AIDS IN AFRICA
By Janice Dahlman and Elizabeth Jones
HIV infection and AIDS is spreading more rapidly and having a more devastating impact in sub-Saharan Africa than in any other region of the world. Of an estimated 30.6 million people living with HIV and AIDS today, two-thirds live in Sub-Saharan Africa. (Baldauf 1997). Even more astounding, however, is the fact of the 5.8 million people newly infected with the AIDS virus in 1997, 4 million live in sub-Saharan Africa. (Pear 1997). Compounded with the other numerous political, social, and health problems that most African countries are experiencing, AIDS has become a major destructive force in the lives of the people and in the economies of the countries.
The situation and spread of AIDS in sub-Saharan Africa is unique compared to the Western world. Unlike the Western world, AIDS is spread predominantly through heterosexual sex, putting the whole population at risk. Whereas the male to female ratio of persons infected with HIV is close to 15:1 in most developed countries, the ratio in Africa is 1:1. (Baldauf 1997). By having men and women equally infected with the HIV virus in sub-Saharan Africa, the virus is more likely to spread through families and especially to children. It is obvious from the statistics regarding AIDS in Africa that the HIV virus is having a large effect on the lives of all people living in sub-Saharan Africa. It must be examined as to why AIDS is having such a more devastating effect on this region of the world as compared to other regions. There are many possible explanations to this growing problem. Some research indicates that the large diversity of culture in sub-Saharan Africa plays a role in the large numbers of AIDS cases present. The differing cultural and social attitudes toward sex contribute to the spread of AIDS in sub-Saharan Africa.
In order to understand the HIV virus, which is devastating the sub-Saharan region, it is necessary to understand its origin. The paper will start with a brief historic overview of the origin of the virus that includes theories of its beginning. Another important aspect of the disease is how it is spread or the main modes of transmission. This issue as well as some of the major regions affected by the disease will be touched on. Since the main mode of transmission is through heterosexual sex, it will be explained the possible reasons for this transmission and how it came about. Two major explanations will be discussed, the possibility that AIDS may have originated in Africa and secondly, the opinionated explanation involving the increased sexual drive and promiscuity of Africans. The latter theory is explained through a socially molded attitude toward sex through various cultural issues of some sub-Saharan African societies. Next, there are two related theories to support our thesis, the truck transport theory and civil strife theory, are evidence that the attitude held by some sub-Saharan Africans effects the spread of AIDS. These theories bring up the issue of commercialized sex, which has become popular in many parts of sub-Saharan Africa. This makes a distinct change in sexual practices, commercialized sex is far different from the traditional cultural practices of many societies. Commercialized sex is more deadly, by increasing the sexual networks of people and widening the base of the spread. The social aspects will basically follow the above sequence in the subsequent paragraphs of this paper, proving that social attitudes do contribute to the spread of AIDS in sub-Saharan Africa.
Many cultural as well as social factors affect the spread of AIDS in sub-Saharan Africa. These factors will also be explored in this paper according to the following sequence. First, a brief overview will be given of the various cultural traditions and behaviors that are believed to contribute to the spread of AIDS. These include the various different sexual relationships that may exist in different sub-Saharan African cultures, the common practice of female circumcision, the general lack of male circumcision, and various tribal healing methods.
Different traditions dealing with sexual relationships will be the first of the cultural factors involved in the spread of AIDS that will be examined. There is much evidence that many of these cultural traditions have increased the spread of AIDS in sub-Saharan Africa by increasing the number of sexual partners a person may have. The practice of female circumcision will then be examined as to its relation to the spread of AIDS. It is generally believed that female circumcision contributes to the spread of AIDS in sub-Saharan Africa by making many females more susceptible to the disease. Following this discussion, the general lack of male circumcision in sub-Saharan Africa will be examined. The lack of this practice is also believed to contribute to the spread of AIDS by making males more susceptible to infection. Finally, certain tribal healing methods present in many sub-Saharan African cultures will be examined. It appears evident from research and studies that many sub-Saharan African tribal healers are not fully aware of the causes of AIDS or how AIDS can be prevented. This is significant to the spread of AIDS in this region since tribal healers are the primary health care providers for many people living in sub-Saharan Africa. It will be evident from this section of the paper that many cultural factors contribute largely to the spread of AIDS in sub-Saharan Africa.
