December 04, 2003

AIDS: Lessons for China from the World

My ability to read books when not on holidays is limited. Not because I read slowly nor because I do not like books. The dangerously high pile on my bedside table attests to the backlog of good books I want to read. But every Friday I receive the Economist magazine. Despite the title it is actually a current affairs news magazine, with articles covering events right across the world. They are openly opinionated, balancing facts with their liberal view of the world. There are always thought provoking items on various issues and events. If you find it hard to keep up with what's going on in the world, the Economist is a good palce to start. [End of plug; please send free subscription my way thanks.]

So on the bus home last night I read this week's article in the Science section on the state of the war against AIDS. I strongly encourage you to take 5 minutes to read it all, but here's some excerpts:

In its (UNAIDS) annual report on the epidemic, it estimates that a shocking 40m people are infected with HIV—2.5m of them are children. In 2003 alone, 5m were newly infected. Although the total number of people living with the virus seems to have grown more slowly in recent years, Peter Piot, head of UNAIDS, cautions against complacency. This apparent levelling off of the figures is largely the result of a steady rise in the AIDS death rate, from just over 2m in 1999 to 3m this year.

Despite such dreadful figures, Stephen Lewis, Kofi Annan’s special envoy for AIDS in Africa, says he is more optimistic than he has been for years. Firstly, political leaders, especially in sub-Saharan Africa, are no longer as silent or apathetic as they were in the 1990s. The second reason for optimism is that there is now more money available. UNAIDS says about $4.7 billion was spent on AIDS in low and middle-income countries this year, compared with just $200m in 1996. Since 2000, the cost of the drug cocktail needed to treat AIDS has fallen from $10,000 per patient annually to $300. This is largely thanks to competition from generic medicines...

This is all the good news. Then there's the bad news.
If the world is, at last, trying to muster an adequate medical response to AIDS in poor places, the same cannot be said about the vast socio-economic implications of the epidemic. It is hard to fathom, let alone fix, a situation in which most teachers and farmers are expected to die of AIDS, as in Botswana.

Arguably the epidemic’s cruellest legacy, though, is the orphans it is leaving behind. Around 11m children in sub-Saharan Africa have lost at least one parent to AIDS. The situation is about to get a lot worse, according to a report published last week by UNICEF. By 2010, there could be as many as 20m AIDS orphans in sub-Saharan Africa. Even if widespread anti-retroviral treatment takes hold, some think it will, at best, spare only 1.8m children from such a loss.

Orphans tend to be poorer than non-orphans, and to face a higher risk of malnutrition, stunting and death—even if they are free of HIV themselves. They also endure the psychological trauma of watching parents waste away, and often have to watch as their subsequent care-givers suffer the same fate. Many are also separated from their siblings.

Their future prospects, too, are grim. Orphans are less likely to attend school—partly because they cannot afford the fees but also because step-parents tend to educate their own children first. Many drift on to the streets, as the teeming slums of Nairobi and Lusaka attest. Many go to work. In Zambia, for example, more than two-thirds of the child prostitutes are AIDS orphans. As a result, these children are themselves at high risk of HIV infection.

While there is welcome progress across many fronts in Africa, much more needs to be done. The same is true of other regions where the disease is now taking hold—among them eastern Europe, India and China. Indeed, the lessons learned and mistakes made in Africa should prove useful elsewhere. But it will take years before the impact of these new, large-scale initiatives are felt. AIDS itself is hard enough to beat; its broader social effects defy any quick fix.

That was my emphasis on China. Richard continually covers the ongoing problem of AIDS in China far better than anyone else. Try this, or this, or this, or this for some recent examples. Until recently China denied it had an AIDS problem. It would be an indescribable tragedy if the lessons of sub-Saharan Africa's experience with this disease were ignored by China. Because AIDS tends to affect those on the fringes of "acceptable" society first, such as IV drug users, gays or sex workers, it tends to be viewed as a shameful disease, a come-uppance for those who engage in "vice". Yet Africa has shown how this disease affects whole populations, not just subgroups. Armies of orphans, wrenching social and economic impacts and whole generations wiped out. It is avoidable in China if the right steps are taken now.

I hope to God China starts taking those steps.

Posted by Simon at December 4, 2003 09:48 AM | TrackBack
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