This is the first of a multi-part series by United Press International on the state of the global AIDS epidemic.
WEST PALM BEACH, Fla. (UPI) -- The tragedy of AIDS begins and ends in Africa.
AIDS most likely occurred first in Africa, probably early in the 20th Century, when an as-yet-unknown carrier animal transmitted the deadly human immunodeficiency virus to a human. Though the disease was first recognized elsewhere, the story of the worldwide epidemic remains unmatched in severity and tragedy on the continent of Africa.
The horror and extent of the disease has brought promises of assistance from high-ranking politicians, such as President George W. Bush, but a combination of poverty, government inaction, myth and stigma continue to drive the epidemic to levels that are difficult for Westerners to fathom.
In the world today, of the 43-million people living with HIV, which causes AIDS, 29.4 million live in sub-Saharan Africa. Of the 5-million people worldwide who will be infected with HIV this year, 3.5 million are in Africa, where 58 percent of those who are HIV-positive are women and the disease is spread mainly due to sexual relations between men and women.
Africa's situation differs tremendously from the United States and Western Europe, where governments and pharmaceutical companies are developing policies and products to treat a disease that affects under 0.5 percent of the population. In Africa, 16 nations have disease prevalence rates exceeding 10 percent -- 20 times that of Western nations -- many governments ignore the epidemic that fills hospital wards and results in millions of homeless orphans.
The continent's epicenter for AIDS is in South Africa, where nearly 5 million people -- 15 percent of the population -- are infected with HIV, and the government for more than three years has blocked efforts to dispense drugs to pregnant women -- drugs that repeatedly have been shown to prevent transmission of HIV to their babies. In South Africa, about 8,000 babies are born to HIV-infected mothers each month. Of those born with the infection, few live beyond age 4.
In recent days, South African officials have sought to de-license nevirapine -- the only approved anti-AIDS drug in the country and a medication shown to reduce mother-to-child transmission of the disease. In response, and under pressure from AIDS activists, other government agencies have demanded health officials draw up a plan to provide anti-retroviral drugs to people with AIDS (the organism that causes the disease actually is a retrovirus).
In 2000, at the World AIDS Conference in Durban, nevirapine was offered free to pregnant women in South Africa. Three years later, the drugs remain unavailable.
As a result, an estimated 600 South Africans die from AIDS every day, and thousands more die in Botswana, Zimbabwe, Malawi -- all across Africa. Only in a few places are drugs being distributed; only in a few countries are preventive messages being heeded.
For sub-Saharan Africa, situation grim is an understatement.
Behind the staggering numbers -- 17 million deaths due to the disease since the 1980s -- are numbing details.
"One has to consider Africa's main agricultural society," Dr. Thomas Quinn, professor of medicine at Johns Hopkins University in Baltimore, said at a recent meeting of the American Society of Tropical Medicine and Hygiene. "Seven million farmers have died due to AIDS. One has to ask who is farming the land?"
Not only farming -- teaching. "One also has to look at the educational process as well as the working process," Quinn said, explaining that 85 percent of teacher deaths in South Africa over the last 20 years have been due to AIDS.
"In fact, AIDS is the leading cause of death within the continent," Quinn said. "Because it affects many people in their young, reproductive ages and the loss of life among those young individuals who are parents, we are left with a very large number of orphans who are children who are not necessarily infected with HIV but are left behind due to the premature death of their parents due to AIDS."
Quinn said even those who have escaped infection that has claimed their parents do not escape an early death. "It has been shown that HIV-uninfected children born to HIV-infected mothers have decreased survival compared to children who are born to non-infected individuals," he explained. This fact suggests that becoming an orphan in Africa -- home to more than 85 percent of the world's AIDS-caused orphans -- is a health hazard by itself, he said.
"From the global perspective, the HIV epidemic has reversed many of the developmental gains that have been achieved in many areas of the world, particularly reversed those gains made over the last three decades," Quinn said. "There has been an economic decline, particularly on the continent of Africa with estimates of that decline ranging from 10 to 40 percent -- a staggering figure in an area that is already economically fragile.
"It has resulted in health system chaos where in some places 50 to 70 to 80 percent of hospital beds may be occupied by HIV-infected people with increasing opportunistic infections many of which go untreated. All of this results in a spiraling factor of political instability."
At the recent International AIDS Society Conference in Paris, Jean-Paul Moatti, professor of economics at the University of the Mediterranean in Marseilles, cited new figures from the World Bank. He said those figures predict if the epidemic continues at its present pace, within four generations the economy of South Africa will be halved by AIDS.
"We now realize that the social loss for economic development related to AIDS has been significantly underestimated and that the potential economic benefits or anti-retroviral therapy have been consequently underestimated," Quinn said.
The myths and stigma surrounding AIDS also thwarts attempts to control the epidemic. For example, breastfeeding newborns is considered the norm in most of southern Africa. Women who do not breastfeed are regarded with suspicion and face harassment or violence because others may think they have AIDS. So if the woman's child is born without having contracted the disease -- either by luck or because she was fortunate enough to receive drugs -- and if the woman breastfeeds to avoid being branded as having AIDS, then the healthy child could become infected through the breast milk.
Young girls -- even children under age 5 -- often are raped by older men, purportedly due to a widespread myth that sex with a virgin can cure or prevent AIDS. Karl Peltzer, a research specialist at the Human Sciences Research Council, Cape Town, South Africa, said the myth -- as well as aberrant sexual behavior -- and the common pursuit of young women by older men, "has led to a disproportionate number of young girls becoming infected with HIV." Among teenagers he said that the discrepancy is about two to one in infection rates.
Peltzer suggested, however, the myth is not why the men rape children. Instead, he said at the 111th annual meeting of the American Psychological Association in Toronto, it might have developed as a way for the society to rationalize why a child would be raped by an adult.
"I share that opinion," said Matsiliso Mokhoka, a counselor with South African Military Human Services. She said AIDS is being blamed for conduct that otherwise is not understandable.
The culture of some African communities exacerbates the problem. In some societies if the husband dies, the husband's relatives take all the family possessions -- including the home and savings, leaving the widow and her children destitute and homeless. The only alternative for many women and many children is commercial sex work, which fuels the spread of the epidemic.
As Quinn noted: "Africa is where AIDS has entrenched itself in the last two to three decades, and is still spiraling out of control. The spread of HIV continues relentlessly across the continent."
Africa may well be dying as the rest of the world watches and dribbles out drugs and money to fight the disease. Today, the only visitor to that continent wielding any impact is the Angel of Death.
Next: As bad as the AIDS epidemic is in Africa, it could easily become worse in Asia, where grim statistics continue to gain momentum -- but without much fanfare.
(Editors: UPI photos WAX2003091001, WAX2003091002, WAX2003091003, WAX2003091004 and WAX2003091005 are available)