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Aids And The Nations Of The South


new internationalist
issue 169 - March 1987

India: an urgent need to screen the blood supply as AIDS spreads.
AIDS and the nations of the South
AIDS is now entrenched in virtually every country of the Third World, where resources to fight the disease - either through education campaigns, medical treatment or research - are at their most limited. Enver Carim and Graham Hancock chart the frightening spread of the virus and conclude that in the world's poorest continent, Africa, a disaster of biblical proportions is looming.

Just before the self-denial of Lent every year in Brazil, there is the carnival. Principally in the cities of Salvador, Olinda and Rio de Janeiro, the pulsating samba music catches the spirit of hedonism, engulfing the dancing, drinking and of course fornicating celebrants in five days and nights of wildness.

The flip side of the same coin is that the country, the 'sex capital' of Latin America, is afflicted with a burgeoning AIDS epidemic. By September 1986 there were 841 confirmed and 262 suspected cases of AIDS, with the greatest incidence in Bahia, Rio de Janeiro and Sao Paulo states.

A random sample found AIDS antibodies in between 2.4 and 2.6 per thousand Brazilians in Sao Paulo and Rio (compared with 1.49 per thousand among US military volunteers). Brazil does have a national AIDS committee, but this has not been noticeably active. And a number of private and State hospitals are reported to have been refusing to treat AIDS patients. Although 92 per cent of infected Brazilians are gay or bisexual men, there is evidence that the initial reaction of fear of AIDS in that community has been dissipated. Uninhibited sexuality is the dynamic likely to spread the virus more and more widely into a population already seriously weakened by ill-health and malnutrition.

In the Caribbean there were, by June 1986, a total of 511 cases, 273 of them in Puerto Rico alone. This latter figure included a high 'second generation' spread, i.e. the heterosexual partners of drug addicts, and the children of seropositive women. Thirty per cent of drug-addicted women who finance their habit from the proceeds of prostitution were found to be seropositive.

It is significant that the first AIDS cases in India appeared among poverty-stricken women working as prostitutes in order to support their families. Having gained a foothold among India's 750 million people, the virus is set to spread rapidly throughout the subcontinent. Part of the reason is that over 50 per cent of the country's blood supply comes from desperately poor people who sell their blood to survive. They are precisely the people who are, according to Dr Handattu Venkataraman Hande, Health Minister of Tamil Nadu, a high-risk group. 'The first and most urgent need for us is to screen the blood of paid donors. There are about 150 places in the State where blood transfusions can be done, so you can imagine the magnitude of the task before us.' Moreover, clinics in the countryside have a history of not sterilising needles before reusing them. Nor can many hospitals afford the cost of the test used to determine the presence of antibodies to the virus in people's blood.

Prostitutes: spreading AIDS in Asia.
Michael Coyne / Camera Press

In many other parts of Asia the virus is likely to be spread by means of a combination of drug addicts who share their needles and the large numbers of prostitutes in that region's cosmopolitan cities. There are estimated to be 'millions' of drug addicts in Asia. Manila, Bangkok, Pattaya, Chiang Mai and Taipei have long been known for the innumerable prostitutes selling their services. In Taipei, capital of Taiwan, for example, there are an estimated 150,000 'hospitality women'; one in six of the city's females is at least a part-time prostitute.

But it is in Africa that the AIDS epidemic finds its most virulent and life-threatening expression. Even if a maximum effort were made - both by the countries immediately concerned and by the international community - hundreds of thousands, possibly millions, of Africans would still die.

All evidence suggests that the disease is out of control and that Africa is now irrevocably set on course for a health disaster of biblical proportions. Added to existing mass killers like schistosomiasis, bilharzia, malaria and dysentery; added to malnutrition-linked diseases like kwashiorkor and marasmus; added to the poverty, war and famine that stalk from country to country and from region to region, AIDS represents an intolerable extra burden. This is particularly so because, in the insanitary conditions and depressed economic circumstances of the world's poorest continent, amongst people who are badly fed, sapped by ill-health and consequently already severely immunosuppressed, the concept of specific 'risk groups' like drug takers is absurd: the 'risk group' in sub-Saharan Africa is the entire population.

One indication of this has been that immunocompromised minority groups like drug addicts and homosexual males were not the first to succumb to the disease. The virus went directly into the general population, capitalising on the low average immune status. This is why the virus affects males and females in almost equal numbers and why, because of transmission in the wombs or at the breasts of infected mothers, there are also more young children with AIDS in Africa pro rata than anywhere else in the world. In 1985 some 22 per cent of all Rwandan AIDS victims were children as against a figure of just 1.4 per cent in America. Medical officials fear that in Zambia, with a population of 6 million, there will in 1987 be about 6,000 babies carrying the virus.

Figures compiled by the Panos Institute give further glimpses of Africa's grim future: of healthy women in their twenties in Kinshasa, one in five are infected, and one in 12 of pregnant women attending prenatal clinics are infected. In Uganda, one in 10 adults have the virus in their blood In Rwanda, 12.5 per cent of the urban population are infected. In Nairobi 66 per cent of female prostitutes are infected. And in Lusaka, the capital of Zambia, one in three of male blood donors aged 30 to 35 are infected by the virus.

The total number of Africans carrying the AIDS virus is now estimated by Dr Mahler, Director-General of WHO, at between five million and ten million, with the levels of infection much higher in the central parts of the continent than in the south or north. All these infected individuals are, of course, infectious themselves and capable of transmitting the virus to others.

The truth is that not a single African country has the wherewithal, either financial, medical or technical, to counteract the ravages of the virus. If the US, the richest country in the world with a well-fed and highly literate population, is finding it difficult to control the AIDS epidemic within its borders despite all its media facilities and its public-education campaign and the $2,000 million being mobilised against the virus, what chance do Ugandans have when their country cannot even afford to buy bleach to keep the tables clean in their threadbare hospitals?

Neither is this a state of affairs to which the richer nations of the North can be said to have yet responded in a constructive or sympathetic way. However, as Dr Nathan Clumeck, head of the Belgian research team in Africa concludes, 'We have a relationship with these African countries. Unless we treat the control of this epidemic as a priority we will face an ineradicable reservoir of a lethal virus which could infect Europeans living, working and travelling in Africa for the foreseeable future'. They will also return home with the virus. And herein lies some promise. Short on altruism, the North is long on self-interest. It is now in the interest of the North to help the beleaguered continent with the resources to bring the spread of AIDS under control.

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New Internationalist issue 169 magazine cover This article is from the March 1987 issue of New Internationalist.
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