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HIV and AIDS in East and Southern Africa regional overview | Avert
Chipo is worried about her eldest daughter, Tatenda, whom she
believes is being sexually molested by her husband, Shamhu. Tatenda
is 12 years old and is beginning to show signs of a Sexually
Transmitted Disease (STD). Chipo is even more worried as she
believes that her husband has HIV, the infection that will cause
AIDS.

What
can she do? If she reports the matter to the police and her husband
is arrested, tried and imprisoned, how is she and Tatenda and the
other four younger children going to be able to live without
Shamhu’s wages? If she reports the matter to Shamhu’s family they
will not believe her, even if they know that she is telling the
truth, as they will not want the stigma that goes with AIDS.
If she persists in wanting the family to take action they are likely
to keep her children and send her back to her own family who, in
turn, will not want the shame of a returned daughter in these
circumstances.

Her
own family would probably reject her and then she would be out on
the streets with no resources and might have to turn to prostitution
for a living.  She knows that she is likely to have been
infected with HIV by her husband and so would pass on the disease…

What
to do?  Chipo is caught in a poverty and cultural trap.
So she does nothing and awaits the time when Shamhu and Tatenda will
contract full AIDS and become sick when she will have to nurse them
at home before they die, knowing that she, too, will follow them on
this path and leave behind the four young children as orphans.


Chipo muses about why her husband had acted so disgracefully.
She knows he is a loving husband but has to go to work in the city
to keep them all.  He returns to his rural home during the
holidays and sometimes on weekends when he has the bus fare.
She knows he is strong and virile and that her culture expects the
wife to turn a blind eye to sexual liaisons of husbands.  She
guesses that he knows he is HIV+ and has omitted to tell her for
shame and so she is unable to take any measures that will protect
her.  She knows, too, that there is a strong cultural myth
around that says if a man is HIV+ he can be cured by having sex with
a virgin…..  And Tatenda is obviously the easiest accessible
virgin!


Although the above story is fiction it is by no means a fiction in
the life of many families in sub-Saharan Africa where AIDS had
reached the proportion of a pandemic similar to the Black Death that
destroyed many European nations during the late middle ages.

 “A
decade ago, HIV/AIDS was regarded primarily as a serious health
crisis.  Estimates in 1991 predicted that in sub-Saharan Africa
by the end of the decade, 9 million people would be infected and 5
million would die – a threefold underestimation.” This was the
opening sentence of the Report on the global HIV/AIDS epidemic of
the United Nations Programme on HIV/AIDS, June 2000.  It cites
the number of people living with HIV/AIDS as 34.3 million at present
and the number of deaths, since the beginning of the epidemic, as
18.8 million; of whom 3.8 million were children.  These are
worldwide figures but sub-Saharan Africa has about two thirds of
these casualties with countries such as Botswana having 35.8% of the
adult population infected and South Africa 20% and still rising.
Zimbabwe, our own country, has 26.8% of the adult population
infected with a higher incidence of infected pregnant women, as high
as 60% in some border towns.  Zimbabwe also has 900,000
children who have been orphaned by the death of one or both parents
from AIDS. This number is rising and by the year 2005 it will be
about one third of the child population under 15 years of age.
South Africa is following suit and, with a much larger population,
will have overall a much higher total number of people living and
dying with AIDS.  In one area alone, Kwa-Zulu Natal, the rate
of infection is 36% of the adult population. 

The
plight of the orphaned children is heartbreaking.  The lucky
ones are those who are being looked after by members of the extended
family, aunts, uncles and especially grandparents. One grandmother
had 30 children to care for from her own sons and daughters who had
died from AIDS.  But when the grandparents die, who is left to
care for the children?


Other children run what are now called “child-headed families” in
which an older child, up ten to fifteen years of age, will look
after the younger brothers and sisters. For most of these children
school is not possible, owing to lack of money and clothes.
They survive by growing a few vegetables or begging on the streets
whilst relying also on neighbours to help them.  Many of them
become full time street children with all the attendant problems of
disease, abuse and prostitution.  Girls especially are subject
to sexual abuse, even from relatives with whom they may be living.
Girls are also more likely to be infected with HIV than boys: (for
instance, in Zimbabwe 15% to 23% of girls in the 15 to 19 years age
range are infected whilst only 3% to 4% of the boys are).
There are biological and cultural reasons for this.
Biologically a young girl engaged in sexual intercourse is more open
to infection because of torn tissues than a boy.  On the
cultural side girls tend to be younger than their male counterparts
and can be the recipients of the myth that having sex with a virgin
cures HIV/AIDS.  Furthermore, in countries of great poverty,
the whole of sub-Saharan Africa, a poor girl is enticed to have sex
with a man for a new dress, food or even school fees.  The
follow-up to this vulnerability often means that the girl is
infected with HIV in addition to often falling pregnant with the
risk of giving birth to a child that is also HIV+.  About one
third of babies born to HIV+ mothers are themselves HIV+.


