AIDS
How many people are
With over 1.5 million deaths officially estimated in the last 12 months, AIDS is overtaking and interacting with other mass killers. In mid 1996 the United
Nations (UNAIDS) estimated that 28 million people had contracted HIV infection world-wide, of whom 6 million had already died. 94% of people with HIV are in Third World countries. Of the 22 million adults with HIV, 42% are women, a percentage that is steadily rising.
Although these global estimates are far more realistic than the official figures the World Health Organisation used to record, they are still probably underestimates. As access to health services in
Sub-Saharan Africa and South East Asia deteriorates, more and more people become ill and die without treatment or diagnosis. Few countries can maintain comprehensive databases of HIV infection or AIDS mortality, and few can afford effective surveillance testing.
For political and economic reasons, many countries minimise the dimensions of their problem. Indonesia's official cumulative AIDS mortality is only
66. But researchers at the University of
Indonesia recently published their estimate that the country suffers 30,000 unrecorded AIDS deaths every year.
Life expectancy in several countries with well established epidemics has already begun to fall. Life expectancy in
Sub-Saharan Africa will decrease from
62 to 47 years by the end of the century.
In Zimbabwe, life expectancy for
The bloated budgets of these private pharmaceutical companies are much higher than the public health research programmes. And in an age where private sector initiative is better than charity, and charity is better than public provision, the public sector limps along as best it can.
At the July 1996 Vancouver Conference, activists demanded the unilateral reduction of the price of treatments, so as make them available to third world patients. They were quickly excluded from the "real" discussion on managing the AIDS crisis.
And yet, mass production of the necessary anti-viral treatments, would mean much lower unit costs. Production could be decentralised to the countries most affected, and the necessary technology could be transferred to local use.
There is another solution. The plague which devastated Europe in the middle ages was not eradicated by medical advances, but by increases in hygiene and diet, made possible by new productive forces. Raising the standard of living in the third world would dramatically reduce the HIV infection rate, giving societies more room for manoeuvre in working towards its eradication. * affected? women is expected to fall from 58 years to 30-35 years by the year 2000
The interaction of HIV infection with tuberculosis (TB) has emerged as a dangerous and key trend in the second decade of the epidemic. TB itself is easily transmissible, particularly to nonHIV positive children and grandparents in the domestic environment. TB can reactivate quite soon after HIV has started to impact on the immune system. The underlying HIV infections often remains undiagnosed in overworked TB wards and clinics. For example, while Cambodia reports only 235 AIDS cases so far, foreign and local TB specialists maintain that the overwhelming majority of the 13,000 adult TB deaths in the last year have been in people with HIV.
Resources for HIV testing in the Third World have been deployed with little regard as to how testing will benefit affected communities and individuals. Much testing takes place through delinked surveys, where pregnant women, blood donors or soldiers are tested, often without explanation, and without individuals being told results or offered support. The effect of knowing, as did the pre-massacre Rwandan army, that over 60% of the group will develop a fatal illness, can be disastrous. In some countries, such as Cambodia, those found positive even in individual diagnostic tests are not told, since it is considered socially wrong for a doctor to give a patient such bad news. [KD] *
April 1997 #287 23
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AIDS