In the 1980s, HIV/AIDS was a “distant” disease represented by statistical data. Now, it is the “undisputed equalizer”, infiltrating all aspects of life. Jennifer Chiriga looks at the reasons for its spread, provides some pointers on fighting it and argues for the urgent need to defend and justify the public sector and public ownership of resources when it comes to health care.

In the mid 80s when I was a student at the university, HIV/AIDS was nothing more than statistical data, which had nothing to do with me. Then I heard that one of our lecturers was HIV positive. The disease and the people afflicted with it ceased to be a distant phenomenon and it stared me right in the face when the lecturer came into the lecture theatre looking weak, thin, and shockingly unfamiliar. Over the years since then, I have watched friends and family infected and affected by this disease. It is about human beings - not only facts and figures, and it is an undisputed equalizer. Rich or poor, illiterate or educated, the impact is the same.

The aggressiveness with which AIDS has insinuated itself into our lives leaves one no choice but to reflect on the colossal cost and burden of HIV/AIDS on the individual, the family and governments. HIV/AIDS is no longer just an issue for health authorities as it affects all aspects of life and has a devastating impact on all population groups and sectors of the national economy. What is even more worrisome is the regional dynamic where HIV/AIDS does not just affect individual countries in the region but whole regions.

I personally agree with the view that the problem of HIV/AIDS in the region is not just a health issue but has fundamentally become a development issue, mainly because the disease exacerbates existing problems such as poverty, food insecurity, shortage of skilled manpower and strained and dysfunctional social and economic institutions. The fact that most economies in the region are weak and largely dependent on donor funding further aggravates the situation.

A number of policy challenges present themselves, especially in the current scenario of political and economic disintegration. The frighteningly high levels of inflation and unemployment, erratic or stagnant economic performance and declining currency values all symbolize the economic crisis which is affecting people’s capacity to look after themselves and their health. For examples 80% of Zimbabweans are living in poverty and are unable to cope. Poverty is therefore worsening an already bad situation.

Within the health sector, increases in health fees as part of the effort to recover costs and improve efficiency in service delivery, has pushed the cost of health services beyond the reach of most vulnerable households, and health insurance costs continue to escalate inexorably. The informal sector and the notion of home-based care have absorbed the shocks of the epidemic. This has allowed the government and the private sector to sit back and pretend that the situation is under control. In essence, governments have abdicated (whether voluntarily or involuntarily) their responsibility to be in the forefront of service delivery. The private sector needs to work in tandem with government to create a vision beyond the profit margin, and to start getting involved in community service in a meaningful way.

At the broad policy level, it would appear the early post-independence experience of African countries has unfortunately been ignored. In most African countries there were state-led models of development and it is clearly established that there were major strides in this time – educational development and reduction of illiteracy through public-led education drives, huge improvement in health indicators, child mortality etc, and housing and transport was provided by the state. After governments in the region adopted cost recovery under IMF and World Bank austerity programmes, this led to increasing social inequalities (e.g. private hospitals and private schools becoming accessible to only the few who can afford them). Given the pre-dominance of AIDS, the health sector is one of the main areas through which there is an urgent need to defend and justify the public sector and public ownership of resources.

There are a number of important interventions (but by no means exhaustive) that policy makers need to reflect on:

1. There is need for a number of interventions to establish the magnitude of the HIV/AIDS crisis as well as investigating why despite many attempts to contain the scourge, the disease has gathered momentum in SADC to a level of being one of the biggest challenges to policy making and intervention. Why is there a higher rate of infection in Botswana than in Nigeria or Angola? What have Ugandans done to gain prominence as having achieved a measure of success in containing the virus?

2. Assessment of drug utilisation, availability, and cost are critical factors for policy formulation. So is assessment of impact of AIDS on food security and agricultural production. We must know the impact on the youth – the most productive sector, as well as the impact on women and children who bear the burden of home-based care.

3. The private sector has the capacity to make inroads through a number of interventions, e.g. provision of medicines, support of home-based care, instituting feeding schemes for the vulnerable e.g. young children at risk of malnutrition. Banks and private industry are making super-profits at the moment but are not ploughing any of those profits back into the communities that need propping up. There are many companies that one can think of – that would be the basis for a meaningful intervention.

4. In all this there is also a role for civic society. The Church, religious groups and other social movements can and should lead a campaign for behavioral change, and open dialogue at family and community level about the disease.

5. People providing home-based care, are doing so largely without proper training or equipment and so are at risk of infection or re-infection. People providing home-based care must be provided with knowledge and the necessary protective measures. Poverty reduction is also a pre-requisite for home-based care initiatives because we do know that a good diet is vital for boosting the immune system.

6. Is there anything being done to deal with the trauma and psychological impact on people, particularly children, of watching their parents dying slowly? People providing care also need care. Children are assuming adult roles and nothing is being done about the psychological effect.

7. What is the role of indigenous knowledge systems in traditional medicine? A lot of Africa’s people believe in traditional methods of treating illnesses. Governments should therefore support joint initiatives by traditional practitioners and scientists in an attempt to merge the traditional and conventional systems. This is already happening in some countries in the region, e.g. Zimbabwe, where there is collaborative research and development of medicines.

8. It is critical to empower young people with knowledge and awareness of HIV prevention. An informed youth will be able to negotiate a safe sex life to ensure good health.

9. Culturally relevant prevention information can be disseminated through the media, faith-based organizations, community groups, schools, and the workplace. To be effective, information must be packaged in an accessible manner, for example, showing sensitivity to rural folk’s taboo approach to sex, and finding the acceptable means to put the message across.

Over 40 million people were living with HIV/AIDS at the end of 2001, and more than 20 million have died since the virus was discovered in the 1980s. If these statistics do not make policy actors sit up and do something, HIV/AIDS will continue to decimate the world’s productive population.

* Jennifer Chiriga is Unit Coordinator at the Globalisation and Alternatives Unit at the Alternative Information and Development Centre (AIDC), Cape Town

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