Preface: My motivation to write this article comes from living in Zambia for three years. Due to a variety of factors, the AIDS epidemic has yet to subside in Zambia, and it remains one of the worst affected countries in the world.
In the jungles bordering the budding city of Leopoldville, a man fatefully killed and ate a chimpanzee nearly a century ago. Unbeknownst to him, the chimpanzee carried a variant of the simian immunodeficiency virus (SIV), which would ultimately mutate to become HIV-1 and HIV-2 during the years to come. Yet, it would be decades before the virus caught any global attention. In the meantime, Leopoldville grew to be a hub of Central Africa under imperial Belgian control. Men flocked to the city from all directions in pursuit of labor work, and by the 1940s, the population of men nearly doubled that of women (Gallagher, James). To accommodate the constant influx of people, the railroad systems leading in and out of the city were rapidly developed and could host nearly one million travelers a day (Gallagher, James). Inside the city, the disparity between men and women led to a soar in prostitution and fueled the sex trade. All the while, the virus first transmitted by a chimpanzee to one unfortunate hunter was silently spreading throughout Leopoldville and nearby settlements.
Eventually, the Democratic Republic of Congo gained their independence from Belgium, and Leopoldville was restored to its original title of Kinshasa in 1960. A year prior to the DRC’s transition to independence, the first case of HIV-1 was detected in a member of the Bantu tribe living in the outskirts of Kinshasa. During the decade that followed, the virus spread from the DRC to Haiti, and is suspected to have first entered the US through a carrier in New York City. Americans initially became aware of AIDS (the latest stage of an HIV infection in which the virus is non-transmittable yet deadly) in the early 80s, and the virus served as an avenue for many to direct hate towards and demonize gay men – the main demographic of AIDS. Although the stigma around AIDS and its connection to homosexuality still persists, cases have steadily declined in America since effective treatment was discovered in the mid 90’s. In the year of 1996, the mortality rate of AIDS dropped by an astonishing 47%, and infection rates have continued to decline since then (Highleyman, L).
As the American AIDS epidemic began to subside, the African epidemic took off. As was the case in America, the 80s witnessed a monumental spread of the virus, mostly from its origin city of Kinshasa. First surging in West Africa and then in East Africa, AIDS finally reached Southern Africa in the latter part of the decade and caused unprecedented infection rates. Unlike in America, the virus was predominantly transmitted through heterosexual relationships along with lesser contributing factors, such as infected needles and infections passed down through an infected mother. Infection and mortality rates of the virus grew uncontrollably throughout Sub-Saharan Africa, and in 1993, nine of the global 14 million people infected with HIV were located in this region (Editorial Team, BHM).
Barriers to Treatment
On average, the antiviral drugs or “drug cocktails” used to treat HIV cost between $10,000 and $15,000 per patient per year during the 90s (Editorial Team, BHM). It is estimated that in order to afford the “drug cocktails” necessary to treat every person infected with HIV within their borders, Sub-Saharan countries would have to divert between 9% and 67% of their GDP (Editorial Team, BHM). This crippling cost of treatment allowed for the epidemic to spread further and seep deeper into communities. By 2001 there were an astonishing 20 million people living with AIDS in Sub-Saharan Africa, yet only 8,000 of them were receiving regular treatment (Editorial Team, BHM).
The epidemic saw its first glimmer of hope in 2003, when WHO launched its 3-by-5 initiative – a program aimed to get three million people infected with HIV in Sub-Saharan Africa on treatment by 2005. During these two years, the number of people receiving treatment increased from 100,000 to just over 800,000. Although it wasn’t the figures WHO had aimed for, it marked significant progress in Africa’s fight against AIDS. The number of people receiving treatment continued to grow as the result of lower antiviral drug costs and amendments made to healthcare systems. In 2008, it is estimated that 42% of people requiring treatment for HIV were regularly receiving it (Editorial Team, BHM). However, progress was slowed in 2010 when WHO’s guidelines changed the requirements necessary to receive antiviral drug prescriptions. A patient’s CD4 count* now had to be lower than 200mm2 instead of the previous requirement of 350mm2 to begin treatment. As a result of this, the number of patients receiving treatment for HIV was reduced to 37% that year (Editorial Team, BHM).
