| Social Obstacles to Controlling HIV |
Researchers have worked diligently and gained an unprecedented knowledge of the biology of HIV and its interaction with the immune system; yet, the AIDS pandemic will continue for years to come. Obstacles to AIDS prevention and control lie not only in the nature of the HIV virus but the very nature of human societies worldwide. Poverty and discrimination exclude those most in need from information and treatment. The control of HIV lies not only in biology but also in the social realm of basic human rights.
AIDS is having the greatest impact in countries ridden with poverty, where public health infrastructures are already strained by drug-resistant malaria, tuberculosis, yellow fever, Rift Valley fever, and other infectious diseases. (See the Emerging Infectious Diseases unit.) Further, the presence of HIV amplifies epidemics of such pathogens. AIDS is the leading cause of death in Africa. In several African countries, more than twenty percent of the 15-49-year-old population is infected with HIV; in Botswana more than thirty percent of that age group is infected. Poverty excludes millions from treatment. Of the roughly 28 million people infected with HIV in sub-Saharan Africa, only 36,000 received drugs in 2002. In response to such statistics drug companies have reduced the cost of treatment to as little as $300-$400 per person in developing countries (treating one person costs at least $10,0000 or more annually in the U.S.) - but even that is too expensive. In 2001 the United Nations launched the Global Fund to Fight HIV, Tuberculosis and Malaria. At the time Kofi Annan, U.N. secretary general, said it would take $7 billion to $10 billion each year to fight HIV/AIDS. As of 2002 the fund, supported mainly by donor nations and philanthropists, had raised only $2 billion.
Poverty is just one obstacle to controlling HIV. Discrimination against particular groups has hindered education, diagnosis, and treatment. The lack of women's rights in some countries has thwarted educational efforts and contributed to the spread of the disease; so has prevailing customs regarding multiple sex partners. Access to basic education, information about HIV transmission, and the power to say no to unwanted sexual advances are as important as access to drugs. Funding for teacher training, education, and prevention materials has been inadequate.
Governments in many countries have been hesitant to implement strong and coordinated AIDS prevention programs. Needle exchange programs for drug users, for example, have been shown in numerous studies to reduce the risk of HIV. Yet, in countries around the world, such programs remain politically unpopular. Condoms protect against transmission of the virus, but promotions of condom use are discouraged by many religious groups and governments. Children around the world are denied access to sex education, mostly for ideological reasons.
By depleting the workforce, AIDS is destabilizing the economies of countries already grappling with poverty and political instability. As people in their twenties and thirties die, countries lose their workers, their teachers, and the parents of their children. Men who have gone to urban areas to work contract HIV, and then return home to give the disease to their wives. Much of the toll of AIDS in Africa is on the women and children, who are critical to maintaining the continent's agricultural economy. In many sub-Saharan countries women are considered their husband's property and have little access to independent income. As men are lost to AIDS their widows become dependent on others or turn to one of the few survival strategies, prostitution. So viral dissemination is amplified and, at the same time, urban and rural economies decline. By the year 2011 there will be 40 million AIDS orphans in Africa. In some countries the illness and death of women in the childbearing years will result in a greatly reduced number of births in the next decades.
In industrialized societies, those touched by AIDS have had considerable impact in fighting the spread of infection. Patients themselves have become active channels for the distribution of information, and participate in policy-making and lobbying for funding. But HIV remains latent in those whose voices are repressed. In sub-Saharan Africa, for example, stigma still surrounds people infected with HIV, and silence impedes progress in controlling the epidemic.
HIV is difficult to control because it exploits the immune system designed to stop it and other infections. Researchers are continuing to explore strategies to foil the virus, but treatments and vaccines are just two components to thwarting the epidemic. Policies that ensure accessibility to medications and information are critical. Education is key. AIDS forces us to talk about things we would rather leave unsaid.
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- Coffin, J. M. 1999. Molecular biology of HIV. In The Evolution of HIV, ed. K. A. Crandall, 3–40. Baltimore: Johns Hopkins University Press.
- Amborzia, J., and J. A. Levy. 1998. Epidemiology, natural history and pathogenesis of HIV infection. In Sexually Transmitted Diseases, 3d ed, ed. K.K. Holmes, P.F. Sparling, P.A. Mardh, S.M. Lemon, W.E. Stamm, P. Piot, and J.N. Wasserheit, 251–58. New York: McGraw-Hill.