Sexual Health: Africas Response to HIV-AIDS - Essay Example

Sexual Health: Africa's response to HIV/AIDS has been widely criticised by the west. What are some central themes associated with these criticisms HIV/AIDS is not the first virus in the world and not the first sexually transmitted disease. All die issues which AIDS raises about sexuality and relationships, health care, pregnancy, birth control, and personal and professional lives were already there. HIV and AIDS merely add a new dimension which must be taken into account. Many thousands of women, children and men have died and many more are becoming ill and dying from AIDS-related causes in Africa. To prevent the millions more deaths that are predicted, governments of African countries need to act. This is a challenge that people' health advocates cannot ignore. Recent years, Africa's response to HIV/AIDS problems has been criticized by international organizations as ineffective one. The problem is that African countries faced with the potentially rapid spread of HIV/AIDS have two options: delay interventions while prevalence rates are still low and intervene only once the epidemic has become visible, or implement comprehensive prevention and treatment programs early on while prevalence rates are still low. Some of development efforts supported by International organizations could be jeopardized as a result of the economic, social, and health burdens created by unchecked HIV/AIDS. Denial of the problem size and importance at all levels of government has long been a significant constraint in Africa. "Most research, debate, policy and activism continues to be preoccupied with a range of issues to do with organizing the institutions and individuals necessary for a response to AIDS, rather than substantive issues" (Justice Africa/GAIN, 2004). In a region going through the upheaval of transition from a command to a market economy, allocating resources to avert a "potential" problem was a difficult proposition. The situation was compounded by the fact that in the early stages, the epidemic was concentrated among marginalized groups, with little or no political clout. The rise of HIV/AIDS thus caught most of the region unprepared to address its impact on the health sector and even less prepared to address its impact on the society at large. On the other hand, current results and surveys provided by African countries do not reflect real situation and rates of HIV/AIDS. For instance, Sarah Bennett in her report shows discrepancy between Nelson Mandela/HSRC Study of HIV/AIDS Report and real state of the matter. She wrote: "Some of the results of the HSRC survey contradict the results of the annual antenatal survey. In the HSRC survey, prevalence amongst adults in Kwazulu-Natal is estimated to be the fourth highest at 15.7%, compared to the 2001 antenatal survey, which estimates prevalence amongst pregnant women in the province at 33.5% and the highest in South Africa" (Bennet, 2002). It was admitted that like other regions, Africa has been slow to make the perceptual leap to begin to see HIV/AIDS as more than "just" health problems. Even today, African leaders and governments have all denied that the epidemic of HIV/AIDS would affect not only the health of individuals, but also the welfare and well-being of households, communities and entire societies. The recent reports and economic prognosis concerning AIDS/HIV impact on economic health of African continent has been prepared primarily by Western and American researchers. In many countries in the region, even the more obvious health aspects of HIV/AIDS have yet to be tackled with resolve. Despite these initiatives, efforts to date have fallen short of what is needed to tackle the epidemics effectively. Surveillance-the methodical collection of data on disease occurrence and its determinants, a basis for effective programs-is weak in most African countries. Prevention programs for high-risk groups are also weak or too small. Political commitment is variable, stigmatization remains a common problem, and interventions such as harm reduction face legal restrictions in many countries. A recent study from the African countries, provided by International Health Organizations, suggests that local policing strategies may be an important determinant of HIV risk among injecting drug users. Fear of police detainment or arrest among injecting drug users reportedly made users reluctant to carry needles and syringes, a practice associated with needle. ActionAids critique admits that "there is a trade-off between the public policy goal of low inflation and a stable macro-economic environment on one hand, and expanded efforts in the health sector on the other (Justice Africa/GAIN, 2004). Western scientists suggest that structural factors are deep-seated and complex problems. They can be resolved in the medium term or long term, through sustained, pro-poor economic growth and poverty-reduction policies and pro grams; control of drug trafficking; effective judicial reforms to reduce overcrowding in prisons; improvement of employment opportunities for young adults; curtailment of trafficking in humans; and improvement of the public health infrastructure to support testing, counseling, tuberculosis control, and other population-based approaches to HIV/AIDS. Lack of political will and recognition of the problem is another area of critique. For years in Africa, denial of the problem by governments at all levels has been a significant constraint. In a region going through the upheaval of transition, transferring resources to a potential problem was a difficult proposition. Governments were able to make the case that in an environment of dwindling resources, dealing with HIV/AIDS was not the most urgent priority. "African Religious Leaders call on African governments toimmediately withhold debt servicing payments to the World Bank,IMF, and wealthy G8 governments and commit to using those resourcesto eradicate poverty and implement HIV/AIDS interventions" (Africa: Debt and AIDS, 2002). Until there is a broader recognition of the magnitude of the potential crisis, countries will not be willing to divert the necessary scarce resources. Efforts have begun at changing the political and societal landscape. Governments of some South African countries are acknowledging