Background Reports

Background Reports

Debra Meyer provided a broad overview of HIV in Africa, beginning by asking for a moment of silence for all those affected by the epidemic. She drew a comparison to apartheid in South Africa, which similarly seemed impossible to change but through persistent effort was proven otherwise. Dr. Meyer noted that the infection rate within sub-Saharan Africa is disproportionately high compared to the rest of the world and is getting worse, not better. At the end of 1999 there were an estimated 34.5 million AIDS cases worldwide, with 24.5 million of them (some 68 percent) in sub-Saharan Africa. By the beginning of 2001, there were 50 million cases worldwide, of which 40 million (80 percent) were in sub-Saharan Africa. In addition to a poor record of preventing infection, the region is not doing well treating those already afflicted.

Dr. Meyer also provided some historical background, noting that the earliest known case of HIV infection dates to 1959, found in Congolese serum, and that the disease is thought to have originated in Africa, having been transferred from monkeys to humans. While acknowledging that there is some dispute about the disease's origins, Dr. Meyer emphasized that the preponderance of scientific evidence clearly points to an African origin and zoonosis. Whether the transfer occurred through mixture of blood through hunting or husbandry or is related to the development of the polio vaccine (which involved monkeys) is not known. Dr. Meyer noted that there are two major strains of HIV (HIV-1 and HIV-2) and a variety of subtypes, so that a vaccine developed for example in the United States might not be useful in other regions.

Causes of the disease identified by Dr. Meyer include unprotected sex; literacy and language difficulties (hampering communication); the economic and cultural status of women, for example placing them in a poor negotiating position with regard to protected sex; cultural beliefs and practices such as wife inheritance; and migrant labor, where men are away from home for long periods of time, resulting in reliance on prostitution as a sexual outlet. As for solutions, she emphasized the importance of educational efforts, care and support, and research into vaccines for each of the various subtypes of the virus. Dr. Meyer also noted that, while some 5,000 simultaneous deaths in the World Trade Center tragedy begat a major war on terrorism, 2 million isolated deaths per year from AIDS has not resulted in any similar massive mobilization.

Alice Ennals, from the Agricultural University of Norway, briefed the participants on a study she is conducting on behalf of the Norwegian aid agency NORAD -- a study on preventive action taken at agricultural universities -- and planned to report back to NORAD with recommendations of best practices. She is disseminating surveys and questionnaires to African colleagues to determine what universities are doing in response to the HIV crisis, what are the impacts of their efforts thus far, and what curriculum changes have been instituted.

Stella Neema of Makerere University in Uganda next presented an overview of AIDS in Uganda, where the disease was first detected in 1981, and at the time was attributed to witchcraft or unknown causes. In 1985 the first blood samples were taken, and the government took quick action, forming a national committee that same year. By 1986 the government had pledged its commitment to fight the disease and instituted an AIDS control program with support from the World Health Organization. Uganda adopted a multisectoral approach, involving government agencies, NGOs, religious and community groups, and concerned individuals, and emphasized providing health information to adolescents. While the rate of infection increased up to 1993, when the percentage of the adult population infected reached 14 percent, it declined from there (among all age groups) to 8.3 percent by the end of 2000. The number of girls infected remains 3 to 6 times higher than that of boys. Dr. Neem attributes the relative success of the Uganda program to the government's willingness to talk about the problem openly and tackle it immediately. As a result, the country has seen favorable changes in high-risk behaviors, such as an increase in the age of first sexual activity, a rise in abstinence and use of condoms, and a reduction in the number of sexual partners per person.

Eleuther Mwageni of Sokoine University of Agriculture provided a similar overview of AIDS in Tanzania, where the first three cases were detected in 1983 in Kagera. By 1986 all regions of the country were reporting cases of the disease, and an estimated 1.3 million people were infected by 1999 according to UNAIDS -- a number representing 1 in 12 adults. In 1999 alone, 140,000 people died from the disease in Tanzania, and some 700,000 children have lost one or both parents. Again, far more women than men are infected with HIV. Studies in the country have shown that, perhaps counter-intuitively, better-educated women have a higher risk of infection than less educated women, a phenomenon that Dr. Mwageni attributes to their higher mobility. Some national efforts were begun in the 1980s, but these efforts were significantly upgraded in 1999 with a program known as Medium Term III, which establishes a National AIDS Committee and National Advisory Board, provides a technical AIDS committee within every ministry, and employs a multisectoral approach. In subsequent discussion, questions focused on the issue of the infection rate among educated women, with some participants suggesting that the salient point was not education per se but a difference between rural and urban women.

Additional discussion focused on whether the decline in HIV infection rates in Uganda was real or instead reflected inaccurate statistics, perhaps the result of under-reporting because of lack of health care access among the poor, in turn a result of Structural Adjustment Programs and general economic deterioration. However, representatives from Uganda noted that the statistics were drawn from a variety of sources and that these remained consistent both before and after the 1993 infection rate peak.