Africa's "future is frightening" because of HIV
CMAJ 2000;162:683
Worldwide, an estimated 8.2 million children have been orphaned by AIDS, and that figure is slated to escalate to 40 million people — roughly 10 million more than Canada's current population — within a decade. But this is only one aspect of the devastating aftermath of AIDS, a panel of experts said during the Sixth Canadian Conference on International Health last fall.
 | A frightening future for many young Africans |
"The future is frightening," said Dr. Lucy Nkya, a Tanzanian physician. "This disease places the greatest burden on an already strained health care system and it hits the workforce."
The social consequences, which include impoverishment and the creation of orphans, are devastating. Many women in eastern and southern Africa are already living in poverty in the aftermath of AIDS because some local inheritance laws dictate that when a woman's partner dies, she inherits nothing. They then may trade sex for employment or a promotion, says Nkya, or they enter the commercial sex trade, in both cases becoming vulnerable to HIV infection. In some regions, 30% to 40% of African women are already infected, as are 20% of babies. Worldwide, the conference was told, women account for 43% of all new HIV infection. "Poverty is the single most important cofactor in the spread of HIV/AIDS in the developing world," Nkya said.
And when the mother herself dies, children become the heads of households and breadwinners, girls turn to prostitution, and the AIDS cycle begins anew. Every day, said the panel, the world sees about 16 000 new cases of HIV infections, and just 12 will be in Canada. The vast majority will be in impoverished, developing countries, particularly in Africa.
"When you see these children, you see the pain in the back of their eyes," said Dr. Abiola Tilley-Gyado, senior health adviser with PLAN International, which operates aid programs in 43 countries; Foster Parents Plan is its Canadian arm.
The HIV/AIDS epidemic is also turning the clock back on progress in African countries, where life expectancy has been declining since 1990. Sub-Saharan Africa is already home to 68% of all HIV/AIDS patients and 90% of AIDS orphans, and the region's overburdened social and health systems are threatened with collapse. "It's been a huge step backward," says Tilley-Gyado. The AIDS epidemic also has profound economic effects. The epidemic in Thailand is expected to cost the Japanese economy 1.2% of its GNP this year.
But it's not all doom and gloom. PLAN International, for example, provides testing facilities and post-test clubs that offer peer support and counselling, while Nkya has created a women's support network in West Africa that gives grants to the needy, offers one-on-one peer support and distributes condoms. In one project, the number of women in a brothel-based business had declined from 300 to 15 in 3 years.
A new guide to twinning HIV/AIDS organizations in Canada with those overseas is available at www.icad-cisd. — Barbara Sibbald, CMAJ
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