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The Body Covers: The 2001 National Conference on African Americans and AIDS
The Life Initiative/Epidemiology: Focus on Africa

February 20, 2001

  • Jacob Gayle, M.D.

Dr. Jacob Gayle gave rare insight into the devastation of HIV on the entire African Diaspora, particularly in sub-Saharan Africa and, increasingly, in the Caribbean. He began by referring to the historic Morbidity and Mortality Weekly Report (MMWR) article from twenty years ago describing the first cases of manifestations of immunodeficiency, which marked the recognition of the syndrome, which became known as GRID and ultimately, AIDS. He juxtaposed this with reports from Africa shortly thereafter of something called "Slim Disease." It was not until the mid 1980s that these two syndromes were recognized as having the same etiology -- HIV. In the years since, the epidemic has taken different courses and very different tolls on the two continents.

Of the 5.3 million new HIV infections in the year 2000, 3.8 million were residents of sub-Saharan Africa, home to 10% of the world's population. Of the 3.8 million deaths worldwide, 2.4 million were in sub-Saharan Africa, and of the 13.2 million children below the age of 14 orphaned by the end of 1999, 12.1 million lived in sub-Saharan Africa. Within the continent of Africa, migrant populations are particularly at risk for HIV. This is reflected in the higher rates seen in those countries with large population migrations for industrial purposes such as Botswana, and also in the higher rates seen in the national military troops. In South Africa 70% of the military are infected, and estimates in Zimbabwe are even higher. HIV has wiped out the hard-earned gains in life expectancy made by sub-Saharan countries in the past decades, and has had a devastating impact on measures of development such as child mortality rates.

Staggering though the above statistics may be, they do not do justice to the human cost of the epidemic. Adolescents in their early-mid teens may govern villages in the absence of any living healthy adults. In order to survive these children may in turn engage in high-risk behaviors. Stories of frequent funerals of family and loved ones abound. On a continent with a traditional dependence on extended family networks instead of government-run safety nets, these support networks are rapidly disintegrating in the face of HIV.

Economic costs are immense. Decreased productivity and income for children compelled to drop out of school in order to care for the ailing, the economic strain on an already taxed health care system, the loss of not only the poor, but also of the affluent politicians, teachers, health care workers and other skilled staff only begins to describe the impact. On a macroeconomic level, there is a one- to three-point drop in gross national product predicted in countries of high prevalence.

Dr. Gayle stressed that despite the devastation only hinted at above, there is cause for a glimmer of hope. Condom sales in countries such as Kenya, Tanzania, Zimbabwe, Cote d'Ivoire and Burkina Fasso have risen significantly since 1995. An indication of change in behaviors, this has been achieved by introducing condoms into the cultural and social perspectives of the people of these nations. He discussed the example of Uganda where HIV rates were decreased from 30% in 1992 to 12% in 1999 through a strong political commitment and leadership, donor support, a comprehensive national AIDS plan with a strong prevention component, and widespread community involvement.

On the topic of the Caribbean, D. Gayle described the region as having the second fastest growth of HIV, particularly countries such as Haiti, Guyana, and the Bahamas.

Dr. Gayle discussed the Life Initiative, a program supported by the U.S. government to try to make a difference on a global level. It is currently operative in 24 countries, 21 of which are in sub-Saharan Africa. He concluded by stressing the increasingly small size of the world and the many and growing interdependencies among the different countries and peoples of the global community.

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