An AIDS epidemic as severe as the one plowing through South Africa will change society. But how and along what lines? Buckling: The impact of AIDS in South Africa, a new publication by Hein Marais, tackles the question in distinctive and critical-minded fashion – and arrives at disquieting and surprising conclusions. A detailed, multidisciplinary review of research evidence, this short book adopts a unique perspective which reveals more clearly the contingency and complexity of the epidemic's effects. It shows how conventional conceptions of AIDS impact (and programme responses) tend to reflect dominant ideological fixations – particularly the overriding emphasis on productive processes and economic growth, governance and security – and how the wellbeing of humans typically is refracted through those preoccupations.
Equity and HIV/AIDS
When Maria (last name withheld), 35 years old and HIV-positive, reflects on the past year she gives an answer that a growing number of Mozambicans living with HIV/AIDS would probably echo. "The year 2005 has been good for my health. It has got so much better because this year I started taking ARVs (antiretroviral drugs)," she told PlusNews. Maria is one of 17,000 people now accessing ARVs of a national target to treat 20,000 people by the end of 2005.
Zimbabwe has failed to meet the World Health Organization (WHO) target of providing anti-AIDS drugs to at least 120,000 HIV-positive people by the end of 2005, local newspaper The Daily Mirror reported on Tuesday. The lack of adequate foreign currency to purchase medicines and the low numbers of people being tested for the virus prevented the country from even reaching its own target of 55,000 people receiving the life-prolonging medication by the end of 2005.
In theory, preventing HIV/AIDS seems simple enough: give people information on how the disease is spread, and the desire for self-preservation will, naturally, make them adopt safer sexual behaviour. The reality has proved much more complex. Almost 30 years after it was first diagnosed, ignorance about HIV/AIDS still persists. According to the UNAIDS Epidemic Update for 2005, [www.unaids.org] "there is new evidence that prevention programmes initiated some time ago are currently helping to bring down HIV prevalence in Kenya and Zimbabwe" but, overall, prevention efforts have a poor track record, particularly in sub-Saharan Africa, which is home to two-thirds of all people living with HIV.
The world's need for antiretroviral drug (ARV) access is "far from met" due to funding shortfalls, Richard Feachem, executive director of the Global Fund, has said following the release of a UNAIDS epidemic update. Stressing that the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria was still in need of US $3.3 billion to meet its 2006 and 2007 goals, Feachem said the UNAIDS report was an affirmation that global investments and commitment could have an impact on the devastation of the pandemic.
There is new evidence that adult HIV infection rates have decreased in certain countries and that changes in behaviour to prevent infection - such as increased use of condoms, delay of first sexual experience and fewer sexual partners - have played a key part in these declines. A new UN report - Aids Epidemic Update - also indicates, however, that overall trends in HIV transmission are still increasing, and that far greater HIV prevention efforts are needed to slow the epidemic. Kenya, Zimbabwe and some countries in the Caribbean region all show declines in HIV prevalence over the past few years with overall adult infection rates decreasing in Kenya from a peak of 10% in the late 1990s to 7% in 2003 and evidence of drops in HIV rates among pregnant women in Zimbabwe from 26% in 2003 to 21% in 2004. In urban areas of Burkina Faso prevalence among young pregnant women declined from around 4% in 2001 to just under 2% in 2003.
The World Bank states that as of the end of 2004, 39 million people worldwide were living with HIV/AIDS, of which more than 95 per cent were in low- and middle-income countries. Nearly two-thirds are in sub-Saharan Africa, and nearly one in five in South or Southeast Asia. The World Bank has been carrying out efforts to prevent HIV/AIDS and mitigate its impact since the late 1980s. Most efforts have been over the last decade: only 9 free-standing AIDS projects and 22 with AIDS components of at least $1 million have been completed. Nearly two thirds of its global projects and commitments have been launched since 2000, the majority of which are accounted for in the Africa Multi-Country AIDs Programme (MAP).
Is high level HIV and AIDS policy cut off from the reality on the ground? Ingrid Young, editor of the Eldis HIV and AIDS Resource Guide, argues that policymakers need to listen to and learn from each other as well as from communities who are experiencing and responding to the crisis. "The development community needs to focus on what communities and organisations are already doing, not only in their response to HIV and AIDS, but also in terms of how they share their information and experiences and how they collectively identify challenges and solutions," she writes.
"The private pharmaceutical industry remains the most important source for the global supply of ARVs today. While the research-based pharmaceutical companies have been responsible for development of many of the medicines used to treat HIV/AIDS, the generic industry for its part has contributed enormously to making widespread treatment possible in the developing world, because of their innovative fixed dose combination tablets (FDCs) and their more affordable prices relative to their brand-name equivalents. FDCs mean that all the required medicines can be combined into one pill which often patients take just once or twice a day."
Where have the billions of dollars poured into Africa to fight AIDS gone? A lot of this money is channelled through non-governmental organisations (NGOs) mainly to pay for life-prolonging drugs and education campaigns on a continent where many national healthcare systems are broke and in tatters. Donors increasingly prefer to fund NGOs rather than African governments, many of which are seen as corrupt. But because the NGOs number in the thousands, it is unclear how much money they have received or how it was used.