In reading this paper in relation to our thesis, it is crucial to understand that this evidence and research is all based upon theory. Mainly these are opinionated studies, which lead to the formation of opinionated theories. It must be known that only theories can be used since there is no exact evidence proving the origin of AIDS in Africa or why it affects Africa in the way it does. This paper simply illustrates some of the many theories that have been produced. Nothing is all encompassing. This research does not apply, or intend to apply to all sub-Saharan African people nor all the many cultures and cultural practices in the region. It simply tries to enlighten the reader of a few of the many explanations in the search for the truth regarding AIDS in sub-Saharan Africa.
HISTORIC OVERVIEW OF AIDS IN SUB-SAHARAN AFRICA
The origin of AIDS in Africa remains unknown. In one theory it is believed that the disease originated in Haiti and was transported to Africa in the mid 1960s when a large number of Haitians immigrated to Zaire. (Bashshur 1991). In another prominent theory, however, it is believed that AIDS originated in Africa by means of a virus similar to HIV found in the African green monkey. According to this theory, the precursor virus may have moved from subhuman primates to people relatively recently, or it may have been present in a few resistant carriers from previously isolated tribes for a long time and was just recently transmitted to the cities by migration. (Bashshur 1991). There is evidence to support and dispute both theories, however, and it remains uncertain exactly when or how AIDS began in Africa.
Although many theories also exist as to where AIDS began in Africa, most evidence points to the theory that it began somewhere in the region of East Central sub-Saharan Africa. Many sources also agree that AIDS probably began closer to the Great Lakes Region since the countries that contain or border these lakes are the countries in which the largest numbers of AIDS patients have been documented to date. (Bashshur 1991). From here, people infected with the HIV virus may have migrated into larger
towns and cities located along major highway and waterway transportation routes. It is also believed that truck drivers and city prostitutes, who often migrate from city to city, have played a large role in the spread of the disease.
As of 1990, the countries of central Africa and adjacent areas appeared to be the most severely affected by HIV infection and AIDS while countries in most of the north, west, and southern Africa appeared to have a relatively lower incidence of identified AIDS cases. (Bashshur 1991). The disease has spread considerably since then, however, and the United Nations estimates that as of November 1997, 9.7 million people in sub-Saharan Africa have died of the disease since the beginning of the epidemic. (Pear 1997).
MODES OF TRANSMISSION
One of the constant problems of battling AIDS in sub- Saharan Africa is the people it targets. It seems that in the sub-Saharan region of Africa, homosexuality, IV drug use, and blood transfusions are not the largest risk groups in contracting the HIV virus; but these groups of people definitely are affected. It seems though, that the heterosexual incidence of spread is more predominant when dealing with the HIV virus in sub-Saharan Africa. Instead, in sub-Saharan Africa, the population as a whole, men, women and children are equally susceptible to acquiring this disease. It is spread predominantly by heterosexual sex.
Most often this "heterosexual paradox" is explained in two ways. Many say that this is a temporary state that exists presently in Africa. It is speculated that AIDS first arrived in Africa and soon enough, AIDS will be just as detrimental in the West. It is explained that what is happening in Africa is a nightmare vision of the future of the West. (Shoumatoff 1988). Many others have the opinion that Africans are different than Westerners in that they are more promiscuous and more likely to have genital ulcers. To many there is no other way to explain the widespread transmission of AIDS. (Geshekter 1997). These two opinions are easily plausible, but there is a lack of proof. Presently there is no research to prove that the AIDS virus actually originated in Africa. There are dozens of links between the deadly virus and the continent, but there is no actual proof.
