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Attacking the Root Cause of the HIV/AIDS Pandemic in Africa
In the developed world, most of us quickly learned how the deadly human immunodeficiency virus (HIV) is transmitted and were mindful of the necessary precautions to avoid it. We screened the blood in our blood banks, switched to disposable needles, donned gloves and masks in our clinics, took the tests, changed our lifestyles, and stayed close to one partner. But in many developing nations, large populations continue to become HIV-infected, and AIDS has become a pandemic. Why?
On a trip to Africa in 1997, I observed a barrage of AIDS-awareness campaigns. It seemed that everywhere I turned—in schools and churches, on the radio and television, and in villages under a tree—people talked, marched, sang, danced, and acted out dramas about HIV and AIDS. I was confident that the young people of Africa were getting the message. Now, many years later, in spite of all of the education, the problem has only gotten worse.
Do they not understand the dangers of HIV? With hospitals full of HIV-positive patients—and death everywhere—why do so many people continue high-risk behaviors? Are the communication methods not working? Recently, I have had the opportunity to speak with several health specialists and educators in Kenya who are developing AIDS-awareness strategies. They helped me understand that the solution to the problem is much more complex then simply teaching people how HIV is transmitted.
Cultural Gaps
Many of the people living in rural Africa do not understand or accept the science of disease transmission that we take for granted in the west. In a culture steeped in spirits and spells, illness is the result of a curse—not a virus or bacteria in the bloodstream too small to be seen. With this belief system firmly entrenched, it is difficult for people to make the connection between lifestyle-activities and disease transmission.
Social Stigma
In many African cultures, promiscuity is shameful and extra-marital sexual activity is taboo. Because HIV/AIDS has been presented as a disease primarily transmitted through sexual activity with an infected partner, getting tested—not to mention being HIV-positive or dying of AIDS—is seen as an admission of promiscuity or unfaithfulness. To save the reputation of the victim, another disease is often blamed for illness or death.
Inconsistent Symptoms
The HIV/AIDS diagnosis often is a hard sell because its victims die from an array of diseases. Since HIV attacks the immune system, individuals are susceptible to a variety of illnesses. Some contract TB; others get malaria, measles, or pneumonia. If all AIDS victims got the same symptoms, the people might be more willing to accept the fact that one virus is the primary cause of death.
What You Don’t Know Won’t Kill You
People do not accept or understand the importance of testing for HIV. They say, "If I test positive, then what? I couldn't afford the drugs I would need to stay alive. I would face ridicule and be an outcast in my village. It is better not to know." Because most people still refuse to get tested, they are still out there infecting others.
While these factors helped explain the high transmission rates in Africa, something still seemed to be missing. During the course of my interviews, a theme not always associated with HIV/AIDS seemed to emerge.
“The young people in my village have nothing to do,” said one young girl in Kenya. “We don’t have jobs, we can’t afford to go to school—we have a lot of time on our hands.” Could it be that with our clinical perspective we have missed an important, underlying cause of transmission? Have our videos, radio programs, posters, and pamphlets glossed over the obvious? Could it be that a major covert agent sustaining the spread of HIV/AIDS is poverty?
In western culture, family, careers, recreation, and entertainment options provide a thousand diversions. The typical young person in Africa has no job, no opportunities, and no future. Trapped in poverty with no legitimate way to break free, most become sad, depressed, and desperate.
“Aren’t you afraid of getting AIDS?” my guide asked a young prostitute. She replied with a raised eyebrow, “If I get AIDS I will die in 5 to 10 years—I know that. But if I do not do this work, I will die in two to three weeks of a much more rapid form of AIDS—Accumulated Illness Due to Starvation.” I was shocked at her candidness, awareness, cynicism, but matter of fact resolve of her fate in life. She was killing herself to survive!
If the west is serious about ending the AIDS pandemic in Africa, then along with our awareness campaigns, condoms, and drugs, we need to be handing out opportunities. This means skills-training in the villages, scholarships for high school, and loans to help people start profitable businesses. A small investment can go a long way to bring people in Africa out of the drudgery of poverty into a life of meaningful engagement.
I spent a day in Kenya with a group of young people who had received ADRA sponsorship to form a youth solidarity group. Visiting the schools, churches, and villages in their area, they did peer-to-peer counseling and AIDS education through drama, singing, and poetry. Near the end of the day they took me to meet a woman who was caring for six of her grandchildren. With so many people dying of AIDS, many grandmothers in Africa have to raise their children’s children. But this was more then a courtesy visit. This grandmother and her AIDS orphans were just one of many families that this youth group cares for. As part of their regular program, group members work the farms of the orphans, offer social support, and protect the family plots from being seized by neighbors or greedy uncles.
“It gives us activity, action, and involvement,” one girl said. “Many of the youth around us have nothing to do. No wonder they become involved in high-risk behaviors. But when you lock arms with 15 other young people—many of whom have lost parents to AIDS—and tell other young people about HIV/AIDS, you develop a certain strength, a resolve to avoid a lifestyle that gives you the virus.”
The leader of the group was thankful for the training and funding from ADRA. “There is so much more that we would like to do, so many more orphans we could protect if there was a more structured program in place.”
It occurred to me that ADRA was getting a real bang for the buck with this project. Not only were they spreading important information about AIDS all through this part of Kenya, they were protecting a large group of orphans, and keeping 16 young people active, engaged, and employed. Money well spent! I wish that resources were available to sponsor thousands of these groups throughout Africa.
Recent efforts by governments and foundations are putting programs in place to provide life-sustaining drugs to the HIV-positive of Africa. While this is welcome news, I hope that it will also be accompanied with programs that also focus on prevention. AIDS education alone is not enough. Condoms and disposable needles are not enough. The only real way to reduce transmission rates in Africa is to reduce poverty. Programs of skills training, income generation, and small loans would attack the problem of HIV/AIDS at its roots!
--Frank Spangler --