The Modern-Day Epidemic and Societal Stalemate
Today the AIDS epidemic is most sorely felt in Southern Africa. Although statistics cannot communicate the pain brought on by HIV, they can illustrate the hold it has over Southern African countries: 27% of Eswatini’s population (which hovers just above one million) is infected with HIV and in both Botswana and Lesotho, just over one-fifth of the population is infected with HIV (The Global Fund). Yet by a large measure, the most concentrated site of the HIV epidemic is South Africa. South Africa alone accounts for 20% of all HIV cases worldwide, and in certain provinces the prevalence rate climbs up to 60% (Allinder, Sara).
Despite the consistent efforts to destigmatize the disease and normalize routine checkups, there are still societal barriers to fighting HIV in Sub-Saharan Africa. A prominent catalyst of stigma against AIDS in Southern Africa is the result of differing interpretations of the Bible. Southern Africa is an overwhelmingly Christian region, as none of nine countries comprising it have a Christian population lower than 70%. The well-established connection between sex and HIV leads many to believe that HIV is God’s way of punishing sin. It is for this reason that workshops with religious leaders and education through the Church is a key way of fighting stigma against HIV in Sub-Saharan Africa (UNAIDS).
The second problem that arises when combating HIV is the adherence issue. HIV patients must take their antiviral drugs daily for the entirety of their lives for the treatment to be effective. Yet, many patients feel fine after a few weeks and believing they’re cured, they stop taking their needed medicine. This cycle is difficult to fight and requires consistent education and intervention from healthcare workers and other community members. Ultimately, HIV remains a disease that is too often silenced, shamed, and punished. It is for this reason that humanizing and learning about the condition is important, even if its effects are no longer as overwhelming as they once were in developed countries.
*CD4 is a protein and a low CD4 count is an indicator of AIDS.
Allinder, Sara M., and Janet Fleischman. “The World’s Largest HIV Epidemic in Crisis: HIV in South Africa.” Csis.org, Apr. 2019, http://www.csis.org/analysis/worlds-largest-hiv-epidemic-crisis-hiv-south-africa. Accessed 28 Feb. 2022.
Belle, JA, et al. “Attitude of Lesotho Health Care Workers towards HIV/AIDS and Impact of HIV/AIDS on the Population Structure.” African Health Sciences, vol. 13, no. 4, 3 Feb. 2014, p. 1117, 10.4314/ahs.v13i4.36. Accessed 28 Feb. 2022.
Editorial Team. “The History of AIDS in Africa.” Black History Month 2022, 25 Aug. 2015, http://www.blackhistorymonth.org.uk/article/section/real-stories/the-history-of-aids-in-africa/#:~:text=Sub%20Saharan%20Africa%20was%20the. Accessed 28 Feb. 2022.
Gallagher, James. “Aids: Origin of Pandemic ‘Was 1920s Kinshasa.’” BBC News, 2 Oct. 2014, http://www.bbc.com/news/health-29442642. Accessed 28 Feb. 2022.
Highleyman, L. “U.S. AIDS Death Rate Decreases by Nearly Half.” BETA: Bulletin of Experimental Treatments for AIDS: A Publication of the San Francisco AIDS Foundation, vol. 12, no. 1, 1 Jan. 1999, p. 5, pubmed.ncbi.nlm.nih.gov/11367240/#:~:text=AIDS%3A%20The%20Centers%20for%20Disease. Accessed 28 Feb. 2022.
The Global Fund. “Eswatini Meets Global 95-95-95 HIV Target.” Www.theglobalfund.org, 14 Sept. 2021, http://www.theglobalfund.org/en/blog/2020-09-14-eswatini-meets-global-95-95-95-hiv-target/#:~:text=Eswatini%2C%20a%20tiny%20country%20of. Accessed 28 Feb. 2022.
UNAIDS. A Report of a Theological Workshop Focusing on HIV-and AIDS-Related Stigma Supported by UNAIDS Windhoek, Namibia. 2005.
UNICEF. “HIV.” Www.unicef.org, 2018, http://www.unicef.org/botswana/hiv#:~:text=With%20an%20adult%20HIV%20prevalence. Accessed 28 Feb. 2022.