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Journal of Nursing

HIV Crisis in Africa 

The Valley of Death or Causes for New Hope? by Stacey White, MSN, MSHA,CRNP Auburn University Montgomery School of Nursing [email protected]


I have constant pain, and there is no help for us-just for the rich people-but if I can find someone to look after my children, I can die in peace. -Lillian M., 38, a person with AIDS, Nairobi (Human Rights Watch, 2001)


Introduction 


The human immuno-deficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS) is of pandemic magnitude. The World Health Organization has declared AIDS as a global health emergency.  Awareness of the serious global impact has climaxed, taking its place with the bubonic plague of the Middle Ages.  The worst is yet to come, for there are 36 million infected and 22 million deaths from this disease. The percentage of infection has continued to escalate in Africa over the past decade, almost 80% of the 22 million deaths from AIDS have occurred in Africa. Experts in the U.N. and Census Bureau report “the HIV/AIDS pandemic is producing orphans on a scale of unrivaled in world history” (Human Rights Watch, 2001).


Botswana 


The population of Botswana is currently estimated at 1.6 million. According to UNAIDS, 2001 data, 300,000 or 38.8% of the population in Botswana were infected.  Botswana remains the highest proportion of any country in the world (Online Newshour, 2003).   Botswana is a very wealthy country, having diamonds, copper, nickel, cole, iron, and silver as natural resources.  The economy primarily relies upon the diamond mines and is considered quite prosperous utilizing the standards set forth in Africa. Due to their prosperity, the country has adopted the goal, availability of anti-retroviral drugs to all citizens in need. 


Botswana’s president, Festus Mogae, is spearheading this nation’s effort; is considered one of Africa’s robust democracies.  The CIA, 2000 World Factbook states the literacy rate for male is 80.5% and female 59.9%, the total population estimated 69.8%.  Due to these literacy rates, it is very hopeful that a prevention program will be successfully implemented.


Kenya 


Kenya is currently ranked ninth highest for prevalence of HIV.  Kenya has 1.25 million adults and 100,000 infected children.  Only 14% know their HIV status.  The Center for Disease Control estimates the total population to be 31.3 million.  There were 140,000 deaths in 2003 attributed to AIDS and approximately 890,000 orphans. (Global AIDS Program, Center for Disease Control, 11/2004). 


The people of Kenya are not only plagued with HIV crisis, but also are battling famine and tuberculosis.  The Kenya Food Security Steering Group (KFSSG) estimate one million Kenyans will be in need of food aid this year.  Shortages will be worse in the East and is a result of poor rainfall for many consecutive years.  In 2000, 2.7 million people were affected by famine. The northwest has a history of sustaining a 40 year drought.  Therefore, malnutrition severely impacts the infected population. Tuberculosis and malaria also plays a contributory role in this devastating situation (Tearfund, March 2004).


Many children find themselves in a caregiver or breadwinner role due to their ill parents.  The primary effected age group is 20 to 40 years old.  Many non-infected orphans find themselves labeled with a stigma due to the demise of their parent from AIDS. Many are rejected by their relatives with no facility to care for them.  UnlikeBotswana, many do not attend school.  There are basic rural schools and recent construction of secondary schools in many communities. The prevalence in Kisumu’s population is directly correlated and serves as a sample of the entire region.  The escalating numbers of infected females continues to be a primary concern. One must also consider mother-to-child transmission within this population, impacting the situation even greater (Tearfund, March 2004).


 


Social and Economic Impact 


HIV/AIDS affects all aspects of social and economic life in Africa. The CDC and USAID have funded the POLICY Project.  The project has contributed greatly to the following findings and  is published in   AIDS IN KENYA. 



  • Health-The health sector is affected by an increased burden of caring for those infected with HIV.  It is responsible for delivering effective treatment of opportunistic infections, providing compassionate care and implementing many prevention programs such as STD control, condom promotion and distribution, and health education.  There has been discussion over the feasibility of providing antiretroviral treatment. 

  • Education- The education system is affected by AIDS in many ways.  Children infected with HIV at birth do not live to enroll in school. Many drop out when they become orphans or to care for sick family members.  Teachers are dying from AIDS.  Education is also one of the solutions to the problem.  School-based programs can help young people understand how to avoid the risks of unsafe sex. 


 



  • Military-HIV prevalence is particularly high among soldiers in countries around the world. Military service often places young men in risky environments away from their families. Military programs for the prevention of HIV can help protect soldiers, their families and communities from the spread of HIV. 


 



  • Transport-Long-distance truck drivers and other transport workers often spend many nights away from home.  Commercial and casual sex is available at truck stops, border crossing points and major transportation hubs.  Truckers may acquire HIV infection in these environments, spread it along their route, and take it back to their home communities.  Improved programs for transport workers and border communities are needed to reduce this important mode of transmission. 


 



  • Communications and information-People need to know about the risks of unsafe sex and the means by which they can protect themselves. People living with HIV/AIDS need to know about access to care and about the human rights that are guaranteed to them in the constitution. 


 



  • Absenteeism- Directly effects productivity and loss of profit. The indirect effect means increased amount of work for the healthy employees. An increase in amount wages related to overtime was noted. Healthy workers become exhausted and overworked due to the new demands. A significant decline in product quantity and quality of many companies.




