World AIDS Day 2008

Red RibbonToday is World AIDS Day. Ignore the date on the post, for some reason its reverted to US time. I am definitely writing on December 1.

World AIDS Day is relevant to this blog because globally, sub-Saharan Africa is the world region most heavily affected by HIV/AIDS.  Two thirds of all people living with HIV (67%) are in that region, which also accounted for 75% of all AIDS deaths in 2007. An estimated 1.9 million people in sub-Saharan Africa became infected with HIV in 2007. The majority of these cases are in southern Africa, with over one third of both new infections and AIDS deaths. (More recent figures than 2007 are not available. It takes time to collate them and so my source, the 2008 UNAIDS Report on the Global AIDS Epidemic, is really mostly about the epidemic a year ago. )

I don’t imagine it’s changed much in a year anyway. And those are staggering figures. You can read more detail in the UNAIDS fact sheet for the region.

The good news is that the epidemic in some of those southern African countries seems to be stabilising, and also that South Africa is doing an about turn on earlier policies based on scepticism about HIV as the cause of AIDS. It’s no coincidence that this scepticism has coincided with the largest epidemic in the world – 5.7 million with HIV, according to UNAIDS – so the change is more than welcome.

I read an interesting book earlier this year that attempted to explain what many consider a nonsensical and dangerous position. In her book on HIV/AIDS in Africa, The Invisible Cure, Helen Epstein suggests that South African President Thabo Mbeki clung to the belief that HIV does not cause AIDS because to do otherwise might play into the hands of racists who blamed the African epidemic on stereotypes of African sexual promiscuity and perversion. She argues that he has been a proponent of an African cultural, economic and political renaissance and such a negative explanation of the devastating epidemic did not fit well with trying to project a positive image of Africa and Africans. But he couldn’t come up with any other reason why HIV – in other countries almost exclusively associated with homosexuality, sex work and injecting drug use – has so disproportionately affected heterosexuals in Africa. 

Whatever his reasons, Harvard researchers last week claimed that Mbeki’s policies are responsible for 300,000 deaths in South Africa. I wonder what he thinks about that? And of course it’s not just deaths – HIV has had a profound effect on African economies in South Africa and other hard-hit countries. It would be a heavy thing to have on your conscience.

Epstein does offer an alternative explanation for the African epidemic. Her theory is that in countries like the US, people practice serial monogamy, but in Africa, people are more likely to have more than one relationship going on at the same time. This can be for cultural or economic reasons – such as marrying your brother’s widow, or young women relying on financial support from older men when structural adjustment programs have eroded their employment opportunities. Or it can just be a different way of approaching relationships. Over a lifetime, an individual African may indeed have fewer sexual partners than a serial monogomast in the west, and they may also, Epstein suggests, remain more committed to the ones they have.

Epstein withholds moral judgement on either system, but points out that it’s a lot harder to pass on HIV through serial monogamy than it is when you’re part of a network of “concurrent” relationships, as she calls them. I won’t go into the details – it’s a complex theory worthy of more space than I can give it here.  If it’s an issue you’re interested in, buy the book, I strongly recommend it.

Epstein isn’t just concerned with dissecting African sexuality, you may be relieved to hear. (Though I think she does it with great sensitivity and integrity). The “Cure” of the title is community mobilisation, an open approach to the problem, and honesty about both the causes and the impact of HIV.  She’s fairly critical of mega-bucks projects financed by western money and inspired by western ideas. The solution, she says, pointing to successful campaigns in Uganda early on in the epidemic, lies with Africans who know their own communities best.


World AIDS day sloganWith the epidemic so bad in Africa, it’s no surprise that our own recent figures on the HIV epidemic indicate that in Australia, proportionally more people from sub-Saharan Africa have HIV/AIDS than other communities for the years 2003 – 2007. I stress that we are talking very small actual numbers here. The proportions are calculated according to numbers with HIV per 100,000, and the 2006 Census indicated there were only 248,699 people born in Africa resident in Australia. The National Centre for HIV Epidemiology and Clinical Research (phew, what a mouthful) which has provided the HIV stats, has a graph showing we’re talking maybe 25 per 100,000, as compared to 4 per 100K for Australian born. But there are far, far more Australian born people with HIV than African born (63% of all diagnoses for 2003 – 2007).

If you look at the whole picture, in Africa and here, it means a growing new group of people in Australia who are affected by HIV. As I’ve said, there not actually many African people here with HIV, but add in partners, families and friends in Australia and relatives back home, and it starts to be an issue that those of us who are part of African communities need to address. Indeed, African communities here have been doing so. A couple of years ago Africans held a World AIDS Day soccer tournament in Sydney to raise awareness about it.

So here are some resources that may be useful if you, or people you care about, are closely affected by HIV/AIDS:

The Multicultural HIV & Hep C website has  info about HIV in quite a few African languages. 

PozHet, Straight Arrows and Positive Women are all organisations for heterosexuals with HIV and I think all have had experience dealing with positive people with some kind of African connection. If you’re gay, the National Association of People Living With HIV/AIDS can refer you to local groups. Here’s some info for partners, families and friends of people with HIV/AIDS, and here’s another list of a range of HIV organisations in Australia, including AIDS Councils.

candlesI’ve left it a bit late in the day to post this, but in Australia lists events and actions for World AIDS Day. If you’re not here in Oz, just google the term. Or go out on the streets and buy a red ribbon. This matters to me personally because I have known people who have died of AIDS. So this is for:

Robert Ariss, who died before my son’s birth, Dodj Trafic & Andrew Morgan, who didn’t get to see him grow up, Simon Nkoli who welcomed us to South Africa the first time we passed through, but never since, plus Amelia,  Megan and Richard, Tony, Jacques, Vaughan …

… and for all those still fighting to stay alive & live good lives with HIV.

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