Epidemics have plagued world history as far back as 430 B.C. with some killing hundreds, thousands, and even millions of people on Earth.  One most noted example is the Bubonic Plague or Black Death that claimed over 75 million lives between 1347 and 1351 (Stine xxii).  However, the beginning of the new millennium has its own version of the Black Death.  Acquired Immune Deficiency Syndrome or AIDS is the most serious disease on Earth presently but especially in Africa.  This paper will analyze the AIDS epidemic in Africa while considering the following:  AIDS the disease, treatment, dangers of treatment and possible alternatives, treatment research with associated costs and problems, influence on the African economy, population decline, cultural contributions, and hope for the future.

AIDS is a disease that develops as a result of infection with the human immunodeficiency virus or HIV.  HIV enters the body mainly through blood or semen, and then it attacks the immune system.  Once in the immune system cells, it could stay there for years without the person ever knowing it.  Eventually, HIV will multiply and kill its host cells virtually destroying the body’s immune system.  A person is considered to have AIDS when their immune system is basically gone (Campbell et all 483).  This causes the body to be completely open to any type of disease without a way of fighting it.  It is not AIDS that kills you; it is another disease you catch that your body cannot fight off because AIDS has destroyed your immune system.  This is such an overwhelming problem that 16,000 people are infected daily with AIDS.

Since AIDS has become one of the most horrific diseases of our time, there have been multitudes of treatments that have surfaced.  There have been lipid solutions that claim to be absorbed through the digestive tract and work against the virus.  Chinese herbs have also been extremely popular, and everyone should remember the ever-popular AZT that really did no good for AIDS patients when used alone.  However, now there is a treatment that seems to be working effectively to turn AIDS into a more manageable problem called the HIV cocktail.  This is a combination of three high impact drugs that combat the AIDS causing virus.  Generally, a patient will take an AZT, 3TC and another drug that stops production of protease such as ritonavir or saquinavir (Lusky 59).  According to researchers, these drugs have proven to be very dramatic.  Doctors have shifted inpatients to outpatients after they have used this treatment.  Of course, with any drug there are problems.  Its side effects mirror those of cancer, and if a patient skips a daily dose then they could develop a strain that is resistant to the treatment.  Perhaps the biggest setback is the cost.  This treatment runs between $1500 and $2000 a month (Lusky 59).

For Africa, the cost of this lifesaving treatment is greatly out of reach.  For Africans it might as well be $1.5 to $2 million a month.  There is a huge battle right now between governments in Africa and pharmaceutical companies.  In 2000, forty-two drug companies filed a claim to challenge a lawsuit, which if won, would destroy Africa’s hopes of getting any quality AIDS treatments.  This 1997 law says that health officials can bypass drug patents and import cheaper generic drugs (Ford et all 65).  If this law is overturned, companies like Pfizer would protect their patents but at the cost of hundreds of thousands of poor Africans. (On April 24, 2001, the pharmaceutical industries involved dropped their lawsuit against Africa.  This could pave the way for affordable generic versions of the AIDS cocktail.)

The big drug companies are claiming that they must protect their patent rights and secure their profits in order to pay for the research to find new treatments, but with the possibility of international campaigns, they are trying to cut prices they charge African countries.  Living in a capitalist world, it is easy to understand that price and profit go hand in hand.  However, when thousands of real lives are at stake, rich countries should help those less fortunate (“War Over” 43).  Since the big pharmaceutical companies are not willing to allow a more reasonable priced drug for such improvised countries, Patricia Lambert, legal advisor to South Africa’s Health Minister, believes that governments should be allowed to infringe on these rights.  She believes that if a country cannot afford the drugs it needs then they should be able to allow cheaper patented imports from a country that has relaxed patent laws, or a government should be allowed to license a local company to make the drug cheaper (“War Over” 43).

Drug companies argue that this power would give governments in Africa too much discretion on when and where to use it.  So in a effort to keep the generic drugs out of Africa, pharmaceutical companies are offering discounts of immense proportions to governments there with some as much as 90% (“War Over” 44).  However, few of these countries have taken up this offer because they claim the prices are still much too high.  Drug companies feel that these patents are their intellectual rights, and allowing copycat generic drugs is just like steeling physical property (Warner).

Ayanda Ntsaluba, Director General of South Africa’s department of health, believes that pharmaceutical companies feel threatened when they should not.  He says:  “The latest figures show that we are about 0.6% of the global market and 1.2% in terms of value.  We are not going to break major pharmaceutical companies.  The issue for them is not South Africa’s market.  It’s the precedent [the case] sets” (Baleta 775).  In fact, it would not matter how much the large drug companies discount their prices.  According to Trevor Jones, head of the Association of the British Pharmaceutical Industry, Africa’s problems are more serious than the cost of some drug in a place where governments cannot provide any health care.  He believes that no price will ever be low enough (Baleta 775).