Poverty is a contributing factor to the AIDS epidemic.  In
Zimbabwe, and many other African countries, at least 70% of the
population live below the Poverty Datum Line.  This drives many
women into prostitution as the only way that they can provide for
their children or parents.  AIDS’ widows in poverty sometimes
resort to prostitution even if they are likely to be infected and so
will pass on the virus.  Poverty and lack of employment also
affect the young who have no money for school fees, for recreation
or for a Western life-style that they see on someone’s television
screen.  Sex is available locally either free or for a small
fee and so they take to that willingly.


Prevention is the most important intervention in the fight against
HIV/AIDS as it is possible to prevent the transmission of the
disease and so save millions of lives in the future.  As the
main mode of transmission (more than 90% in Africa) of the HIV
virus, which causes AIDS, is through sexual intercourse, this
intervention must stress the need for people not to engage in sex
before marriage or outside marriage and to marry only an uninfected
person.  Young people must be encouraged, before they are
tempted to become sexually active, to observe the commandments of
God about sex.  But this must not be done in a negative way.
Our Peer Education programmes stress positive relationships between
boys and girls, friendship and respect and involvement in healthy
recreational activities.  The trained Peer Educators in schools
and youth clubs spread the word and encourage others.  Research
indicates that young people obtain most of their information about
sex from their contemporaries, not the older generation, not even
their parents.

The
second intervention is caring for those who are infected and for the
families who are affected by this person’s illness.  People
with HIV/AIDS should accept that they have the disease and be
willing to communicate this information to those who can help them.
It is essential that they also inform their wives, husbands or other
partners so that they will not be at risk of contracting the
disease.  In fact this is a moral obligation on their part.

In
most developing countries, and especially in Africa, it is not
possible to obtain long term care in hospitals for AIDS patients,
because of costs, lack of equipment and lack of drugs, and so the
concept of HOME-BASED CARE was established.  This means that
the patient is cared for at home by a relative, usually the wife,
who has been taught how to care for an AIDS patient.  Teams of
volunteer workers have been established in many places by
government, churches and voluntary organisations. These workers go
from house to house assisting the families, sometimes with drugs,
and/or food and in many cases helping with the household chores, or
doing the shopping.  When there is no money for shopping they
try to help with some financial assistance. 

Home
Based Care is a new and vital form of apostolate for Christians.
Many of those involved in this apostolate are themselves suffering
from HIV/AIDS but not yet to such an extent as to be incapacitated.
This is the way they show their love for others who are sicker than
they themselves.

In
recent years major advances have been made in the First World in the
use of drugs that delay considerably the onset of full AIDS to those
that are HIV+.  However, these drugs cost up to US$800 per
month and also require frequent medical consultation to avoid side
effects. Even if sold at a reduced price of US $200, as some drug
companies have offered, they are out of reach of poverty stricken
Africans, nor do they have the necessary medical back up.

The
third intervention is the care of orphans. We do not call them “AIDS
orphans” as they are likely to be stigmatised and the vast majority
of them do not have the disease as they were born before their
parents became infected.  A better expression is Children
Affected by AIDS (CABA).  A United Nations definition of these
orphans is one who has lost both or one parent to AIDS.  The
majority of these children are looked after by the extended family,
according to African tradition, but these families themselves often
have scarce resources and are unable to provide school or medical
fees for the children and so they need help.  The children that
go to orphanages are those without any other relatives and this is
only recommended in extreme cases.  If a family cannot be
found, the local community is often the one to help by supervising
the children, some of whom have a “child headed family”, an older
brother or sister sometimes only in their early teens.

In
all programmes for orphans it is essential that they are able to
carry on with their schooling so as to be self sufficient, or find a
job in the future.  The church has some programmes to provide
school fees, uniforms and books for these children.  For
abandoned HIV+ babies the church has also projects in some countries
where they are looked after by surrogate mothers.  The church
never has enough funds and relies on donors, mostly from overseas,
but essential funds are still lacking.

In
poverty-stricken countries oppressed by debt and international trade
barriers, donations will never be enough for those with HIV/AIDS and
for millions of orphans.  The time has come for rich countries
to acknowledge this, and take positive structural action.


Jesuits everywhere, whilst involved in many other ministries,
willingly make the effort to reach out to those infected with HIV+.
How pass over in silence men such as Father Jack Gillick and all
that this Jesuit in his eighties continues to accomplish in
Johannesburg, Father Angelo D’Agostino and his work for abandoned
children in Nairobi, the two Fathers Michael Kelly in Zambia,
Brother Kizito Makora and our scholastics in Zimbabwe, our novices
in Tanzania and our men in the Ivory Coast and the Democratic
Republic of the Congo?  The list of Jesuits involved in
HIV/Aids work in Africa is endless.  How could it be otherwise?
Youth clubs, counselling, training programmes, hands-on involvement
in the hospitals and orphanages, the formation of peer
educators…all this and more so as to respond as best they can to
the needs of God’s People.  Whilst the Society can be justly
proud of their efforts, their only desire is that it were possible
for them to do so much more!

The Struggle Against AIDS Must Be Based on Human Rights
AJANews No. 4, February 2003

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