During the twenty-year AIDS epidemic, almost twenty-two million people worldwide have died of the disease and an estimated 36 million are living with the HIV virus, which develops into AIDS. The first reported cases of HIV/AIDS in the early 1980s were followed, especially in the West, by rapid scientific advances in naming the disease, finding its cause, and learning about its modes of transmission. This burst of scientific discovery fostered an optimism that AIDS could be conquered. However, by the mid-1980s, the disease was recognized as an international epidemic. It spread explosively across the African continent and to many other parts of the world, including Asia and South America. It is estimated that 90 to 95 percent of AIDS infections occur in developing countries, primarily in sub-Saharan Africa where some of the world’s worst living conditions exist. According to current estimates, 70 percent of those infected with AIDS live in this region. Today, AIDS is called pandemic because it has spread to every inhabited continent in the world.
Globally, AIDS is a disease which has been, and continues to be, primarily a sexually transmitted disease (STD) spread through unprotected sex between heterosexual men and women. It is shortening the life expectancy of working-age adults, dramatically increasing the number of infant and child deaths, shrinking the workforce, creating millions of orphans, widening the gap between rich and poor countries, and reversing developmental gains. Currently, the areas most affected by AIDS are Africa, India, and China. Almost every country in Asia and the Pacific area has recently experienced an increase in HIV infections.
Why AIDS is a major problem in developing countries
Wealthier countries have experienced a decrease in AIDS infections due partly to the development of AIDS medicines and the implementation of preventive measures. Government officials, medical scientists, and the public in Western countries have addressed many of the complex issues involved in combating AIDS. While the affluence of developed nations has helped decrease the transmission rates of AIDS in the West, widespread and worsening poverty in developing nations has limited public education about AIDS and the ability to act constructively to combat the disease. Poverty in developing countries has also blocked the development of adequate health care facilities and the purchase of AIDS medicines, even at drastically reduced prices. One estimate of the cost for AIDS drugs for an individual is $12,000 or more per year; however, the entire annual health budget of some African countries allots less than six dollars per person per year.
Although over 90 percent of people with AIDS live in developing countries, it is estimated that 90 percent of the AIDS drugs are consumed by those in the developed world. Large drug companies have not been interested in marketing AIDS drugs to poor countries because these countries have low purchasing power. A heated dispute arose in 1999 between the South African government and its supporters on one side and western pharmaceutical companies, the government of the United States, and the European Union on the other. The South African government attempted to reduce high drug costs by introducing amendments to international drug patent laws, but Western pharmaceutical companies reacted furiously, raising a lawsuit against forty South Africa–based drug companies. The western pharmaceutical companies argued that even if they did provide AIDS drugs more cheaply to developing countries, such nations had no infrastructure to administer the drugs. AIDS activists accused the pharmaceutical companies of putting profits before humanity. The issue was settled when the companies, pressured by worldwide public outrage, dropped their charges against the South African drug companies.
Poverty in developing nations not only blocks access to affordable AIDS medications, it also helps contribute to the spread of the disease. For example, evidence suggests that poor groups in developing countries, including injecting drug users and increasing numbers of commercial sex workers, run a higher risk of contracting AIDS. Many prostitutes reside along long-haul truck routes. Male and female adolescents between the ages of fifteen and nineteen, whose parents cannot provide them with adequate food and clothing, frequent these truck stops to trade sex for money and gifts. In addition, when men cannot find jobs in their villages, they go to bigger cities where they must work for months at a time. The men visit brothels and carry the AIDS infection back to their homes, often infecting their wives; in these countries, women are not expected to question their husbands or suggest the use of condoms. This same situation exists among businessmen, among whom it is not uncommon or socially unacceptable to have a wife and family as well as multiple sexual partners.
In addition to these problems, weak educational systems and lack of information about HIV/AIDS contribute to the spread of the disease. Some of those in developing countries do not know that they are infected with AIDS or even what the disease is. Embarrassment about having contracted AIDS as well as discrimination against those who have it can lead to an unhealthy silence and denial. Some governmental leaders in developing nations have not wanted to admit that their country has an AIDS problem. For example, Thabo Mbeki, the deputy president of South Africa, publicly stated that HIV and AIDS were not related issues. Some of these nations also suffer from internal strife, political upheaval, and wars, creating populations of refugees in which AIDS spreads unchecked. Other STD’s and major diseases such as malaria and tuberculosis ravage some of these countries as well, complicating health care problems. Illnesses and deaths among people in their prime working years further impoverish these nations by hurting already weak economies and creating a new generation of “AIDS orphans,” estimated at over eleven million children globally. Clearly, AIDS in developing countries is more than a health issue, as it undermines countries economically by affecting productivity, security, education, health care, civil service systems, social cohesion, and political stability.