There are proponents of this entire problem that are trying to urge ethics with regard to AIDS treatment in Africa.  In the eyes of Federico Mayor, Director of UNESCO, these new AIDS treatments are a great new creation for everyone.  He believes that even though these treatments are expensive, we should not leave suffering people to suffer when we have the resources to help them regardless of cost (Sandra et al 7).  It is clear that profit is important, but I will always choose a human life over profit.  It is incumbent upon us to help people who cannot help themselves, and AIDS in Africa is the prime example.  Thousands of people die in Africa daily with the AIDS virus, yet we sit on the answer because they cannot afford it.  The truly ironic thing is that these same companies who developed these lifesaving drugs did it in the name of humanity to combat the world’s AIDS epidemic.  In the wake of big profits these companies are only humane to the people who can afford it.  Another powerful advocate of cheap or free drugs for AIDS in Africa is the relief agency Oxfam.  In February of 2001, Oxfam began a campaign against the big drug companies saying that they were “conducting an undeclared drug war against the world’s poorest countries” namely Africa (“Oxfam”).

It is very unclear what will happen with all of these patents vs. profit cases between the pharmaceutical conglomerates and Africa.  The case in South Africa has generated credible claims on both sides.  Drug companies say that the drugs would not exist without patents, and AIDS activists say the drug companies are committing “legal” genocide.  The sad fact remains that in Africa many countries do not even honor patent laws, but they still cannot afford medications.

Compounding the problem that Africa is unable to pay for AIDS drugs, their economy is being slammed with debt due to this debilitating disease.  Currently, Africa has a debt of $300 billion, and this leaves no money for health care (Ashraf 611).  According to the Xinhua News Agency, Ethiopia alone is racked with $500 million annually because of the AIDS virus.  Over 90% of their work force age 15 to 49 years old are infected with AIDS.  It is also believed that over 3 million people in Ethiopia are HIV positive (“AIDS Costs”).  This is just one example of the problems occurring in one African country.  This economic problem does extend beyond the borders of Ethiopia and affects much of Africa.  AIDS in Africa stunts economic growth because investors are suspicious of Africa.  It will be hard for them to invest in Africa when they are experiencing such turbulent problems in their work force.  In fact, the per capita income of the average African is less today than it was in the start of 1970 (Ashraf 611).

According to a report by the New York Times, AIDS is also beginning to creep into farming and rural areas.  This will have very serious implications for farming families that depend on every adult to work the land.  Jacques du Guerny, an AIDS expert at the Food and Agricultural Organization says:  “HIV hits particularly young adults, and they are the core of the labor force, the keystone of the farm household” (qtd in McNeil A11).  This has the possibility to devastate every farm in Africa.  If the young labor force becomes unable to work and many adults are already unable to work, who will that leave in the labor force?  When the farms begin to collapse, then the problem compounds itself.  More starvation will occur in an already famine ridden continent, and entire economies could falter due to the shortages.

Population studies are also becoming a major concern for scholars who are researching the effects of AIDS in Africa.  In a projection made by the US Agency for International Development, by 2003, several countries in Africa including Botswana, South Africa, and Zimbabwe will experience a negative population growth, and many others will see a zero population growth (Stephenson 556).  This will be the first time that a country sees a negative or zero population growth due to AIDS.  This has serious implications not only for a declining population because of a high death rate, but there is also a low birth rate as a result of AIDS.  A study conducted by B.G. Williams showed that the prevalence of this epidemic doubled every 15 months, which means that a person with AIDS infects another person every 15 months.  It was concluded that if the average life of a person with AIDS in Africa were 7 years then they would infect six people before they die (Williams et al 299).  The goal in this case would be to decrease the rate of prevalence so population will begin to increase.

Life expectancy is also dropping by decades because of the AIDS virus in Africa.  This is very alarming considering we are in the 21st century.  In Botswana the average life span as decreased from 71 to 39, and in Zimbabwe it has dropped from 70 to 38.  Even more shocking is that by the year 2010 life expectancies that normally would have been in the upper 70’s in Africa will drop to around 30 (Stephenson 557).  Life expectancy drops seem to be affecting women more than men.  This could lead to an even more alarming cycle.  Since men are affecting women most of the time, by the year 2020, it is believed that there will be more men than women in Africa (557).  When and if this happens, men will begin to look for younger partners and infect them as well.  In other words, this could begin to decimate the female population in Africa.

