents. Which you can see is a bloody ritual and is a great way to spread Ebola or any virus. But even at the risk of death, the practice continued because the ritual was too strong. Therefore doctors showed the population how to do ritual cleansing, using proper barrier nursing, like latex gloves, face masks. As soon as they did this new infection rate of Ebola dropped to tenfold.
Why do so many people say malnutrition, dirty water or other non-infectious things cause AIDS in Africa?
Part of this is due to the lack of medical facilities. In the sub-Sahara most Africans still use tribal doctors for medical treatment. If those tribal doctors fail, then they go to those of the "European Man," as he is called. Though in reality it may be an African trained in nursing or medicine in Europe. By the time an African gets to a medical clinic he may very well be very ill or just hours away from dying.
Poverty plays a keen role in AIDS. Even in America, the more access you have to better medical facilities generally, you have a longer life expectancy and your quality of life is better.
If you suffer from HIV or AIDS it's hard enough, but try to imagine having an illness and eating only twice a week. Yes in Africa it is routinely common for areas to be so poor the population eats twice a week.
The biggest problem to the theory that poverty causes AIDS is Africa is, in countries which have low HIV infection rates and high poverty and malnutrition, have not had an increase in AIDS deaths. So the poverty is there but no AIDS.
Why do so many think AIDS in Africa is just a new name for old diseases?
Most of this is due to extreme poverty. Before 1980 TB was fairly well controlled. After AIDS started to take over. TB stopped being confined to the poor and malnourished, it became common to people in middle classes and those well fed.
Part of it is due to poor medicine. For example in a misguided effort to control Malaria in the 1980s, people were told; if they get a fever take anti-malaria drugs. But because Africa lacks even the basic medical care, as seen in the West, whenever someone had a fever they took the anti-malaria drugs.
It's estimated over 90% of sub-Saharan Africans have antibodies for Malaria. Meaning they've been exposed to it. Indeed Malaria wiped out thousands of European explorers while only mildly affecting the native Africans.
In an effort to control Malaria as soon as they got any fever they took the anti-malaria drugs. Soon the Malaria started to develop resistance to the drugs, and malaria became more serious, because the milder strains died out. Now malaria that was mild and endemic to Africans is out of control and killing them.
This is one of the reasons you don't see the opportunistic infections such as Kaposi's sarcoma that you see in the West. Because TB and Malaria are taking the toll so quickly that Kaposi's sarcoma never has a time to show up. The Africans are dead before it shows up.
IN addition Kaposi's sarcoma has shown up in alarming rates in Kinshasa and in urban areas of Uganda.
What is the controversy with Catholics and AIDS in Africa?
Most of this relies on one Catholic rule, the refusal to approve the use of condoms. This goes back to core Catholic belief that says all sexual relations must be open to procreation. If it's not, it cannot be used.
In Uganda a study of increase use of condoms did cut the rate of new infections by half. So it appears to work IF the condoms are used.
So now you have a conflict and the church's opposition to birth control overrides the safety rate of condoms.
So why not throw the Catholics out?
Simple, there would be no one to replace them.
The Catholic Church provides more medical facilities in sub-Saharan Africa than any other source in the world, including the governments of African nations.
For hundreds of square miles the Catholic Church may be the only source of medicine or nursing care. They are needed greatly. As bad as AIDS is, there are many diseases that are worse, such as malaria, TB, and outbreaks of hemorrhagic fevers.
You should think AIDS as a long-term health issue, while the Catholic Church is providing health care for the short-term diseases. In deed the anti-malarial drugs given out at a Catholic nursing station may make the person well enough to have sex and get AIDS.
Anything else to say about AIDS in Africa?
Wherever medicine is sloppy, due to lack of funds or staffing questioning statistics will come into play. Africa is a mess when it comes to diseases but remember, so was Europe before the mid 1850s. By lacking even the basics like bleach to sterilize needles everything is made worse.
And finally on a continent where we have massive killings and genocide of their own peoples (think Rwanda) it wouldn't be so improbable for local African leaders to let AIDS kill off a populace they didn't care for anyway, simply by denying the disease exists. Some leaders have instisted that AIDS is simply nature's answer to birth control. Seeing that Africa has the highest birthrates in the world it makes sense to some.