AIDS workers in Zimbabwe were running into trouble late last year. They were part of a promising study which provided a relatively cheap drug, Nevaripine, to women in labour and their just-born infants. In preliminary trials, the drug seemed almost as effective as a much more complicated regimen in preventing transmission of HIV from mother to child, and it only costs $4(US). The trouble, then, was getting women to admit to having AIDS.
At the end of 1999, the UN estimated that 800,000 women in Zimbabwe were infected with the disease, part of the 25% of Zimbabweans who are now afflicted. In urban Botswana, 44% of pregnant women are positive for HIV. By the end of 2000, an estimated 1.1 million children under 15 were living with HIV in Africa, mostly due to mother-to-child transmission.
These statistics highlight the potential of the Nevaripine study to help prevent vertical transmission of HIV from mother to child. In South Africa, activists have taken a reluctant government to court to try to force them to include Nevaripine in public health programs. What, then, is the problem in Zimbabwe?
In Zimbabwe, as in most of Africa, the stigma surrounding Acquired Immune Deficiency Syndrome has become as much an impediment to treatment as the rampant poverty and the price of AIDS drugs. Almost all cases of HIV in Africa are transmitted by heterosexual intercourse, and the spread has been fuelled by the unequal distribution of power between the genders, as well as a lack of education. More than a third of women in sub-Saharan Africa are in polygamous marriages, although this varies widely by country and age.
In this type of family situation, the first person to test positive for HIV is considered to have brought the disease into the family. By acknowledging their HIV status, or even consenting to being tested, women in Zimbabwe risk expulsion from their homes, and likely a life in prostitution to support their children.
Prostitution, of course, only continues a vicious cycle. Prostitutes are often unable or unwilling to risk losing money by asking a man to wear a condom during intercourse.
Confusion about how AIDS is transmitted makes it even less likely that this type of risky sex will be protected.
A reliance on traditional faith healers over practitioners of Western medicine has contributed to widespread misconceptions.
Some African men believe that marriage confers immunity from infection, or, even more disastrously, that sex with a virgin, including rape, can cure AIDS.
In his book, AIDS and STDs in Africa: Bridging the Gap between Traditional Healing and Modern Medicine, Edward Green reported that in 1992, a “master healer” in Swaziland whom he interviewed told him that “Swazis, including traditional healers, believe that AIDS is fictitious. It is a European plot to trick Swazis into using family-planning devices in order to reduce the size of their families.”
Misinformation and social stigma are only the first of many obstacles to mitigating the disaster of AIDS in Africa. Even among those Africans who have been tested for HIV, and have acknowledged the seriousness of a positive diagnosis, treatment options are scarce and expensive.
About three-quarters of the continent’s people survive on less than $2 a day. This makes even the most inexpensive medications, at about $350 a year, well beyond the means of most African AIDS victims. That $350 does not include the expense of finding and travelling to a clinic, of lost work, or of procuring enough food and clean drinking water.
AIDS is a wasting disease; its sufferers are more susceptible to malnutrition. Most rural Africans are subsistence farmers, growing just enough food to feed themselves. Malnutrition would be a problem even without AIDS. Also, by attacking the body’s immune system, AIDS leaves its victims more likely to contract other opportunistic diseases. Illnesses which have long been treatable in Western societies, from tuberculosis to foot fungus, can be fatal when contracted by an AIDS patient, especially without reliable access to treatment.
Lack of education and scarcity of treatment stem from one other major need: money. Kofi Annan, the Secretary-General of the United Nations, has estimated that as much as $10 billion is needed each year to combat HIV in low- and middle-income countries. So far, the UN’s global fund has attracted only about $1.5 billion in pledges.
The money from richer Western nations is needed to expand local health programs, to embark on massive education campaigns and to offset the prohibitively high cost of HIV medication.
The cost of anti-retroviral cocktails, which can reach tens of thousands of dollars per year in the United States and Canada and must be continued for a lifetime, has been one of the cornerstones of conflict between the least developed countries and the most developed.
Until recently, poorer nations risked legal battles and trade sanctions if they attempted to import or produce generic drugs at a lower cost than the ones produced by major pharmaceutical corporations.
These drug company giants claimed that by subverting patent law with generic copies of AIDS drugs, the company’s incentive to develop new drugs would be lost.
Researching and developing a new drug costs hundreds of millions of dollars and can take several years, and generic drugs undercut the profits expected from the sale of the final product.
Last November, at the meeting of the World Trade Organization in Qatar, the international policies which govern the manufacturing and sale of generic drugs began to change.
A coalition of 60 poor nations calling itself the “Africa Group” demanded that the WTO agreement on Trade-Related Aspects of Intellectual Property Rights (the TRIPS Agreement) be amended.
They successfully lobbied for the rights of countries to declare a health emergency and subvert patent law without fear of reprisal. African countries are now free to produce and distribute cheaper generic AIDS drugs. There was no agreement reached, however, on importing generic AIDS drugs to countries too poor to produce them themselves.
In a statement released last month, Médecins Sans Frontières (MSF), a group which won the Nobel Peace Prize in 1999 for its work on international health, announced that “the declaration adopted in [Qatar] on TRIPs and public health [is] an important step in the right direction.”
The declaration is still only one step of many. To conceive of an Africa without AIDS, “intense work will still be needed.”
Look for Part III of this series in the March 4th issue of the Varsity which will examine U of T’s contribution to solving the AIDS crisis.
