HIV/AIDS in West Africa

It is estimated that around 30 million people in sub-Saharan Africa are living with HIV or Aids. The virus also affects many people in more developed countries, but there are cultural, social and economic factors that make West Africa a HIV hotspot.

Extreme poverty is endemic. People survive in any way they can. For many women, this means they have less control over their bodies. They may have to resort to prostitution just to get by. For some girls, a relationship with an older man is the only means of paying school fees or having pocket money. In both of these situations the woman may not be in a position to demand that they use a condom, which means they are both at a much higher risk of spreading sexually transmitted infections such as HIV. In the case of prostitution it means that she is in sexual contact with many different men, and therefore increasing the likelihood of being exposed to the virus, and indeed transmitting it.

There is less support for people living with HIV in West Africa than there is in Europe. The opportunistic infections that characterise the deterioration of someone who is HIV positive can be fought with the plethora of medicines that are available to western society. In West Africa medicine is simply not an option, as it is only available to the wealthy few. It is then up to your depleted immune system to battle the infection which, if it stops short of killing you, will significantly weaken you further.

Similarly, anti-retroviral drugs are rarely available. In the UK, such drugs are available on the NHS. In West Africa there is no such thing as the NHS. Some governments in West Africa subsidise ARV’s, which can make them an option for a few more people, though they are still in the vast minority.

Unprotected sex is generally the most common means of transmission, and in West Africa this is the case. Again, blood transfusions may also spread the virus, if the donated blood has not been screened. There appeared to be a growing recognition of the dangers of this amongst the people Tackle Africa spoke with which suggests that the necessary steps are being taken.

One difference is that there is little intravenous drug use. Another significant difference is the widespread practice of male and female circumcision. This tradition is maintained in many tribes and often carried out in groups. One single blade might be used on several different people without proper sterilisation, which is a assured way of passing on the virus.

It is common, even expected, in some ethnic groups that if a mans brother dies he take responsibility for his brothers wife and children. This practice, known as sororisation, means that both parties are exposing themselves to a greater risk of sexually transmitted infections. In addition to this, many people told of cultures in which men were expected to be promiscuous, which naturally is placing them in greater danger of contracting HIV. Both of these situations are by no means present in all of the numerous and vastly different tribes of West Africa, though they are common to many.

Stigmatisation in West Africa, as in Europe, is another problem for those who are HIV positive. The emotional impact of being rejected by friends, loved ones, the whole village can weaken the body further, speeding the deterioration. Tackle Africa visited an orphanage that took care of children who were born HIV positive. All the orphans were equals, and were kept clean, warm and well fed by a dedicated group of nuns. Some of the children had reached the age of sixteen, with no ARVs, because they are kept cocooned in an environment that accepts and values them. There was a time when they used to go to schools outside of the orphanage, but that is no longer allowed. Once a film crew came to see the setup, and showed the footage on television. Some schoolchildren noticed one of their classmates and word soon spread that he was HIV positive. He was made an outcast; isolated and humiliated by his former friends. The nuns withdrew him from school; meanwhile, his condition worsened. He died a few months later. The orphanage is in Ethiopia, but the moral applies universally.

There is generally a high level of awareness among West Africans of what HIV/AIDS is. There are, however, some myths that are believed or at least repeated in most of the places Tackle Africa visited. Some people think that the US invented HIV to keep Africa down, and that if they could be convince to use condoms, one day there will be no more Africans. Others say that the lubricant or spermicide present on condoms is the HIV virus itself. As well as a deep-seated mistrust of condoms, there is some disbelief that HIV exists at all. It is rare, but some people Tackle Africa spoke to were adamant that it was made-up. One Ghanaian man would not give it credence because it displays no unique outwards signs. Someone can have HIV and may exhibit the symptoms of a cold, because that is what they have, but it may kill them, because HIV has made them weaker. This is a leap of faith that some are unwilling to make.

The biggest challenge facing those who seek to eradicate HIV/AIDS is changing behaviour. It is helpful to educate people about the dangers of unprotected sex and the way in which the virus works. But what about the single mother who has no choice but to turn to prostitution in order to survive and provide for her children? Yes, there are condoms, and people are waking up to the fact that they do work, despite unacceptance from more traditional sectors of society. But the woman may not be in a strong enough position to insist on protected sex. There will always be another woman willing to take the risk and steal her custom.

How do you change this behaviour? Perhaps the sight of many of their peers perishing may prompt this generation into sudden conscientiousness and prudence, but many believe the problem runs deeper. Only when the extreme poverty that forces so many into desperate acts is eliminated, and the societal structures that subjugate women and other vulnerable groups are altered can HIV and AIDS in West Africa be truly eradicated.

By Frank Dalleres