As for the second opinion of increased promiscuity of Africans, there was a study that attempted to link the increased amount of sexual contact of some, but not all, Africans to the heterosexual spread of AIDS. In the early eighties, scientists were baffled as to the rates of HIV positivity between Africans and Americans. Africans showed that five of every one hundred people on the continent are infected with the HIV virus. American results show that the HIV virus infects one of every seven thousand people in the country. (Geshekter 1997). This is a huge difference in the number of people infected in African than in the United States. In regards to the wide gap in the number of those infected in different regions of the world, especially between African and much of the Western World, a study was conducted to try and determine some exact figures. The study showed that an HIV-negative woman converts to positive only after one thousand unprotected contacts with a positive man. A negative man becomes positive only after eight thousand contacts with a positive woman. (Geshekter 1997). This study, in many minds, proves the increased promiscuity and increased sexual drive of some, but not all, of the African cultures. It is the opinion of those who conducted the study that the combination of the high transmission rates in Africa and the results of this study that Africans have large amounts of sexual contact. This is simply a conclusion reached by the scientists who conducted the study and in no means reflects concrete proof, it is simply a theory.
Increased sexual contact does not alone explain the AIDS epidemic in sub Saharan Africa. It is examined by many resources and journals as to what leads to a seemingly increased sexual drive in some sub-Saharan Africans. There are no tests to be performed dealing with this issue or events that led to these happenings. For some unknown reason, many people label, perhaps incorrectly, that it is simply the African way of life. Many assume that these attitudes toward sex must have evolved from something, more than likely, it is explained by age-old cultural and social practices and beliefs that may have molded a majority of Africans of the present to act in these ways.
SOCIAL FACTORS WHICH CONTRIBUTE TO THE SPREAD OF AIDS
Sub-Saharan African’s attitude toward sex is one that has been molded over time into its present state. Mainly, there seems to be certain social factors that have influenced this attitude. According to Charles Hunt, Africa has a distinct cultural system, which places emphasis on certain issues, many relating to sex. High fertility and high reproductive rates are very common and important in many sub-Saharan African cultures. (Hunt 1996). Since this is an opinionated statement, there are, more than likely, many cultures existing in Africa that do not follow Charles Hunt’s opinion. He seems to be making a general statement on the African culture to help understand basic cultural principles. Between these two social pressures, sexual contact and activity are at a high level and are a necessary means to fulfill what is expected of the typical, yet often inaccurate stereotyped African woman.
Along with high fertility and high reproductive rates, there are other characteristics of an African culture system that may have impacted the sexual nature of sub-Saharan Africans. Charles Hunt has the opinion that seems to associate a weak marriage bond, the lack of importance placed upon chastity and the freedom of young people in regard to sexuality with an increased number of sexual partners (Hunt 1996). However, it should be understood that this is simply an opinion dealing with social attitudes toward sex. These attitudes many be held by many sub-Saharan Africans but in no way is it to be implied that this attitude is held by everyone living in sub-Saharan Africa. An increase in sexual partners tends to greaten the probability of transmission of a sexually transmitted disease, including AIDS. The contraction of a sexually transmitted disease is the ultimate, most obvious consequence of the pressures of this cultural system.
Not so obvious however, is the evolving attitude of sub-Saharan Africans toward sex. With such a great emphasis placed on fertility and the weakness of the marriage bond in sub-Saharan Africa as well as other social factors, there begins the acceptance of polygamy, adultery and promiscuity. This acceptance has lead to many sexual partners, and even more recently a widespread diffusion of sex. " The major change in nonmarital sexuality has been not in volume but in diffusion." (Hunt 1996).
One theory marking the diffusion of sex in sub-Saharan Africa due to the various social factors regarding sex is that of the truck transport theory. This theory mainly discusses the spread of the AIDS virus due to the trucking routes in sub-Saharan Africa, yet, with regards to this paper and thesis, this theory also justifies that their everyday lives are punctuated by their social attitude toward sex. This attitude tends to effect every aspect of life, including work schedules. The truck transport theory argues that the AIDS epidemic and its patterns in sub-Saharan Africa may be found in the transportation routes of the trucking and road system. It is asserted that the African transportation and trucking system and traveling along the Trans-African highway spread the HIV virus from town to town, usually beginning in southwestern Uganda or eastern Zaire. (Hunt 1996). From the origin location, the spread of the disease can be traced in a gradual and continual spread outward along the highway. It continually spreads until it has affected all of Africa. Dates can be assessed to the outbreak of AIDS along the Trans-African highway and these dates occur in consecutive and spreading circles. (Hunt 1996).
