World AIDS Day: HIV/AIDS situation in the African Great LakesNews
Since 1988 the World Health Organisation(WHO) has marked the 1st of December as the International World Aids Day, a day aimed at commemorating AIDS victims and uniting people all over the world to come together in the fight against HIV. As the struggle of humanity against the pandemic continues and more and more is discovered about the disease, the challenges ahead remain numerous, although different for every region and group of people. For the Great Lakes region and its immigrants in particular, research shows that mostly young women are infected and that there also seems to be a high prevalence rate in immigrant populations in Belgium.
Inside the region Great Lakes region, only Rwanda and Burundi have achieved significant decline of HIV infections in 2011 (UNAIDS 2012). In addition, Rwanda has already met Millennium Development Goal 6: to halt and begin to reverse the HIV epidemic by 2015. The rest of the countries, such as the Democratic Republic of Congo, Uganda, Tanzania and Kenya, have seen less improvement.
The Rwandan Minister of Health, Agnes Binagwaho, in her blog of June 7th 2012 said: ‘With the support of its global partners, Rwanda has made substantial gains in the fights against HIV/AIDS, tuberculosis, and malaria. HIV prevalence has fallen from 13.9% in 2000 to 3% today due to an integrated approach to tackling the pandemic with urgency and equity.’ Furthermore, the prevalence has been kept at this 3% since 2005 (UNGASS 2012) and Rwanda has implemented HIV/AIDS policies ‘as a cross-cutting pillar’ of Rwanda’s Vision 2020 and its Economic Development and Poverty Reduction Strategy. Also, Rwanda has been, in line with the WHO’s and UNAIDS’ recommendations, promoting voluntary male circumcision using a new PrePex device with which the procedure takes about three minutes and doesn’t require more than a few hours for recovery. Multiple studies have shown that male circumcision reduces the HIV infection risk by 60%. Rwanda’s goal is to reach 2 million men by June 2013 (UNGASS 2012).
A recent HIV/AIDS annual report of the Belgian Institute for Scientific Research in Public Health, WIV-ISP, shows that between 2009 and 2011, among not-Belgians living in Belgium and infected with HIV, 62,1% (908 patients) was from sub-Saharan Africa, whereas 22.6% was from other countries in Europe, 12.8% from America or Asia and 2.5% from Northern Africa. The numbers are revealing: 3 out of the top five countries are from the Great Lakes. The most affected immigrants from sub-Saharan Africa are Congolese (19.5%), Cameroonians (17.2%), Rwandans (11.2%), Guineans (9%) and Burundians (5.8%). A further look into these details shows a striking fact. Among this group of Africans, the male to female ratio is 0.5, compared to for example 2.7 for North-Africa and 3.3 for Asia and America. Furthermore, the report states that a part of the immigrants has only been in Belgium for a short period and has probably entered the country already infected. Luckily, 36% of all the patients who are monitored medically are also from sub-Saharan Africa, indicating that a majority of those infected is seeking medical treatment.
Overall, the report states that the number of people who carry the human immunodeficiency virus in Belgium has generally increased in the past ten years, with figures showing 3.2 new positive diagnoses every day in 2011. This trend is mainly due to the rise of new infections among men who have sex with men (MSM), but heterosexual contacts are still the leading cause of virus transmission, accounting for 49,6% of the positive diagnoses in 2011.
In its message on this World Aids Day, the WIV-ISP stresses the importance of an early diagnose, as this often leads to a better disease response because of the early initiation of therapy and counseling.
The sad reality about the HIV/AIDS pandemic on a global scale is that it seems to be a disease of the poor in the first place and a disease of the Africans in the second. Sub-Saharan Africa alone accounts for more than 70% of deaths caused by the virus worldwide (UNAIDS 2010). Countries in Southern Africa in particular, such as Botswana, South-Africa and Zambia have some of the highest numbers in infections. For a long time, the continent and its inhabitants were stigmatized in several global HIV/AIDS interventions and debates, as Africans sometimes were portrayed as overly engaging in sexual risk behaviours by having multiple partners, refusing to use a condom due to ‘cultural aspects’ and not being able to talk about HIV/AIDS as sexuality was a ‘taboo’ in many societies. Arguments like these would often be used to explain why so many Africans are suffering from this infectious disease compared to for example Europe, Asia or America.
However, in the past years, Africa, together with the rest of the world, has been significantly fighting back this monstrous and destructive virus and has seen an impressive decline in the incidence rates, including the mother-to-child-transmission. Irina Bokova, Director-General of UNESCO in her statement on this World AIDS Days said: “The number of people newly infected continues to fall across the world. The number of adults and children acquiring HIV infection in 2011 stands a full 20 percent lower than in 2001. It is encouraging that the number of people dying from AIDS-related causes in sub-Saharan Africa declined by 32 percent from 2005 to 2011.”
This is partly due to more availability of anti-retroviral medicine and more knowledge transfer through counseling and testing. Although the debate regarding the accessibility of Africans to new AIDS drugs in relation to intellectual property rights is still ongoing, in sub-Saharan Africa, 56% is now receiving antiretroviral therapy (UNAIDS 2012), although this is mostly the first generation of drugs. These medicines have proven to be highly effective in keeping the disease under control by not only prolonging the life of patients, but also by improving the quality. As a matter of fact, especially in the developed world where the second and third generation of Highly Active Antiretroviral Therapy (HAART) is readily available, HIV/AIDS is now a chronic disease.
Furthermore, many African countries have implemented Voluntary Counseling and Testing (VCT) through their national programs. As it states on the homepage of the World Aids Day website: ”If you understand how HIV is transmitted, how it can be prevented, and the reality of living with HIV today – you can use this knowledge to take care of your own health and the health of others, and ensure you treat everyone living with HIV fairly, and with respect and understanding.”
However, even with the better management of the pandemic, Africa is still lagging behind and in some circles, still stigmatized. Nevertheless, emerging research that looks at the links between poverty and inequality and HIV/AIDS, provides us with new insights as to why this might be.
Despite the inequality in drugs, which also makes that the poor and less influential are more affected, Eileen Stillwaggon in her book “AIDS and the Ecology of Poverty” also discusses the relationship between bad living circumstances such as malnutrition, worms and infectious diseases and the occurrence of HIV. According to her research, conditions as living with mosquitoes, disease vectors, soil-transmitted worms and poor sanitation can increase the transmission of HIV through different mechanisms. According to Stillwaggon, sexual risk behavior is a small part of the problem and poverty as a whole should be a central target in HIV/AIDS intervention.
As the world prepares to reach zero new infections, zero discrimination and zero AIDS-related deaths (UNAIDS 2012), the 2012 World AIDS Day message of Ertharin Cousin, Executive Director of the UN World Food Progamme (WFP) seems to affirm this possible new approach: “As we work toward a hunger-free and HIV-free world, we must enable the poor and hungry to seek life-saving treatment. We have turned a corner on the HIV epidemic, but we have a long way to go. We encourage the global community to build on the positive momentum by expanding the role of food and nutrition in the HIV response.”
2012 UN AIDS World AIDS Day report: http://www.unaids.org/en/resources/campaigns/20121120_globalreport2012/
World AIDS Day website: www.worldaidsday.com
Eileen Stillwagon – The Ecology of Poverty
World Health statistics 2012: http://www.who.int/gho/publications/world_health_statistics/2012/en/index.html
2012 UNGASS: Country progress report: Rwanda: http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_RW_Narrative_Report.pdf
2012 Annual HIV/aids report of the WIV-ISP: https://www.wiv-isp.be/Documents/Rapport%20VIH-SIDA%202012_NL.pdf