the importance of HIV/AIDS, but the other problem is that "national governments and the international community have such low credibility among ordinary Africans, that everything they say is automatically treated with suspicion" (Justice Africa/GAIN, 2004). International financing is increasing, through grants, credits, and loans. But most of this costs does not spend on HIV/AIDS related programs. International organizations are also supporting a range of analytical and advisory services in the region. The discussions and preparation processes leading up to these projects are themselves vital in generating and building commitment among populations. The projects generally rely on a broad battery of actions to address political will, such as media campaigns that increase public awareness, multisectoral partnerships, training for workers and government staff, educational programs, and the development of new legal frameworks. These actions help create broader recognition of the threats posed by HIV/AIDS and help build commitment to take action by the many players involved in implementing a program. Nevertheless, "the IMF response accused ActionAid of failing to be constructive and of reverting to 'recriminations and accusations.' It said the report was 'partly correct but fundamentally wrong.' It argues that it is already implementing many of the recommendations (e.g. allowing grant aid to finance deficit spending), and disputes its role in the country cases analysed (specifically Uganda and Zambia)" (Justice Africa/GAIN, 2004). The political will that has to help bring about these projects reflects progress in raising the level of awareness, but it is still only the beginning of a long and challenging process. One reason societies are slow to come to grips with the HIV/AIDS crisis is that many aspects of the problem are considered taboo or are frowned on by large segments of the population. Governments do nothing to solve these problems. It is difficult to raise awareness or build consensus on an issue that cannot be discussed openly. The problem is exacerbated by the fact that the majority of people affected by HIV/AIDS belong to groups that are marginalized by society. The primary groups affected by HIV/AIDS-injecting drug users, commercial sex workers, and inmates-have limited access to community service infrastructures. They are also among the least likely to be well informed about safe sex practices and disease prevention. It was reported that: "Sub-Saharan Africa is home to two-thirds of the world's 40 million HIV/AIDS cases. But experts are still debating whether unsafe injections or unprotected sex is the culprit behind the region's skyrocketing statistics" (Diamond, 2004). Since HIV/AIDS is still largely identified with these groups, there is a sizable element of society. As long as the disease is perceived to affect only marginalized groups, it is not considered a threat to the larger community. In his book "HIV and Aids in Africa: Beyond Epidemiology", Ghost writes that:" Public health action takes place on a terrain of contested meaning and unequal power where, different forms of knowledge struggle for control" (Ghost, 2004). Personal and ethnic taboos create environments that are not conducive to treating these diseases. Some African tribes have historically avoided certain types of medical care, for personal and cultural reasons. Involving such groups in dialogue on safe sexual practices is a complex and difficult process. Other religious and ethnic traditions can also affect willingness to participate in screening, prevention, and treatment. "The contradictions between situational needs and societal response have been particularly sharp" (Ghost, 2004). Western peacemakers appealing that changing the environment of social constraints and stigmatization is fundamental to eliminating other constraints-to building political will and commitment, changing the legislative framework, and building capacity at the state and local levels. Critical steps that must be undertaken include: achieving an understanding of social contexts and influences; disseminating public information at every level; campaigns on disease awareness, prevention, and treatment must be focused and strategically targeted to high-risk groups, including ethnic minorities and young people. Unfortunately, most of these does not taken into account by African leaders, but "economic models show that the AIDS pandemic in sub-Saharan Africa will have long term economic consequences that may be resolved only by international economic assistance" (Dixon, et al, 2002). Community infrastructure, or the lack thereof, is increasingly seen as having a major impact on health-related issues, including the implementation of tuberculosis and HIV/AIDS programs. Especially in countries with weak central governments, communities can play a vital role in education, treatment, and care. Unfortunately, many communities throughout the region are still recovering from the transition and lack the self-reliance required to support these initiatives. Efforts must be made to build capacity for community support and outreach programs. In addition, African governments do nothing to destigmatise the disease providing education, in schools and communities. Efforts need to include production of educational materials, such as brochures, booklets, and films. Conducting workshops and seminars for health workers, educators, and community groups (Gisselquist, 2003). Gender inequality is another critical factor that does not addressed by African countries. In many African countries, women remain excluded from decisionmaking bodies in community councils and local government. Low levels of education among women, particularly among some minorities, contribute to a low level of awareness about the disease, its transmission, and prevention. At the same time, men are more affected than women in the current epidemiological profile; the epidemic has not become feminized. High-risk behaviors such as unprotected sex, multiple partners, and injecting drug use have increased; the rigid social control of the past has eroded; and new common norms and values have yet to become firmly grounded. Modifying risk behaviors in this context must become a multisectoral effort that involves schools, religious groups, and