  • Declining labor productivity- In many industries such as agriculture, labor productivity is the most important determinant of output and profitability. Lower performance due to illness also contributes greatly to this ongoing problem. 


 



  • Costs of Mortality-In companies heavily affected by AIDS, death is either the leading or one of the leading causes of employees’ exit from the company. Illness is the second.  AIDS is responsible for the high right of morbidity and mortality currently being experienced ( Sixth Ed., 2001).


 


Intervention 


The five priority areas of the National HIV/AIDS Strategic Plan:



  • Prevention and advocacy

  • Treatment and support of the continuum

  • Management and coordination

  • Mitigation of the socioeconomic impact

  • Research, monitoring, and evaluation


(Kenya Aids Disaster Response Project, December 2004)


In the interview with President Bush, Susan Dentzner states:


Under the partnership, the Gates Foundation and Merck are providing  $100 million over five years for treatment and prevention initiatives.  Pharmaceutical giantMERCK has also donated two anti-retroviral drugs that it produces, Stocrin andCrixivan (Online Newshours, July 10, 2003).


The Center for Disease Control (CDC) is partnering with the Ministry of Health (MOH) to develop policy, counseling and testing protocol.  Training standards are set forth for the national voluntary counseling and test (VCT) program. An expansion from three sites in the year 2000 to the current 220 sites is quite a progressive outcome. In 2001, CDC introduced the finger prick testing followed by the oral rapid tests in 2003. Also, the CDC is providing financial and technical support for the development of a 5-year national program for prevention of mother-to-child transmission. Initiating pioneered mobile VCT programs for rural regions and campaign promotions for youth and couples.  Assisted with targeting a low risk population for blood donors. (Global AIDS Program, CDC, 2004).


Other areas of interest, in the process of being implemented:



  • Expansion of VCT units and improve home-based care

  • Expand services to prevent mother-to-child transmission

  • Strengthen STD treatment

  • Strengthen AIDS education in school               (AIDS in Kenya, Sixth Ed, 2001).


 


Challenges   


The following are sited in AIDS in Kenya:


Participation-All sectors of society are invited and needed to join the effort against AIDS. Many private sectors, non-governmental agencies, donor agencies, communities, provincial and district administration officials, religious communities, educational institutions and parents.


Socio-Cultural Issues-Efforts must be made to create social norms, values and beliefs that will reduce the risk of HIV transmission.  Consensus of religious teachings on sexuality must be harmonized through advocacy, counseling, education, persuasion and law enforcement.


Legal and Ethical Issues-Human rights are to be upheld without discrimination. Discrimination diminishes a person’s desire to know their HIV status. Policies are in place to ensure human rights (Sixth Ed., 2001).


Conclusion 


HIV/AIDS has created a crisis; the prevalence in Africa is unprecedented. Strategic planning for intervention and prevention is paramount. Globally, all must band together and put forth effort to redirect the momentum of this catastrophic pandemic. Millions are dying resulting in a vast amount of orphans. The projections for the future are at a critical state.  Funding and medications are crucially needed; in turn, focusing on education and prevention for long-term planning.


Botswana and Kenya are just two countries, previously discussed, fighting this battle. There are many other countries requiring immediate intervention to lessen the impact on this continent. A percentage of funds and medical care are being directed toward contributing factors such as malnutrition, tuberculosis, and malaria. There are many socioeconomic factors impacted by this crisis; there is great concern for the economic structure in its current fragile state. One must ponder what will the outcome be? Projections are made resulting in catastrophic proportions, leaders of these countries are crying out for assistance and intervention. Many challenges and unforeseen obstacles lie ahead in this battle, but participation is the most essential. The latest data reflects a slight decrease in prevalence and morbidity due to the recent interventions.  Can hope be restored to a population that is dying by the millions?  The fight against this pandemic must gain fortitude, demonstrate perseverance, and create hope.


References 


1.  Center for Disease Control, Global AIDS Program, 2004.www.cdc.gov/nchstp/od/gap/countries/Kenya.htm


2.  Matthews, Christopher. Keeping hope alive in HIV-ravaged Kenya. San Francisco Examiner, July 18, 1999. 


www.aegis.com/news/sfe/1999/SE990701.html 


3.   Ministry of  Health, AIDS in Kenya, Sixth Ed., 2001.


4.   Human Rights Watch, 2001.


www.hrw.org/reports/2001/kenya/kenya0701-03.htm 


5.  Online Newshour. Bush Pledges AID to Africa:  May 11, 2001. AIDS in Africa: May 15, 2001. Fighting AIDS : Feb 10, 2003. AIDS in Africa: July 10, 2003.


www.pbs.org/newshour/health/aids_in_africa/botswanafacts.html 


6.   The Drum Beat 56- HIV/AIDS, Africa, Communication. July 17, 2000.


www.comminit.com/drum_beat_56.html 


7.  Kenya and AIDS. 2001.


Plaza.ufl.edu/crystalp/KenyaandAids.htm 


8.  Tearfund, March 2004.


9.  Kenya AIDS Disaster Response Project. Dec 2004.


10. Geography IQ. Africa. 2002.


www.geographyiq.com/countries/ke/Kenya_map_flag_geography.htm


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