AIDS/HIV challenge: Africa's life and death struggle

In a day when modern medicine, new-age drugs and a growing awareness of healthier lifestyles are helping to extend the life expectancy of Americans and Western Europeans, the average life span of people in southern Africa is getting shorter by the day.

Life expectancy at birth has dropped below 40 years in nine African countries— Botswana, Central African Republic, Lesotho, Malawi, Mozambique, Rwanda, Swaziland, Zambia and Zimbabwe. What is the biggest culprit? It's AIDS and HIV, of course. All these countries are severely affected by the disease, with Zimbabwe having the highest percentage of people infected with HIV/AIDS (24.6 percent).

Solving this growing and devastating epidemic is a daunting challenge in these poor southern African countries, where health professionals are lacking, economic conditions are dire and access to critical medications such as antiretroviral drugs are in short supply.

Even if the ongoing health crisis was somehow mitigated today, future generations are likely to suffer permanent scars, as the economy will take many years to recover, families and livelihoods are gone forever and vast numbers of children across Africa have been left without parents. They will face a darkened future largely alone.

Numbers tell part of the story:

• About 15 million children under 18 have been orphaned by HIV/AIDS worldwide, and about 12 million of these live in sub-Saharan Africa. The number of African orphans is expected to jump to 18 million by 2010, according to a 2004 report from the United Nations.
• Sub-Saharan Africa has just over 10 percent of the world's population, but is home to more than 60 percent of all people living with HIV–some 25.4 million.
• Southern Africa remains the worst affected region in the world, with data from selected clinics in urban areas showing HIV prevalence surpassing 25 percent, having risen sharply from about 5 percent in 1990.
• In Zimbabwe, by some measures the epicenter of the AIDS crisis in Africa, 78 percent of the more than 1 million orphans are AIDS orphans.
• At last count, nearly one quarter of all the people in Zimbabwe, 1.6 million people, suffer from HIV/AIDS. This is a higher percentage than any other African nation.
• As in the other countries in the region, women are disproportionately bearing the brunt. Twice as many of the women aged 15–24 years as men in this age group were living with HIV (22 percent vs. 10 percent), according to one population-based survey. Overall, almost 57 percent of people with HIV in 2003 were women and an equal proportion of AIDS deaths were among women, according to the Ministry for Health and Child Welfare Zimbabwe.
• In Zimbabwe, life expectancy at birth has plunged to 37 years in 2003, according to the World Health Organization. That compares with 52 years in 1990 (Chitate and Muvandi, 2004).

National emergency
In 2002, Zimbabwean government declared HIV/AIDS and the lack of antiretroviral therapy an emergency, intending to provide access to treatment to everyone in need.

While some recent estimates have shown that infection levels have steadied, infection levels in Zimbabwe nevertheless remain among the highest in the world, underscoring the need to bolster prevention activities.

Goods news
The global movement to scale up access to HIV treatment has made critical gains during the past few years. There has never before been such a level of financial resources to fund treatment, care and support, nor the strength of political will in countries to provide them. The price of many medicines and diagnostics has fallen dramatically.

In Zimbabwe, a relatively organized health system with reasonable infrastructure, with a fairly strong network of health facilities, provides a platform for expansion, according to the World Health Organization. However, additional laboratory support is still required.

The bad news
The amount of work – on a regional and in individual countries – is daunting to say the least.

In sub-Saharan Africa, for example, an estimated 4.3 million people need AIDS home-based care but only about 12 percent receive it. Access to antiretroviral treatment and other HIV-related disease care remains low. The World Health Organization estimates that nine out of 10 people who urgently need HIV treatment are not being reached. About 5 to 6 million people in developing countries will die in the next two years if they do not receive antiretroviral treatment.

Strains on health care
In Zimbabwe, the health system is experiencing numerous difficulties due to the adverse economic climate, according to the World Health Organization. The health crisis, a sagging economy and reduced donor support have combined to severely strain the delivery of medical services. Trained doctors continue to emigrate to other countries, and a growing number of health workers succumb to HIV/AIDS. Shortage of funding, drugs and supplies are major constraints. As a result, a phased approach is necessary for scaling up antiretroviral therapy, the organization says.

All the while, the scourge continues to rack up victims. An estimated 3,290 people die from AIDS in Zimbabwe each week. The tragedy is magnified when you consider how the crisis inevitably ripples throughout the society.

Impact on education
To cite one example: The epidemic is expected to significantly contribute to future shortages of primary teachers. Many experts say countries such as Zimbabwe will have great difficulty meeting their school enrollment targets as skilled teachers fall sick and die. Thus, the quality of education will suffer. How will this affect those left behind, namely the children growing up in a place where the quality of life seems in perpetual decline and a way of life in upheaval?

Only time will tell.

One thing for sure, people working to solve the problem can make a difference. In Zimbabwe, numerous local community organizations have sprung up to help care for the sick and the orphans left behind. Consider Kasirayi Hwete, from Bulawayo, Zimbabwe's second-largest city. After his sister died from AIDS, Hwete, in 1998 founded Loving Hand, a community-based group that provides day care services to scores of orphans and home health care services to child headed households and persons living with HIV/AIDS.

Hwete is just one of several leaders of similar grassroots organizations who have partnered with Brother Brother Sister Sister to provide assistance to children and sick people. This is where Brother Brother Sister Sister – and you come in. We believe by partnering with organizations such as Hwete's we can all make a difference. It is part of our mission to help Zimbabwean citizens help themselves.

To find out how you can help, see how to donate.

Sources:

• UNAIDS Report on Zimbabwe and the global AIDS epidemic
• Avert, a U.K.-based international AIDS charity
• USAID in Zimbabwe

— Updated March 19, 2008