HIV/AIDS – Yesterday, Today, and Tomorrow

By Marcie Christensen

The disease we know as HIV/AIDS is believed to have transitioned from non-human primates to humans in Africa.  It was recognized as a new disease in 1981, when homosexual men and intravenous drug users in the United States were dying from “unusual opportunistic infections and rare malignancies”.   In the 1980’s and early 1990’s, HIV/AIDS was frequently in the news in the United States as more and more people were diagnosed, there was no effective treatment, and the inevitable outcome was death.

HIV/AIDS Today

Scientific research led to the creation of several anti-retroviral drugs which, taken in the right combination, can control HIV/AIDS and today, lead to a nearly normal life expectancy.  The U.S. death rate started to plummet in the mid 1990’s, and death rates worldwide continue to fall, as does the rate of infection. Although a cure has not yet been found, HIV/AIDS no longer has to be a death sentence.

Sub-Saharan Africa is the epicenter of the epidemic, according to The United Nations Joint Programme of HIV/AIDS (UNAID). As reported in The Gap Report 2014 –

• Of the 35 million people living with HIV, 24.7 million are living in sub-Saharan Africa – nearly one in every 20 adults.
• Seventy-four percent of all people in the world who died from HIV/AIDS-related causes in 2013 were in eastern and southern Africa – approximately 1.1 million people.
• Women account for 58 percent of the total number of HIV-infected. More than half of them are not receiving anti-retroviral therapy.
• There were approximately 210,000 new HIV infections among children in 2013.

As grim as these statistics sound, they represent a sharp drop over the previous decade. Eastern and Southern Africa have seen a

• 30 percent reduction in new HIV infections between 2001 and 2011
• 50 percent reduction in new child infections between 2001 and 2011
• 39 percent reduction in AIDS-related deaths between 2005 and 2013

Progress is directly due to the rapid increase in the number of people on antiretroviral therapy. The region has witnessed an expansion in the coverage of HIV treatment to record numbers of people. In 2013 alone, 1.7 million additional people living with HIV received antiretroviral therapy. South Africa has the highest number of people on HIV treatment—nearly 2.6 million—and has committed to nearly doubling that number in the next few years.

AIDS Orphans

The loss of a parent (or parents) obviously has serious consequences for a child’s access to shelter, food, clothing, healthcare, and education. In the early days of the AIDS crisis, many well-meaning NGOs built orphanages to care for the growing number of children who lost parents. The response was unsustainable as the number of orphans rose. The majority of orphans are now cared for by kin. However, kinship care often results in large, female-headed households where more people are dependent on fewer income earners. Orphaned children are often pressured to contribute to the household by working, begging, taking on housework, and caring for other children.

When parents have been productive and left assets for their children, inheritance rights of the orphans may be threatened by land and property grabs by unscrupulous relatives. There is also a relationship between children orphaned by AIDS and increased child labor.

Although the death rate due to HIV/AIDS has been falling, due to the time lag between when parents become infected with HIV and when they succumb to the disease, the number of AIDS orphan is expected to increase over the next few years.

Grandmothers as Caregivers

A group of grandmothers in Uganda are facing the challenges of caring for their children’s children.  The Nyaka AIDS Orphans Project (DFW Featured Program September 2014) will train trainers for 91 self-organized groups of grandmothers, aimed at improving their life skills and economic stability, enabling them to better cope with the added responsibility of raising orphaned children.

When adult children experience the debilitating effects of HIV/AIDS and can no longer work, they often return to their parents’ home to be cared for, and that burden falls mostly upon their mothers.  Caretaking usually involves sinking deeper into poverty.  Women may not have access to land for raising food.  Often, most of the elder’s meager resources are spent on the dying adult child.  Especially when the adult child survives for an extended period of time, the caregiver’s resources are severely depleted.

Care is both emotionally and financially draining.  Once the adult child has succumbed to the disease, the elder must cope with burial expenses and usually the expenses of caring for the orphaned child or children.  Sometimes the child or children arrived with the parent, and sometimes the HIV/AIDS victim asks the caregiver to take in his or her orphaned children who are living elsewhere.

According to the World Health Organization, “Almost 90 percent of all respondents had no regular monthly income or net yearly income, and yet they took on the challenge of caring for their dying children and their orphaned grandchildren.”

In addition to the financial and physical challenges of caring for their dying child, elderly parents have to cope with the stigma surrounding HIV/AIDS within the community, including from healthcare workers.  The elder is often shunned, and frequently reports a sense of loss around the lack of social support.   The stigma is especially a problem if an orphan is HIV positive.

Moving Forward – The Focus on Women

Women are at higher risk of contracting HIV for a variety of reasons:

• Often, women cannot negotiate safe sex practices or condom use with their partners.
• Women in conflict zones are at risk of exposure to the disease because of rape.
• Poverty pushes some women to engage in transactional sex.
• Pregnant women are infected with HIV at higher rates during pregnancy because of biological changes to the reproductive tract.

As women are at greater risk of exposure, the focus on women has become the most promising strategy for eliminating the disease. Preventing HIV infection among women requires action on all of the following fronts:

• Provide proper sex education for both genders
• Provide family planning services and contraceptives
• Teach women how to negotiate safe sex practices with their partners
• Increase the availability of condoms (including female condoms) and promote the development of medications known as microbicides that can be creams and gels used to protect against infection.
  
• Increase testing of pregnant women and provision of antiretroviral drugs for those testing positive for HIV

World Health Organization guidelines recommend that  pregnant women who test HIV-positive go on a regimen of three antiretroviral drugs as soon as possible and stay on these drugs until their infants are born and breastfeeding has concluded. Ideally, the mothers themselves will also remain on treatment once breastfeeding has concluded, for their own health.  Mothers who adhere to this regimen can reduce transmission of HIV to their babies by 95 percent or more.