 Achievements at riskHanging in the balance are achievements made by the world community over several decades in reducing infant mortality and improving child health and nutrition. Mortality rates for those under age 5 have been cut in half over the past 30 years. About 8 of every 10 children worldwide are now immunized against six major childhood diseases: measles, polio, diphtheria, pertussis, tetanus and tuberculosis. Polio is on the verge of eradication, and measles and neonatal tetanus are on the same path. Deaths of children from diarrhoea—which, along with pneumonia, is the number one killer of children in poor countries—are also in retreat because of cost-effective treatments like oral rehydration therapy (ORT). Since 1985, 2.5 million young lives have been saved each year through low-cost health programmes.Numbers are faceless, though, and I am fortunate to have spent enough
time in developing countries to have seen the faces behind the numbers.
In 20 years of working in these countries, I have watched the achievements
evolve and met the people whose lives have been changed as a result. Today
when I travel to Latin America, I see old people crippled by polio, but
not children, because polio has been eliminated from the western hemisphere.
When I travel to countries like Bangladesh and Kenya, I see packets of
oral rehydration salts for sale in corner kiosks, and I know that many
fewer children are dying from diarrhoea. In Africa, in Asia, in many places
that I travel, I see volunteers going door to door to make sure that every
child turns up for the next vaccination day, or to support new mothers
in breastfeeding, or to explain how to use ORT.
These achievements are real, and the groundwork is in place for them to continue. But whenever we start to celebrate them, they are quickly overshadowed by the bad news about AIDS. The explanation for its relentless sweep through communities and countries is rooted in its fundamental nature. AIDS has succeeded so far in defeating efforts to stop it because it is not just another disease. Rather, it is fundamentally a development challenge, intermingling issues of poverty, inequality, culture and sexuality in complex ways. Worldwide, HIV infection most often results from heterosexual intercourse.
Beyond that biological reality, some people are especially vulnerable to
HIV infection because of their social, cultural or economic situation.
One such cause of vulnerability is the social inequality between women
and men. Women, especially young women, have little power to dictate the
terms of sexual relationships and are therefore much more vulnerable to
infection. The ‘sugar daddy’ phenomenon is not new, but in the age of AIDS,
older men are pursuing ever younger women and girls in the belief that
they are less likely to be infected. Thus, a key to stopping the epidemic
is action that enhances the ability of women and young people to control
their lives, including their sexual relationships.
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