The Driving Force of HIV Infection in Africa

After completing this lesson, you will be able to:

• identify the factors that promote HIV infection in Africa;
• describe the interplay of such factors; and
• share your knowledge of the topic with your students.

We have learned in lesson 9 that Sub-Saharan Africa is the region of the world that is most affected by HIV/AIDS.  With an estimated 26.6 million people living with the condition and 3.2 million new infectious occurring in 2003 alone.  This assertion could be said to be true for most other preventable infection like tuberculosis and cholera.  Why should this be so?  Why should Sub-Saharan Africa be the region mostly affected?  What are the forces or interplay of forces that drive the HIV/AIDS pandemic in Sub-Sahara Africa aside an individual’s intrinsic vulnerability.  Various social, cultural and economic factors greatly influence the individual’s risk to acquiring HIV infection in addition to accelerating the progression from infection to full blown AIDS.  These factors, which cumulatively drive the epidemic to its present state in Sub -Sahara Africa include; ignorance, fear and stigma, cultural factors, poverty and conflicts.  The forces, which are mutually synergistic, usually affect the same individual or populations in different ways.

Ignorance

Ignorance could be of two types; “real” and “informed”.  “Real ignorance” refers to the lack of information on some or all aspects of the HIV/AIDS infection which may include information on the transmission, spread and preventative measures.  “Informed Ignorance” or partial ignorance refers to those that are fully aware of the infection including its transmission and control but somehow for some reasons refuse to believe on some aspect of the infection (like causative agent) or believe that the condition can be cured either through local herbs or some other methods.

Overcoming ignorance is the essential first step towards achieving behavioural change which for now, remains the most important strategic option for control of the epidemic.  This ignorance is still high in many parts of Africa especially the rural areas.  Studies in Nigeria in 1999 (UNICEF 2001) found that about 90 per cent of men and 74 per cent of women knew of AIDS with variations within age groups.  In some parts of the country, the study showed only 47 per cent and 50 per cent of women and men respectively knew about HIV/AIDS.  Significant percentages of people were reported to be unaware of any way of preventing HIV infection (in some places as high as 30 per cent).  Similar picture may prevail in other parts of sub-Saharan Africa especially West Africa.

Fear and Stigma

Fear and Stigma associated with HIV/AIDS is at two levels; individual and institutional.  At individual level, the stigma associated with the disease at both family and community results in fear, withdrawal or even suicidal tendencies.  This has been shown to contribute greatly to the reluctance of individuals to go for voluntary testing or in some cases concealing the true status from family and friends.  The consequence of this is the “business as usual” approach by such people and the limitation to access to treatment options, care and support.  It also has the potential of spreading the infection to many other people.

“Institutional” fear of stigmatisation is manifested through under-reporting by some states or regions within a country or even a whole country.  This is to avoid their perceived stigmatization as “HIV endemic” region or country.

Cultural Factors

Some cultural values, beliefs and attitudes further compound the problem of ignorance and reinforce each other to promote the spread of HIV infection.  One such cultural value is shyness which prevents open discussion and education on sexuality and reproduction thus leaving adolescents to acquire such information from their uninformed peers or by experimentation, and trial and error!  Similarly, the culture of polygamy and frequent divorce in Sub-Sahara Africa greatly promote and aid the spread of HIV.  Other equally negative practices include female genital mutilation, mass circumcision for boys especially in rural areas, traditional face markings and culturally – based gender discrimination in access to education.

Poverty

Poverty drives the HIV/AIDS phenomenon in two broadways; by increasing the population of people at risk and secondly by limiting the management of those already infected.  Poor people are more prone to engage in high risk behaviour such as commercial sex work and drug use.  They are also more likely to become migrant workers, (being un-or semi-skilled), a group that has been identified as being among those at the greatest risk of acquiring and spreading the infection. 

Poor people with Sexually Transmitted Infections (STIs) are similarly more likely to resort to self medication and the use of traditional herbs being unable to afford full hospital diagnosis and management thus creating another pool of people at great risk of acquiring HIV/AIDS.  Tuberculosis,  a disease closely associated with HIV/AIDS in Africa is basically a disease of poverty. 

Poverty further limits the education of children and adolescents, especially girls thus making them more ignorant.  AIDS, by its very nature impoverishes the affected individuals, families and communities as indicated in Lesson 9.  The synergistic relationship and vicious cycle of poverty, ignorance and disease is thus clearly manifested in HIV/AIDS.

CONFLICTS AND SOCIAL STRIFE

Sub-Saharan Africa has been going through various conflicts and social strife for decades either within or between nations.  These conflicts have created a large population of refugees and caused damaging social vices within the continent.  Child soldiers, social violence, drugs and prostitution have become the norm in many of the countries involved.  This is aside the total breakdown in social services and infrastructure like health and education.  The net result of all these is the total absence of any meaningful HIV/AIDS control programmes in such countries and the phenomenal increase in the people at risk and promotion of high risk behaviour.

For Africa to fight HIV/AIDS effectively, the implementation of the various control programmes must go in tandem with measures that address the driving forces of the infection in the continent especially poverty alleviation, conflict resolution and improved access to social services like health and education.

Resources: Costumes and stage settings for a drama on the topic

Procedure: Facilitate the conduct of a drama presentation by your students on the topic. The drama should project the influence of wars, poverty, and illiteracy on the spread of HIV/AIDS in Africa.

In this lesson, we learned that

• Various social, cultural and economic factors greatly influence the individual’s risk to acquiring HIV infection in addition to accelerating the progression from infection to full blown AIDS.  These factors, which cumulatively drive the epidemic to its present state in Sub -Sahara Africa include; ignorance, fear and stigma, cultural factors, poverty and conflicts.  The forces, which are mutually synergistic, usually affect the same individual or populations in different ways.
• Ignorance could be of two types; “real” and “informed”.  “Real ignorance” refers to the lack of information on some or all aspects of the HIV/AIDS infection which may include information on the transmission, spread and preventative measures.  “Informed Ignorance” or partial ignorance refers to those that are fully aware of the infection including its transmission and control but somehow for some reasons refuse to believe on some aspect of the infection (like causative agent) or believe that the condition can be cured either through local herbs or some other methods.
• Some cultural values, beliefs and attitudes further compound the problem of ignorance and reinforce each other to promote the spread of HIV infection.  The culture of polygamy and frequent divorce in Sub-Sahara Africa greatly promote and aid the spread of HIV.  Other equally negative practices include female genital mutilation, mass circumcision for boys especially in rural areas, traditional face markings and culturally – based gender discrimination in access to education.
• Poverty drives the HIV/AIDS phenomenon in two broadways; by increasing the population of people at risk and secondly by limiting the management of those already infected.  Poor people are more prone to engage in high risk behaviour such as commercial sex work and drug use.  They are also more likely to become migrant workers, (being un-or semi-skilled), a group that has been identified as being among those at the greatest risk of acquiring and spreading the infection. 

(Write the answers in your notebook)
 

1. Describe ways by which poverty and illiteracy fuel the spread of HIV in Africa.

2. State factors other than those presented in the lesson that are significant in accelerating the rate of HIV infection in your country or sub-region.