It seems obvious that the best way to lower the rate of infection of AIDS in Africa is to try and educate Africans about the severity of the disease and how it is spread.  However, there are many factors contributing to the spread of AIDS in Africa that are culturally based and therefore hard to stop.  Some of the more prevalent cultural contributors are female circumcision, promiscuity, bloodletting, and sharing instruments.

Some researchers have proposed that the likelihood of AIDS infection has increased because of the influence of female circumcisions.  In actuality it is nothing more than female genital mutilation.  It is believed that this is an effort to stop sexual sensations in women to keep them faithful.  Research indicates that this act increases the possibility of AIDS infection because a “circumcised” woman may have a very thin vaginal wall, which during intercourse could cause small tears along with the transmission of HIV (Hrdy 256).  These very unsterile procedures, although decreasing in number, still occur in countries like Zaire, Kenya, Central African Republic, and Tanzania (Hrdy 257).

Promiscuity is also a very sad reality in African culture that does in fact contribute to the spread of AIDS.  In Zaire for example, sexual relations between young men and young women are encouraged by the society.  This is done in order to allow the man to sleep around until he finds a woman that is suitable for him to marry (Hrdy 258).  This obviously has the potential for disaster.  Not only could a potentially infected male spread AIDS to his future wife but he will also give it to all of the candidates along the way.  As a side note, promiscuity also increases as people leave rural villages and go to live in the cities.  It is believed this is caused by the loss of village traditions in the city and the high amount of prostitution (258).

One of the most horrific cultural contributors to AIDS in Africa is bloodletting.  Bloodletting is the practice of placing deep incision into the skin to allow free blood flow.  It can be ritual or medicinal.  It is estimated that people who use it for medicinal purposes could have as many as 100 of these procedures performed on them annually (260).  Midwives are also exposed to free blood flow.  Birthing clinics in Africa usually have very little interference in the actual process of childbirth (260).  In other words, the woman is virtually left alone to give birth, which can lead to large amounts of blood at the birth site.

Perhaps the most serious contributor to this epidemic is the sharing of instruments.  The most common is unsterilized needles.  However, these needles are not used by drug users, but by so called medical practitioners.  They travel from city to city to “cure” certain ailments using injections (260).  Another shared instrument is the one used in the process called scarification.  Scarification is the process of making linear or circular cuts in a person’s face to allow for a sense of group belonging and to promote tribal integration.  It is also used for beauty (261).  Genital tattooing is also prevalent in Africa where the tools are shared.  This includes female genital tattooing, male circumcision, and group circumcision all with the same instruments (261).

It is clear that these practices seem very sadistic to any Westerner, but they are very accepted in certain areas in Africa.  The problem that exists is how to make people in these regions of Africa understand that these practices are contributing towards their demise.  In effect, we would be asking them to give up hundreds of years of cultural practices.  This will certainly prove to be one of the major blockades in educating African people on their survival.

Even in the face of all this sadness, there is some hope for Africa in the battle against AIDS.  In Uganda, the rate of infection has dropped from over 30% to about 15% of the population.  Instead of dismissing the problem, Uganda officials have given the epidemic a face and “exposed it as a deadly enemy of the population” (Key and DeNoon 23).  This process has lead to a very high awareness of the AIDS problem, even in the rural areas that are normally not exposed to any public policy issues.  They are trying to change the behavior people have about sex and its ramifications.

According to the UNAIDS director, education of African youth is the cornerstone of their programs (Henderson 26).  He believes that because AIDS is spreading so fast in Africa, the only way to stop the epidemic in lieu of a cure is to educate the ones who do not have it yet.  As cruel as it sounds, this will begin to get the problem under control as the older AIDS patients die off (Henderson 26).  Other programs that he would like to see instituted are “mother-to-child transmission, condoms, educational programs, treatment of sexually transmitted diseases, and blood safety programs” (27).  However, it is estimated that these programs could cost as much as 1 ½ to 2 ½ billion dollars.

To absorb some of the costs, a new cooperative program has been formed.  It is called the International Partnership Against AIDS in Africa.  Its purpose is to bring together African governments, donors, the UN, private firms, and non-profit organizations to develop and put into place an effective AIDS program for everyone in Africa (Henderson 27).  This program should prove to be very effective as long as it remains stable and viable.  It will be imperative that the organizations involved in this venture remain in close communication, and they need to put aside any political differences for the good of the people in Africa.

In closing, there are many different aspects to consider when you look at a problem like AIDS in Africa.  Many people only see the disease.  They fail to realize that the disease has the potential to affect every part of someone’s life or an entire continent like Africa.  It will become the duty of the world to try and help Africa combat this problem.  If we do not, then the entire population will become decimated, which would be a great loss in terms of knowledge and culture.  There is little doubt that if we do not then this could very easily happen to another continent.  The only question is which one?

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