This theory is directly related to certain social attitudes toward sex in the fact that many African men involved in the trucking industry frequently involve themselves with prostitutes during their trips, contributing to the spread of the HIV virus along these routes. The frequent use of prostitutes by these men illustrates some of the social attitudes toward sex held by many sub-Saharan Africans. Prostitution is one of the main forms of promiscuity common to many sub-Saharan African societies. And since sex is held in such a high regard and an increased number of partners is a normal consequence of such a issue, the use of prostitution is frequent. Not only is it frequent, but it occurs in many different places with many different people, increasing the likelihood of transmission of a sexually transmitted disease, mainly AIDS. This use of prostitution is a direct result of a socially influenced sexual attitude.
Prostitution is one of the major differences in the present sexual attitude than one of the past. The form of promiscuity has changed from polygamy and cultural traditions within the family to something more for fun and enjoyment. "Traditional sexuality with the family was largely self-contained." (Hunt 1996). Even during such times of civil disorder, prostitution has been factored into. Smallman-Raynor and Cliff have a thesis stating that recruited soldiers will, during their stay in the armed forces, frequent prostitutes and, upon returning home, take any sexually transmitted disease with them. Once again, like the truck transport theory, many scientists share the opinions that the sexual attitude of many, but not all, sub-Saharan Africans is exhibited in very non-sexual aspects of life. It seems that civil disorder would effect the region in a different way, with the threats of warfare and tribal conflict. Instead, the rise of unrest is one that could further destroy sub-Saharan Africa, not from violence, but from the spread of the HIV virus.
The present commercialized use of sex is very different from the traditional polygamous use of sex, in the fact that it widens the base of the HIV virus. Previously, sexual relations were kept between family member’s spouses and the men’s other wives. " Those relationships of men with other men’s polygymously married wives or with neighbors were probably of longer term and confined to fewer women over a year or a lifetime…" (Hunt 1996). Presently, commercialized sex makes it so one person positively infected with the HIV virus, could theoretically pass it to countless others in different sections of the continent. " a widening of sexual networks in that individuals have more partners, and an overlapping of networks in that those partners are not residentially so localized, and males are more likely to patronize bars, night clubs and hotels of now more commercialized society." (Hunt 1996).
Over time, the prominent social factors in some of the culture systems of sub-Saharan Africa, the pressure for high fertility and high reproductive rates, has caused many sub-Saharan African’s sexual attitude to evolve into one which finds it necessary to have an large number of sexual partners. This increased number of partners has lead to the tolerance of high levels of promiscuity, mainly commercialized forms. The possible transmission of the HIV virus increases with every new sexual act and new sexual partner. With this attitude, many assume that sub-Saharan Africans cannot help the fact that their likelihood of acquiring the disease is heightened. Frequenting prostitutes is another possible way in which sub-Saharan Africans increase their likelihood of acquiring the disease. Prostitution, being one of the most frequented forms of commercialized sex, makes it possible for a sexual encounter almost anywhere in sub-Saharan Africa and the possibility of passing any disease, including the HIV virus to someone from the opposite end of the continent. This attitude held by sub-Saharan Africans causes an increased number of sexual partners, causes tolerance for promiscuity and prostitution and increases the likelihood of transmission of the HIV virus.
