According to statistics released by the United Nations AIDS Project (UNAIDS) and World Health Organization (WHO), approximately 34 million people living in Africa south of the Sahara desert have been infected with HIV, and 11.5 million of them have already died. In 1998 alone, AIDS killed approximately 2 million people on the continent—80 percent of those dying of the disease worldwide. Many of those infected are unaware they have the virus because of the lack of basic health care and testing.
Since the disease first appeared, 83 percent of all AIDS-related deaths worldwide have taken place in sub-Saharan Africa. Seventy percent of the 5.8 million new cases of HIV in 1998 occurred in this region.
In Botswana, Namibia, Swaziland, and Zimbabwe 20 percent of the population between the ages of 15 and 49 is infected. In Malawi, Mozambique, Rwanda, South Africa, and Zambia between one in seven and one in nine adults is HIV-positive. In the Central African Republic, Ivory Coast, Djibouti, and Kenya at least 10 percent of adults are infected.
UNAIDS and WHO say that the disease has cut the average predicted life expectancy in the nine worst-affected countries from 64 to 47.
These horrifying statistics are not simply a medical question. They underline a social relationship imposed by the imperialist exploiters on the oppressed nations—and the workings of the profit system itself. These conditions are reinforced by unequal trade relations forced down the throats of the African nations and the tribute paid by the African peoples to service the foreign debt, which stands at about $235 billion.
In contrast to Africa, death rates in Europe among people infected with HIV have fallen to less than a fifth of what they were in 1995, according to a study published last November in The Lancet, a British medical journal. Death rates are also decreasing in the United States. The Centers for Disease Control reported in August that the number of new AIDS cases in the United States fell by 20 percent from 1997 to 1998.
These shifts are a consequence of growing understanding of the disease–including education campaigns such as those carried out among gays–and the advent of new drugs such as protease inhibitors contribute to these shifts. Without these medicines, most of those who contract HIV can expect to be dead within a decade of infection.
But the $15,000-a-year protease inhibitors are far out of reach for workers and subsistence farmers in Africa. Most governments on the continent budget less than $6 per citizen for health care on an annual basis. Many working people have no access to basic medical care, let alone health insurance. Sanitation is very poor, particularly in rural areas and informal settlements.
In contrast to the soaring infection rates in this region, 1 percent of adults worldwide are infected with HIV. The rate is 0.76 percent in the United States and 0.33 percent in Canada. Norys Mayo Castro is one of about 400 Cuban doctors serving in South Africa. "People here are very poor," Mayo said in an interview. "Some aren't working. It's difficult to get healthy food—even to get food at all—and essentials. It's difficult for people to stay clean.
"If people with HIV/AIDS are eating, are healthy, and are clean and get another infection, it won't be so bad," she said, because their bodies will be able to resist sickness to a greater extent.
"It's easier to get sick if a person is already infected, but anybody can contract HIV/AIDS" if they are unaware of the way the disease spreads, especially through unprotected sex. "There are a lot of sexually transmitted diseases, especially among young people." The presence of these diseases, she explained, sharply increases susceptibility to HIV infection. "We have to educate the community," she emphasized.
Much HIV/AIDS research in North America and Europe is devoted to engineering expensive drugs that can generate continual blood-profits for the capitalist pharmaceutical monopolies. Relatively little research is geared toward finding cheap vaccines that can cure the disease.
Over the past year the U.S. government threatened Pretoria with trade sanctions over legislation passed here that would allow the purchase of cheaper medication—including AIDS drugs—for state hospitals by bypassing the pharmaceutical monopolies. This law brought an avalanche of protests from drugs companies in the U.S.
On September 17, the Clinton administration announced an agreement to back off from trade sanctions on this question, and South African president Thabo Mbeki pledged that the law would be implemented without breaking World Trade Organization (WTO) rules on "intellectual property."
Three days later Mbeki told reporters at a UN gathering, "the fundamental question is affordable medicine."
Because capitalism generates unemployed workers and landless peasants who cannot be absorbed into the work force by the profit system, the AIDS pandemic in Africa is spoken of by a few forthright bosses as an almost welcome development.
The Nov. 15, 1998, New York Times carried an article on how businesses in Africa view AIDS. It quoted Patrick Gorman, chief executive of Chilanga Cement in Lusaka, Zambia. Gorman told the Times that between 20 and 25 of the people he employs are dying of AIDS each year.
The article stated: "Most of (the company's) deaths are among laborers, who are easily replaced, and the company is laying off men anyway, Gorman said. 'To put it callously, it's achieving what we want,' he said. 'Natural wastage is letting us reach our manning levels.' Absenteeism for funerals had increased 15-fold between 1992 and 1995, but 'we've stamped on that,' he added."
The oppression of women and poor education are key factors in the spread of HIV.
In many rural areas south of the Sahara, no education has been done on the disease and how it spreads. Even in more urbanized areas of South Africa there are high levels of unprotected sex, according to press reports.
A social stigma is also attached to the disease. Last December, Gugu Dlamini, a 36-year-old AIDS education volunteer, was killed by a crowd in KwaMancinza, near Durban, after she announced over the radio that she had HIV.
South Africa's apartheid regime took no steps to educate this country's population on the disease. Now, government officials estimate that within two years the annual AIDS death rate will reach nearly a quarter of a million people, and half a million a year by 2007.
The African National Congress-led government, elected in 1994, has initiated a large-scale political campaign and popular education, including secondary school programs, to combat the spread of the pandemic. The Congress of South African Trade Unions launched an AIDS awareness campaign at its congress in August.
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