| The HIV/AIDS epidemic represents a huge and spreading medical burden and a moral crisis. It shows no signs of abating and will remain highly visible to most of us for our lifetimes. GLOBAL EPIDEMIOLOGICAL OVERVIEW
UNAIDS gives a birds' eye view of the world HIV/AIDS situation up to 2001 and this summary is gleaned from the UNAIDS Barcelona report.1
Compared with the catastrophic deaths from flu (25-40 million), smallpox (15 million) and plague (25 million), AIDS is becoming the most devastating disease humankind has ever faced. Worldwide it is the fourth-biggest killer and in sub-Saharan Africa it is the leading cause of death. Since the epidemic began, more than 60 million people have been infected. At the end of 2001, about 40 million people globally were living with HIV, about one-third of whom were aged 15&endash;24. In many parts of the developing world, the majority of new infections occur in young adults, with young women especially vulnerable.
Central Asia - especially Russia - is growing the fastest, with high levels of STDs, HIV and Tuberculosis. Asia and the Pacific has 7 million living with HIV/AIDS with pockets of high prevalence such as Thailand, Cambodia and Myanmar. In Cambodia, 2.3% pregnant women had HIV in 2000.
In Sub-Saharan Africa there were 3.4 million new infections in 2001 and 28 million are now living with the disease. 30% of pregnant Botswana women carry the virus. At lease 5 African countries have an overall 5% rate of infection. Life expectancy is falling steeply &endash; in four countries Botswana, Malawi, Mozambique and Swaziland it is less than 40 years, down from 62 years. 12.1 million African children have lost their mother or both parents and the number is forecast to more than double over the next decade. The orphans themselves are especially vulnerable to the epidemic and to the impoverishment and precariousness it brings. In Zimbabwe, 70% of child deaths before 5 years are due to AIDS.
In North Africa and the Middle East prevalence is slowly but widely rising.
A resurgence also threatens high-income countries such as North America, parts of Europe and Australia, with 75,000 new infections in 2001. So called "unsafe sex", outbreaks of sexually transmitted infections, and widespread injecting drug use are propelling these epidemics.
The relatively low national HIV prevalence rates in South and Central America contrast strongly with the 2% prevalence in the Caribbean. Life expectancy in Haiti has dropped to 53 years from 59. In the Bahamas, 60% of deaths among children under the age of five are due to AIDS. Economic effects
By 2020, badly affected countries of sub-Saharan Africa will lose more than 20% of GDP. Companies face higher costs in training, insurance, benefits, absenteeism and illness. 53% of all illnesses among staff in 15 firms in Ethiopia over five years were AIDS-related. According to a new UNFAO report, 7 million farm workers have died from AIDS-related causes since 1985 and 16 million more are expected to die in the next 20 years, precipitating a decline in agricultural output with widespread food shortages and hunger. In hard-hit areas, households cope by cutting their food consumption and other basic expenditures, and tend to sell assets in order to cover the costs of health care and funerals.
The epidemic also creates loss of much needed money to treat the ill. In Rwanda, households with a HIV/AIDS patient spend 20 times more on health care annually than households without an AIDS patient. Only a third of those households can manage to meet these extra costs. A quarter of households in Botswana, where adult HIV prevalence is over 35%, can expect to lose an income earner within the next 10 years while each income earner can expect to take on four more dependents as a result of HIV/AIDS.
Education and along with it the future is affected. Children are removed from school to take care of ill family members and to regain lost income, especially women and especially the young and the elderly. Families often remove girls from school to care for sick relatives or assume other family responsibilities, jeopardizing the girls' education and future prospects. In Swaziland, school enrolment is reported to have fallen by 36% due to AIDS, with girls most affected. "SAFE SEX"
While the Church has consistently condemned condoms for both contraception and also for AIDS control, world use of condoms has undergone a fading reception over the years.
It was promoted as so-called "safe sex" in the 1980s in controlling AIDS transmission and was considered superior to promoting abstinence, which was felt to be unrealistic. Studies under laboratory like conditions assured prospective clients of high effectiveness but only if used under these conditions. Cold reality both in lower effectiveness and also on behavioural factors modified the tag to "safer sex" during the last decade and in Apr 1997 abstinence or sexual contact only with a partner known to be uninfected was recommended by the CDC Atlanta as the best protection against HIV.
Its star has fallen further since then. On 27 Jun 2002, Zenit drew attention to the report "HIV/AIDS, Awareness and Behaviour," 2 published by the U.N. Department of Economic and Social Affairs Population Division on 23 Jun 2002 which asserted that much "effort has been spent on promoting the prophylactic use of condoms as part of AIDS prevention. However, over the years, the condom has not become more popular among couples."
The study which examined HIV/AIDS-related awareness and behaviour in 39 developing countries, 24 from Africa, 7 from Asia, and 8 from Latin America and the Caribbean showed that despite widespread knowledge of AIDS and easy access to condoms, fewer than 8% of women in all countries surveyed reported that they had changed their behaviour by using condoms. Among married women, the percentages were particularly low. The only significant behavioural change has been towards more monogamous relationships.
Accompanying this report, the UN has made some new appointments. Under the direction of former head Nafis Sadik, UNFPA was the world's largest supplier of condoms and UNFPA's AIDS-prevention program focused on the promotion of condom use. On 24 May 2002, Sadik was appointed by Kofi Annan as his special envoy for HIV/AIDS in Asia but it is unclear how Sadik will integrate the conclusions of the UN Population Division report into her new initiative.
It is hardly surprising that condoms cannot control risky sexual behaviour. They're the cause of it. Like other contraceptives, they represent and reinforce the inability or unwillingness to internalise a code of sexual restraint - especially in the generation of the last 50 years. Even each HIV case that may have been prevented by a condom would be accompanied by the further relaxation of this code in the user and in his milieu.
Even in the face of criticism, the Church has been consistent in urging abstinence both in family planning and in HIV transmission control and has insisted on keeping one's values in the face of a self destructive world culture that extols recreational and alternative sex and was hardly surprised when a group of parents sexually molested their own children and sent pornographic pictures of them worldwide over the Internet.
Ultimately the choice we need to beware of is to seek short-term gains for eternal losses. For we believe that from the moment we are conceived, we are immortal. How we live now is how we will live forever. If this seems fatalistic, we have only to remember how Jesus himself lived and died and Socrates too 4 centuries before him.
"To a man who preserves his integrity no real, long-term harm can ever come....Real personal catastrophe consists in corruption of the soul. That is why it does a person far, far less harm to suffer injustice than to commit it." Socrates (470-399 BC) |
| REFERENCES
1. The Report on the Global HIV/AIDS Epidemic, "The Barcelona Report" ; UNAIDS at Barcelona, XIV International Conference on AIDS, Barcelona, 7-12 July 2002
2. HIV/AIDS: awareness and behaviour, United Nations Department of Economic and Social Affairs, Population Division, ST/ESA/SER.A/209/ES. AIDS/43, DEV/2394, POP/831; 23 June 2002 |