CULTURAL FACTORS WHICH AFFECT THE SPREAD OF AIDS
One of the main reasons that the AIDS problem remains unresolved in sub-Saharan Africa is the numerous different cultural traditions and behaviors that exist toward sex. The cultures of this region are extremely diverse and include a wide variety of traditions dealing with sexual relationships, circumcision, and tribal healing methods that contribute to the spread of AIDS. In one Zambian culture, for example, it is tradition that a woman have sex with all of her husband’s male relatives when he dies. This is done to purge the husband’s ghost and there is strong resistance to eradicating this tradition by both the males and females of the culture. (Bashshur 1991). In another culture, the Lese of the former Zaire, young men are encouraged to have sexual relations with a number of eligible women during the time between puberty and marriage. (Bashshur 1991). In such cultural practices as these, there is little support for change to safer sex behaviors.
Female circumcision and the general lack of male circumcision are other cultural practices that are thought to contribute to the spread of AIDS in sub-Saharan Africa. Several types of female circumcision are practiced in Africa and since normal vaginal intercourse is a relatively ineffective process for HIV transmission, it is believed that heterosexual HIV-transmission is enhanced by female circumcision. "It is hypothesized that these practices may increase the likelihood of female exposure to the HIV during intercourse by the tearing of tissues due to the small introitus, the presence of scar tissue, and the abnormal anatomy of a mutilated vagina." Although female circumcision and infibulation is most commonly practiced in the Arabian peninsula, isolated areas of West Africa, the horn of Africa, the Sudan, and northern Kenya, knowledge relating to this practice is very incomplete. It is also possible that the practice may have been spread and been introduced into new urban areas through large population movements from rural to urban areas and across national boundaries. (Bashshur 1991).
Even more important in the spread of AIDS in sub-Saharan Africa, however, is the general lack of male circumcision. The lack of this practice is believed to assist in the sexual transmission of HIV.
Since the infectious agents … depend on a break or abrasion in the skin to gain entry into the body, the cervical secretions of a woman infected with the HIV are more likely to be transferred … through the delicate, easily abraided penile lining … than when the foreskin is absent.
Although male circumcision is practiced in some areas and is encouraged by some traditional healers, the percentages of men who are circumcised is very low in sub-Saharan Africa, especially in the central sub-Saharan region. In Rwanda and Burundi, for example, the percentage of males who are circumcised is estimated to be zero. There is much variation in the practice of male circumcision even within countries, but it is generally believed that there is a correlation between high rates of HIV infection and a lack of male circumcision. In western Kenya, northwestern Kenya, and western Tanzania, for example, the practice is absent and HIV rates for these areas are the highest in each country. (Bashshur 1991).
The tribal healing methods of many cultures in sub-Saharan Africa are also thought to contribute to the spread of AIDS. Although some tribal healers are aware of
how AIDS can spread and encourage condom use, many tribal healers are not fully aware of the causes of AIDS and the preventative measures that can be taken to avoid contraction of the disease. Among the Botswana, for example, most traditional healers use divination to determine the cause of a disease and the appropriate treatments. In the Yoruba culture, ancestral spirits and other supernatural forces are also thought to block good health and AIDS especially is thought to be supernatural in origin because of its manifestation of wasting, which implies the power of witches to eat the life soul of the victim. It is also considered inappropriate to discuss venereal disease in this culture since talk about breaking sexual taboos could bring about jealousy and lead to witchcraft. Overall, since in many African cultures AIDS is known to be incurable, "beliefs in predestination and life after death support an attitude of stoicism and fatalism about the course of the disease as it affects the individual, and, perhaps, as it spreads throughout the community." (Goldin 1994).
Not only are many tribal healers unaware of the causes of AIDS, but many are not fully aware of how to treat the disease and to prevent its further spread. Many sub-Saharan cultures have knowledge of western medicine and limited access to it, but since STDs and AIDS are considered indigenous in origin, most tribal healers treat these diseases with traditional medicine. In Swazi culture, for instance, traditional healers treat STD symptoms, including those of AIDS, with "applications of herbal pastes, administered with unsterilized razor blades on various bleeding cuts on the body, and used repeatedly on different patients." (Goldin 1994). Also, in a study among South
African traditional healers, when asked how AIDS can be cured, 37 of the 55 healers mentioned herbal treatment or consulting or beseeching the ancestor spirits. (Dupree 1995). When asked what types of sexual behavior are forbidden or considered dangerous, the healers mentioned intercourse with a widow the most. (Dupree 1995).
