Aids: The Poor Person’s Epidemic

By Jacky Delorme, ICFTU Online..., 264/981201/JD, 1 December 1998

Brussels, 1 December 1998 (ICFTU OnLine): At the end of 1997, some 30 million people were infected with the aids virus. One year later, this figure has risen to 33 million. Many of them are young men and women fighting for their survival. They have never heard of the—genuine—progress in medical research. It is the greatest paradox that emerges from the latest report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) published to mark international aids day: for some it is a chronic disease, for many a fatal one.

In the rich countries, new combined therapies are proving effective. Medical teams armed with an array of pharmaceuticals and the latest knowledge have been able to hone AIDS treatments to the extent that they are now achieving success rates of 60 to 70 per cent; this means that in two thirds of patients the progress of the HIV virus (the human immuno-deficiency virus) is being halted and the quantity of the virus present in the body reduced. In the industrialised countries it is now a matter of managing a chronic disease, albeit with onerous treatment with numerous side-effects.

But while hundreds of thousands of patients are now getting better, the great majority (95 per cent) of people infected with AIDS will die in a relatively short space of time because they have not received even the most fundamental treatment. Their problem: being poor, in a poor country.

According to UNAIDS latest estimates, 2.5 million people died of AIDS in 1998, more than any other year since the disease first appeared in 1981, and twice the number of deaths from malaria, for example. Sub-Saharan Africa is the hardest hit region: four out of every five deaths have taken place there, since the epidemic began. The disease is developing fastest in Southern Africa, where the worst affected countries are now to be found: in Botswana, Namibia, Swaziland and Zimbabwe, nearly one quarter of people aged between 15 and 49 are affected by the virus. South Africa, which until recently was relatively untouched, now has disturbingly high rates of infection, with one in seven of all new cases recorded in Africa this year occurring in this country. Strong demographic pressure, particularly the high number of migrants fleeing the country?s poorer neighbours in search of a better life, is largely responsible. In the mining towns where drugs and prostitution - two of the main channels for spreading the HIV virus - are part of daily life, working conditions have become so alarming that they alone may explain the risks the migrants take. In South Africa?s gold mines, the miners have one chance in 40 of being killed by a landslide and one in three of being seriously injured. Compared to that, the risks associated with the slow progress of the HIV virus may seem fairly remote explains UNAIDS.

War and the displacement of populations that this entails also create conditions favourable to the spread of the AIDS virus. In the refugee camps of the Great Lakes region, overcrowding, violence, despair and sometimes the need to turn to prostitution to survive are all factors that have contributed to the growth of the epidemic.

Throughout the world, the young are the worst affected. Almost half of new cases occur in the 15 to 24 age group. According to estimates by UNAIDS, which throughout the year has carried out a campaign aimed at the young, some 7000 young people are infected every day, about one every five minutes. Without global action that takes into account their great vulnerability, both the human and the economic costs of the epidemic will continue to rise. All too often, the lack of respect for young people?s human rights increases the risks they face, making them easy prey to the virus. They are often denied, in the name of morality, culture or religion, the right to education on the risks they may be running.

The spread of the virus has already put the development of the worst affected countries at risk. According to estimates, life expectancy in the nine countries where the rate of infection among the adult population is 10 per cent or more will fall by 17 years on average. The costs incurred by the disease are rising sharply. Enterprises can no longer operate because the already limited number of skilled workers has been decimated. In east and southern Africa, millions of adults have died, leaving behind them orphans or partners in need of care. In some of the worst affected areas, three quarters of hospital beds in the children?s wards are occupied by children with AIDS.

Yet even in some of the countries where the epidemic has caused terrible damage, encouraging results are emerging, proving that it is possible to slow the progress of the disease even with very modest means. In Uganda, for example, the country?s leaders have succeeded in demystifying the disease, and at encouraging discussions on sexuality. With the cooperation of civil society, employers and trade unions have succeeded in developing a very effective prevention policy and a system of care.

Another sign of hope lies in the launching of an anti-AIDS programme financed by the United Nations in 11 countries, aimed at treating 30,000 pregnant women infected with HIV. It has been found that treatment with AZT (a medication introduced in 1985 which remains effective until the patient?s body develops a resistance) during the last weeks of pregnancy reduces the rate of transmission from mother to child by about 50 per cent. But the size of the programme does not match needs in terms of testing and care among pregnant women, given that in the town of Mutare in Zimbabwe, nearly 40 per cent of pregnant women are infected with HIV. Anti-AIDS associations are denouncing the logic of the donor agencies for whom only the reduction in infant mortality counts (treatment is not continued after birth, and the mothers still face death in the medium term) and the strategy of the drugs manufacturers who give maximum publicity to their very limited action on behalf of the poor countries. The multinational Glaxo Wellcome is taking part in this programme, helping just 30,000 pregnant women, when the drug in question (AZT) is to become publicly available anyway, as from 2001.

The cynicism of the multinationals is particularly evident in their reticence to develop vaccinations against AIDS, knowing the countries concerned couldn?t afford to pay for them. It is still far more profitable for companies to develop and market drugs for HIV patients in the rich countries. There is some progress however. International pressure and additional funds have boosted research, and it is believed that the development of one or several vaccines against different strains of the virus is an achievable objective over the next ten years.

In the meantime, prevention is still the only real remedy. In Asia where the spread of HIV is beginning to cause alarm, programmes are only now being set up (except in Thailand where there has been a vast programme in place for several years). The lack of means is also very worrying in eastern Europe, where HIV continues to spread at a rapid rate among drug addicts.

Even in the industrialised countries, prevention and medical care do not always reach those most in need. Infection rates are highest among the poorest sectors of the population. In the United States, the rate of infection among Afro-Americas is eight times higher than among whites. In France, several associations are protesting at discrimination against immigrants, the most affected by AIDS, who have the greatest difficulty in getting the proper treatment. In short, the AIDS epidemic is far from being under control and has reaped more victims in 1998 than ever before.