Fighting AIDS togetherPeter Piot *
The world's children are benefiting from several decades of unprecedented health progress. Child-killing diseases are succumbing to vaccination campaigns and low-cost remedies, reducing death rates and improving the quality of young lives. But in about 30 developing countries, HIV/AIDS is threatening and even reversing these strides. Meanwhile, in the industrialized countries, AIDS is starting to be called a ‘manageable’ disease, as costly miracle drugs seemingly pull its victims back from the brink of death. Now the fight against AIDS faces new dangers: complacency in the industrialized countries and divisiveness between them and the developing nations.
In the early days of my involvement in the global effort against AIDS, I visited the women’s medical unit of the giant Mama Yemo Hospital in Kinshasa. There, women in their late teens and early twenties, many of whom had supported themselves as sex workers, were wasting away from AIDS-related infections. As I passed bed after bed of young women resigned to death, I realized that similar scenes were playing out in clinics all over sub- Saharan Africa. I wondered how we could ever hope to gain any ground against AIDS in developing countries with primitive medical tools and scattershot, underfunded prevention programmes. And I wondered what the explosion of AIDS cases would do to all the hard-won gains in child survival and development.
That was 14 years ago, and the world community has since woken up to the crisis and begun to mount a credible response. But I still hold onto that mental image from Mama Yemo Hospital and I still hold many of the same concerns: Despite expenditures of about $18 billion a year (as of 1993), despite emerging miracle drugs, despite the talk of AIDS as a ‘manageable’ disease, not enough has changed in those countries that are home to 90 per cent of the epidemic, and there are growing indications of division between those countries and the wealthier ones where people with AIDS are far fewer and resources far greater.
Every day, 1,000 children around the world die from AIDS. In 1996 alone, the disease took the lives of 1.5 million people. About 90 per cent of the 23 million people currently infected with HIV live in developing countries. Experts estimate that 30 million to 40 million people will be HIV-positive by the year 2000, about the same number as the entire population of Argentina or Spain.
In about 30 countries, mostly in sub-Saharan Africa, AIDS is stalling and even reversing the best efforts to improve the health of children and adults, women and men, the poor and the rich. And only 8 per cent (approximately $1.5 billion) of the $18 billion a year is being spent on prevention, care and research in the developing countries.
Even more ominous is the fact that the majority of newly infected adults are under 25 years old, with all too obvious implications for the future. Women, mostly in their childbearing years, now account for nearly half of new infections.
And the worst may be yet to come. According to some forecasts, rates of infection will not peak until the year 2010 in 19 of the hardest-hit countries, most of which are in sub-Saharan Africa. While the deaths attributable to AIDS represent a small percentage of total deaths, they are enough to reverse some improvements in life expectancy. Fifteen sub-Saharan African countries may experience a decline of up to 11 years of life expectancy by the year 2000 compared to projections of deaths without AIDS.
Still to face the brunt of the epidemic is Asia, home to over half the world’s population. Despite the fact that AIDS has only recently begun to take hold in the region, the number of new infections each day is already comparable to the number in sub-Saharan Africa. Unless major advances are made in preventing and treating the disease, projections are grim for high-population countries like India, where clinic data show that HIV is beginning to work its way into the middle class.
And it is not just those who become infected who suffer. AIDS is a disease with strong ripple effects, primarily because it strikes so relentlessly at people in the prime of life. When a mother becomes debilitated by AIDS-related illness, often the first thing to happen is that her children’s care suffers. Those children may miss vaccinations, eat fewer and less nutritious meals, suffer more bouts of illness. Then a child (or more than one) is likely to be pulled out of school to work in the market, cultivate the family plot or care for the baby.
When the mother dies, she may follow several other extended family members
to the grave, so the likelihood of an aunt or uncle being able to take
in her newly orphaned children is slim. In regions that formerly were noted
for the unbreakable links of extended family networks, we now have the
shocking reality of households headed by aged grand-parents or children—12-year-olds
responsible for providing food and shelter for a family of even younger