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HIV/AIDS:
A health or development issue?
Jennifer Chiriga
Extracted
from Pambazuka News 248
March 30, 2006
http://www.pambazuka.org/en/category/comment/33103
In the 1980s,
HIV/AIDS was a "distant" disease represented by statistical
data. Now, it is the "undisputed equalizer", infiltrating
all aspects of life. Jennifer Chiriga looks at the reasons for its
spread, provides some pointers on fighting it and argues for the
urgent need to defend and justify the public sector and public ownership
of resources when it comes to health care.
In the mid 80s when I was a student at the university, HIV/AIDS
was nothing more than statistical data, which had nothing to do
with me. Then I heard that one of our lecturers was HIV positive.
The disease and the people afflicted with it ceased to be a distant
phenomenon and it stared me right in the face when the lecturer
came into the lecture theatre looking weak, thin, and shockingly
unfamiliar. Over the years since then, I have watched friends and
family infected and affected by this disease. It is about human
beings - not only facts and figures, and it is an undisputed equalizer.
Rich or poor, illiterate or educated, the impact is the same.
The aggressiveness with which AIDS has insinuated itself into our
lives leaves one no choice but to reflect on the colossal cost and
burden of HIV/AIDS on the individual, the family and governments.
HIV/AIDS is no longer just an issue for health authorities as it
affects all aspects of life and has a devastating impact on all
population groups and sectors of the national economy. What is even
more worrisome is the regional dynamic where HIV/AIDS does not just
affect individual countries in the region but whole regions.
I personally agree with the view that the problem of HIV/AIDS in
the region is not just a health issue but has fundamentally become
a development issue, mainly because the disease exacerbates existing
problems such as poverty, food insecurity, shortage of skilled manpower
and strained and dysfunctional social and economic institutions.
The fact that most economies in the region are weak and largely
dependent on donor funding further aggravates the situation.
A number of policy challenges present themselves, especially in
the current scenario of political and economic disintegration. The
frighteningly high levels of inflation and unemployment, erratic
or stagnant economic performance and declining currency values all
symbolize the economic crisis which is affecting people’s capacity
to look after themselves and their health. For examples 80% of Zimbabweans
are living in poverty and are unable to cope. Poverty is therefore
worsening an already bad situation.
Within the health sector, increases in health fees as part of the
effort to recover costs and improve efficiency in service delivery,
has pushed the cost of health services beyond the reach of most
vulnerable households, and health insurance costs continue to escalate
inexorably. The informal sector and the notion of home-based care
have absorbed the shocks of the epidemic. This has allowed the government
and the private sector to sit back and pretend that the situation
is under control. In essence, governments have abdicated (whether
voluntarily or involuntarily) their responsibility to be in the
forefront of service delivery. The private sector needs to work
in tandem with government to create a vision beyond the profit margin,
and to start getting involved in community service in a meaningful
way.
At the broad policy level, it would appear the early post-independence
experience of African countries has unfortunately been ignored.
In most African countries there were state-led models of development
and it is clearly established that there were major strides in this
time – educational development and reduction of illiteracy through
public-led education drives, huge improvement in health indicators,
child mortality etc, and housing and transport was provided by the
state. After governments in the region adopted cost recovery under
IMF and World Bank austerity programmes, this led to increasing
social inequalities (e.g. private hospitals and private schools
becoming accessible to only the few who can afford them). Given
the pre-dominance of AIDS, the health sector is one of the main
areas through which there is an urgent need to defend and justify
the public sector and public ownership of resources.
There are a number of important interventions (but by no means exhaustive)
that policy makers need to reflect on:
- There is
need for a number of interventions to establish the magnitude
of the HIV/AIDS crisis as well as investigating why despite many
attempts to contain the scourge, the disease has gathered momentum
in SADC to a level of being one of the biggest challenges to policy
making and intervention. Why is there a higher rate of infection
in Botswana than in Nigeria or Angola? What have Ugandans done
to gain prominence as having achieved a measure of success in
containing the virus?
- Assessment
of drug utilisation, availability, and cost are critical factors
for policy formulation. So is assessment of impact of AIDS on
food security and agricultural production. We must know the impact
on the youth – the most productive sector, as well as the impact
on women and children who bear the burden of home-based care.
- The private
sector has the capacity to make inroads through a number of interventions,
e.g. provision of medicines, support of home-based care, instituting
feeding schemes for the vulnerable e.g. young children at risk
of malnutrition. Banks and private industry are making super-profits
at the moment but are not ploughing any of those profits back
into the communities that need propping up. There are many companies
that one can think of – that would be the basis for a meaningful
intervention.
- In all this
there is also a role for civic society. The Church, religious
groups and other social movements can and should lead a campaign
for behavioral change, and open dialogue at family and community
level about the disease.
- People providing
home-based care, are doing so largely without proper training
or equipment and so are at risk of infection or re-infection.
People providing home-based care must be provided with knowledge
and the necessary protective measures. Poverty reduction is also
a pre-requisite for home-based care initiatives because we do
know that a good diet is vital for boosting the immune system.
- Is there
anything being done to deal with the trauma and psychological
impact on people, particularly children, of watching their parents
dying slowly? People providing care also need care. Children are
assuming adult roles and nothing is being done about the psychological
effect.
- What is the
role of indigenous knowledge systems in traditional medicine?
A lot of Africa’s people believe in traditional methods of treating
illnesses. Governments should therefore support joint initiatives
by traditional practitioners and scientists in an attempt to merge
the traditional and conventional systems. This is already happening
in some countries in the region, e.g. Zimbabwe, where there is
collaborative research and development of medicines.
- It is critical
to empower young people with knowledge and awareness of HIV prevention.
An informed youth will be able to negotiate a safe sex life to
ensure good health.
- Culturally
relevant prevention information can be disseminated through the
media, faith-based organizations, community groups, schools, and
the workplace. To be effective, information must be packaged in
an accessible manner, for example, showing sensitivity to rural
folk’s taboo approach to sex, and finding the acceptable means
to put the message across.
Over 40 million
people were living with HIV/AIDS at the end of 2001, and more than
20 million have died since the virus was discovered in the 1980s.
If these statistics do not make policy actors sit up and do something,
HIV/AIDS will continue to decimate the world’s productive population.
* Jennifer Chiriga is Unit Coordinator at the Globalisation and
Alternatives Unit at the Alternative Information and Development
Centre (AIDC), Cape Town
* Please send comments to editor@pambazuka.org
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This work is licensed under a Creative Commons License unless stated otherwise.
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