What’s being done to address the problem of AIDS
In response to the magnitude of the AIDS crisis, countries throughout the world have developed national AIDS programs (NAPs) adapted to the specific needs of their populations. The World Health Organization (WHO), a United Nations agency, founded a global HIV/AIDS trust fund in 1987 to help fund the NAP programs. These programs focus on the prevention of the sexual transmission of HIV and the transmission of HIV through blood and blood products, including injection drug use. The NAP programs have also supported strong international efforts to de-stigmatize AIDS and to ensure the human rights of those with HIV/AIDS. In addition, the programs attempt to reduce mother-to-child transmissions, which are a much greater issue in less affluent countries.
These national programs sometimes include working in partnerships with nongovernmental organizations (NGOs). NGOs, at the national level, provide a broad range of services, from confidential counseling and testing to support and legal services for people with AIDS. Some NGOs focus on solidarity, bringing people with AIDS together to fight the disease. Organizations composed of people living with HIV/AIDS are extensive and do international advocacy work to deal with the AIDS epidemic. One such organization, the Global Network of People Living with AIDS (GNP+), encourages members to network and share personal experiences. The organization leads the movement working to establish AIDS self-help groups. NGOs such as Doctors Without Borders, Oxfam, and The AIDS Coalition to Unleash Power have pressed drug companies to reduce their prices to poor countries. These activists are working to get generic versions of AIDS drugs at drastically reduced prices to countries in need.
Worldwide organizations have brought attention and resources to the global response to AIDS. The International AIDS Conference, which first convened in April 1985 in Atlanta, Georgia, has been the primary venue for professionals to share scientific and medical advances in AIDS research, as well as a forum for important AIDS policy debates. In addition, the United Nations established the joint UN Programme on HIV/AIDS (UNAIDS) to work with national governments and others to alleviate the AIDS epidemic. For example, in 1997, the UN gave China a 1.8 million dollar grant to help fight AIDS over a four year period. China used the funds to train ministry workers and increase prevention education among high-risk populations. HIV education programs are common in urban areas of China, but they have not reached rural areas. Another organization, the International HIV/AIDS Alliance, founded in 1993 in London, England, focuses its efforts in Africa, South America, and Asia, working to build up local AIDS organizations in these areas.
One of the few success stories in the fight against AIDS is Thailand, where the use of condoms is mandatory in brothels, which are closed down if they do not comply with government regulations. Thailand is one of the two developing nations, along with Uganda, which has experienced a drop in HIV infection rates and is a prime example of how prevention practices can work. In eastern Africa, where the rates of new infections are also beginning to stabilize or even decline, Uganda was the first country to report its AIDS cases. In the 1980s this country had the world’s highest HIV infection rates, but the government responded quickly. After preven- tion through education and the promotion of safe-sex practices such as the use of condoms, Uganda has also experienced a decline in HIV rates.
Although some prevention efforts have succeeded, many analysts believe that the ultimate solution to the global AIDS crisis is the development of a vaccine that will prevent people from contracting AIDS in the first place. Many researchers believe that the development of a preventive vaccine is possible and absolutely necessary in order to eradicate AIDS. However, many pharmaceutical companies do not want to invest in AIDS vaccine research because of the large expense involved and the belief that profits could not be made on the vaccines. Funding for research to develop an AIDS vaccine comes from several sources, mainly the International AIDS Vaccine Initiative (IAVI), UNAIDS, the U.S. National Institutes of Health (NIH), U.S. government agencies, and a few multinational pharmaceutical companies. In 1997 U.S. President Bill Clinton called for the development of an HIV vaccine within a decade and announced a new center for vaccine research. Some researchers believe that a vaccine will be developed in the next five to seven years.
In the meantime, AIDS continues to spread in the developing world. Although successes have occurred, many experts contend that much more needs to be done. They argue that the response to AIDS needs to be of greater duration, greater quality, and greater scope to reach the many areas of life which AIDS touches and affects. Working together with others in the international community utilizing multiple approaches will enhance the ability of developing nations to cope with the disease. The viewpoints in AIDS in Developing Countries: At Issue explore the HIV/AIDS pandemic which has become an ongoing challenge to human ingenuity and compassion.