other community organizations. Community development and outreach programs should be built into project and components, and alliances with NGOs should be forged to foster community development (HIV/AIDs and STDs, 2005). These issues take on special importance when it comes to implementing effective intervention strategies. A "do or die" approach was proposed by local journalist Liz Clarke to "track the strategies and realities both helping and hindering the struggle" (Pushing the surge of moral energy" - towards an AIDS-free society, n.d.). For example, initiating and carrying out effective biological and behavioral surveillance systems depends on many factors, including the capacity to screen and analyze donated blood, conduct demographic and health surveys, maintain voluntary counseling and testing sites, and track and analyze mobile populations. Only some African countries have effective levels of these capacities, many others do not. Skilled scientists, laboratory technicians, demographers, analysts who can assess gaps in program management skills at the country level, educators, and counselors are all in short supply, as are the underlying infrastructures that support them. Also in short supply are the management skills necessary for planning and administering large and intersectoral programs at the national and local levels (Campbell, 2003). Many parts of the continent, including Zaire, also face post conflict issues that exacerbate the problems associated with HIV/AIDS. Not only have these conflicts drained resources and disrupted already deteriorating service infrastructures, they have generated new problems, including growing numbers of illegal migrants (who are unable or afraid to seek treatment), trafficked women and girls, and injecting drug users. Another fundamental capacity issue is geographic, social, and financial access to services. Providing health services in most areas is difficult. All of Central Africa is affected by this problem, but does not receive government support. Underlying many of these problems are weaknesses in educational systems across the continent. Education on HIV/AIDS should be a critical component in the prevention of HIV/AIDS, through school prevention programs targeted at high-risk groups, awareness training, and dissemination of information to the public. Just as important, education is essential to train the community workers, counselors, and other health sector professionals required to address the crisis (Ghost, 2004). Because of the nature of HIV/AIDS, the ways in which is transmitted, and the groups initially affected, an array of legal issues arises in implementing testing and treatment programs. For example, a key component in the harm reduction strategy is needle exchange, which is illegal in some countries. Many local regulatory frameworks do not allow key steps recommended under harm reduction practices. Legal issues also arise in prisons, a primary source of HIV transmission, where local regulations sometimes counter best practice for both tuberculosis and HIV/AIDS prevention and treatment. Legal and regulatory frameworks are also critical in many peripheral areas of combating HIV/AIDS. Western critics suppose that legal frameworks must be developed or altered to allow for the licensing and accreditation of health professionals and new educational programs. Insurance and risk pooling are other areas that need to be updated and sometimes restructured to deal with the changes necessitated by new treatments and expensive long-term regimens. A range of societal issues, such as privacy and worker rights, also needs to be addressed (Bennett, 2002). With the rapid influx of funding, staff, and new programs, there is a risk of misapplying scarce resources. Some risks arise from the desire to disburse funds very rapidly-even in the absence of local capacity to absorb and manage them effectively (Dixon, 2002). These risks include waste, inefficiencies, and the inappropriate use of drugs, which could lead to drug resistance There is a potential conflict between a rapidly changing-and still relatively unknown disease profile and the slow-moving processes that are characteristic of large international institutions. It is possible to conclude that a variety of important external constraints affect the success of the objectives and the progress of regional country programs on HIV/AIDS. Increased attention should be given to disease surveillance and to estimates and projections of the economic impact of HIV/AIDS. Greater emphasis should be placed on interagency coordination and country leadership. Bureaucratic procedures are common in African countries with complex missions, but the procedures for lending operations remain excessively complex. To be of maximum benefit to African countries, it is essential that institutions be vigilant to changes in the operating environment and ensure that there is enough flexibility in programmatic decisions that they are not locked into a single course of action and thus miss important developments in the pandemics. References 1. Africa: Debt and AIDS. (2002). Available at: http://www.africa.upenn.edu/Urgent_Action/apic-061402.html 2. Bennett, S. (2002). Under the surface: a critique of the HSRC HIV/AIDS survey. Available at: http://www.eldis.org/fulltext/sbennett.pdf 3. Campbell, C. (2003) Letting Them Die. Indiana University Press 0-253-21635-4 4. Diamond, B. (2004). Debate escalates on source of sub-Saharan Africa's AIDS epidemic Available at: www.nature.com/nm/journal/v10/n5/full/nm0504-441b.html 5. Dixon, S., McDonald, S., Roberts J. "The impact of HIV and AIDS on Africa's economic development", BMJ, 2002, 324, pp. 232-234. Available at: http://bmj.bmjjournals.com/cgi/content/full/324/7331/232 6. Ghost, J.(2004) HIV and Aids in Africa: Beyond Epidemiology. Blackwell Publishing. 7. Gisselquist D, Potterat JJ, Brody S, and Vachon F. (2003) Let it be Sexual: how health care transmission of AIDS in Africa was ignored. International Journal of STD & AIDS. #14, pp.148-161. 8. Justice Africa/GAIN. (2004) October http://www.justiceafrica.org/civil_society_homepage.htm 9. HIV/AIDs and STDs (2005). http://allafrica.com/aids/bydate/n=1 10. Pushing the surge of moral energy" - towards an AIDS-free society (n.d.) http://www.hivan.org.za/edit_essays/February02.asp Read More