Since most STD symptoms, especially prior to AIDS, clear up spontaneously as the diseases become chronic and enter latent phases, there is much continued belief in the effectiveness of traditional cures. (Goldin1994). It is possible that AIDS may be reinterpreted as a foreign disease as the epidemic increases even more in intensity, but for the present it seems that AIDS is still primarily understood to be supernatural in origin and thus not treatable by Western methods. In most sub-Saharan African cultures, traditional healers could play a large role in the treatment and prevention of AIDS, but for now cultural norms prevent people from looking realistically at the AIDS epidemic and taking proper preventive measures.
With sub-Saharan Africa having two thirds of the world’s AIDS population, the AIDS problem is only likely to get worse. The continuation of the truck transport theory in combination with the cultural traditions are likely to allow the disease to spread even further. It seems that without a cure for the HIV virus, there will be no stopping the spread of the virus in sub-Saharan Africa. According to the National Research Council, the average life expectancies of most sub-Saharan African countries are likely to drop drastically as a result of AIDS. By the year 2010, it is predicted that AIDS will lower the
life expectancy in Zambia from 66 to 33 years, in Zimbabwe from 70 to 40 years, in Kenya from 68 to 40 years and in Uganda, from 69 to 31 years. (Bolstered 1995)
Before the AIDS problem can be improved in sub-Saharan Africa, the cultural and social attitudes that promote the spread of AIDS need to be changed. The cultural and social behaviors that result from these attitudes toward sex are the key to the spread of AIDS. Overcoming such behaviors as the frequent use of prostitution, traditional female circumcision and lack of male circumcision, and ignorance among tribal healers could prevent the further spread of AIDS. Behaviors such as these, however, have been embedded in the sub-Saharan African cultures much longer than the HIV virus has been plaguing Africa.
Baldauf, Scott. "Mixed Global Progress Against AIDS." The Christian Science Monitor News on the Web 1 Dec. 1997. Archives. 22 Feb. 1998.
Bashshur, Rashid L., Gerald F. Pyle, and Gary W. Shannon. 1991 The Geography of AIDS. New York: The Guilford Press.
Bialy, Harvey, E. Papadapulos-Eleopulos, John M. Papadimitriou, and Valendar F. Turner. 1995, AIDS in Africa: Distinguishing Fact and Fiction. The World Journal of Microbiology and Biotechnology. 11: 135-143.
"Bolstered Behavioral, Social Research Needed to Help Stem Spread of AIDS in sub-Saharan Africa." 1995, Office of News and Public Information.
Bunce, Matthew. "Chirac Seeks Worldwide Relief for AIDS in Africa." Boston Globe news on the Web 8 Dec. 1997. 4 March 1998. <http://www.boston.com/globe/healthscience/packages/hiv/>
Dupree, John, Edward Green, and Bongi Zokwe. 1995, The Experience of an AIDS Prevention Program Focused on South African Traditional Healers. The Journal of Social Science and Medicine 40: 503-511.
Geshekter, Charles L. "Rethinking AIDS Homepage". "Reappraising AIDS in Africa: Under Development and Racial Stereotypes. Sept/Oct 1997. Continuum, Heal, Meditel. 10 Mar 1998. http://www.virusmyth.com.
Goldin, Carol S. 1994, Stigmatization and AIDS Critical Issue in Public Health. The Journal of Social Science and Medicine 39: 1359-1365.
Hunt, Charles, 1996, Social VS. Biological: Theories on the Transmission of AIDS in Africa. The Journal of Social Science and Medicine. 42: 1283-1296.
Pear, Robert. "New Estimate Doubles Rate of H.I.V. Spread." New York Times 26 November 1997 (http://search.nytimes.com/search/daily/b…ite+site+26131+HWAAA+ Aids%7Ein%7Ein%7EAfrica)
Shoumatoff, Alex. 1988 African Madness: In Search of the Source of AIDS. New York: Random House, Inc.