Issue 59 / July - September 2007
A Cry of Desperation Are We Listening?
Ayse K. Coskun
27, black, living in South Africa, and HIV positive; this is no longer a shocking matter. It has become like getting flu, only deadlier. I never thought Iâ€™d make it. But one thing that kept me going was the thought of leaving my 10 year old little girl behind. I just couldnâ€™t bear that thought...â€ť Vie
HIV/AIDS is one of the most devastating health issues in modern history. Since the first case was reported in 1981, over 25 million people have died of HIV/AIDSrelated causes. Despite a better understanding of the disease, extensive knowledge about virus-human interaction, improved preventive measures, and medical treatment options, most experts agree that the pandemic is still in its early stages and rapidly spreading. According to the World Health Organization, in 2006 4.3 million people became infected with HIV and a total of 2.9 million people died of HIV/AIDSrelated causes. As of 2007, over 40 million people are living with HIV/ AIDS around the world and nearly half of them are females between the ages of 15 and 24.
With a vaccine still perhaps decades away, the best hope for impeding the spread of this deadly disease lies in effective prevention, early diagnosis, and successful treatment. For more than two decades, thousands of researchers from the most prestigious institutions around the globe have been struggling to discover more effective screening, diagnosis, and treatment options against HIV/AIDS, but a great deal has yet to be accomplished. At the moment, the high cost of the current medical treatment options and limited accessibility to HIV testing worldwide remain as additional obstacles to be overcome. Below is a table showing the spread of HIV/AIDS worldwide, based on the best available information provided by WHO in 2006. Additionally, the map below represents the regional distribution of adult HIV/AIDS cases by region based on UNIAIDS 2006 Report on the global AIDS epidemic.
What is HIV/ AIDS?
Healthy human bodies have a wellprogrammed defense mechanism (the immune system) that fights infections and helps prevent the development of cancer cells. Human immunodeficiency virus (HIV) primarily targets vital elements of the immune system, such as helper-T cells, macrophages, and dendritic cells. Due to the damage and destruction of these cells, the human body loses its ability to fight against infections and cancerous developments. This makes the body more susceptible to certain types of cancers, such as Kaposi sarcoma, and to opportunistic infections that would normally be easily defeated, such as pneumonia (Pneumocystis carinii) and Cryptococcal Meningitis. These infections might result in severe damage or the death of the patients. Therefore, it is not the Human Immunodeficiency Virus that causes death in HIV(+) individuals, but opportunistic infections or cancerous developments that a weakened immune system cannot repel. Hence, the later stages of HIV infection are called Acquired Immunodeficiency Syndrome (AIDS).
In spite of many obstacles, in industrial countries there has been a remarkable improvement in the medical care of HIV/AIDS individuals as a result of testing for HIV on a regular basis, particularly among high risk groups. This facilitates early diagnosis and therefore an early start in medical treatment, which allows HIV(+) individuals to live for decades after diagnosis. However, worldwide, particularly in developing countries, 90% of those carrying HIV have not been tested or do not have access to adequate treatment for the disease. Furthermore, every year a considerable number of HIV(+) individuals in developing countries die without even knowing what HIV is and leave thousands of orphans behind who do not have any idea what took their parents away. The number of people living at critical poverty levels in some of these hardest-hit regions, such as sub- Saharan Africa, has reached over 43 percent in recent years. Women encompass 80 percent of those who are living on less than a dollar a day. For people who live in such abject poverty, neither treatment for an HIV+ /AIDS individual (which normally costs around $25,000 annually) nor routine HIV screening seems realistic. On the other hand, even though testing and medical treatment options are available in developed countries, the economic burden on the health care system is becoming greater with every passing day.
HIV and children
As of 2007, over 2.3 million children are suffering from HIV/AIDS worldwide. A small percentage of these children were exposed to the HIV in medical settings, due to unscreened blood transfusions or reused or insufficiently sterilized equipment. Pediatric HIV outbreaks in Romania in 1989 and in Libya in 1998 are two devastating examples of the consequences of negligent or insufficient precautions taken by medical personnel in hospitals. Currently, health care professionals are required to take strict precautions when cleaning and sterilizing medical equipment, while blood banks are monitored closely to ensure the careful screening of blood. These precautions seem to have led to a significant reduction in the number of HIV infections which are acquired in hospital settings. However, motherto- child transmission still constitutes 90% of pediatric HIV cases. An HIV (+) mother has about a 35% risk of transmitting the virus to her child during her pregnancy, child birth, or nursing. This risk can be reduced by administering AZT (an antiretroviral drug) to the mother during the last trimester of pregnancy, delivering the child by C-section, giving one dose of prophylactic antiretroviral therapy to the baby after birth, and by avoiding breast-feeding the infant. As a result of widespread screening and the use of prophylaxis for mother-to-child transmission, the rapid spread of HIV among the pediatric population in industrial countries is relatively under control.
Sadly, not all nations have benefited uniformly from the recent advances in our knowledge about the prevention of transmission. Mothers and infants in developing countries face a different scenario than those in the â€śmodern world.â€ť In places like sub-Saharan Africa, where the majority of HIV/AIDS cases are due to mother-to-child transmission, the number of new infections is rapidly increasing; it seems that ensuring the abovementioned precautions are in place is extremely difficult due to several limitations. These limitations should be discussed in another paper, however to give a brief idea to the reader, one of these instances can be examined. It is a fact that if an HIV(+) mother avoids breastfeeding her newborn baby the risk of her infecting the child with HIV is dramatically reduced. Although this sounds like a wonderful way to combat HIV infection in infants, it poses many problems to mothers in sub-Saharan Africa. Every year, more than one million babies die in the first 28 days of their life in Sub- Saharan Africa. Most of these deaths are due to malnutrition and infections. In most situations breast-feeding is the only clean source of nutrition a mother can offer her child. It also provides natural immunization against most of the infectious agents to which a newborn can be exposed in the later days of his/her life. Babies who are not breastfed have almost no other alternative source of clean nutrients and stand little chance against infections. An HIV(+) mother in Sub-Saharan Africa has to face this dilemma every single time her baby cries from hunger: either take the risk of infecting your baby with HIV or let your child die of malnutrition or infections which kill approximately 3,000 African children every day.
Another issue concerning children in the hard-hit HIV regions is the loss of one or both parents or primary care-givers at a very early time of their life. So far in Africa, HIV/AIDS related deaths have left 14 million orphans. The United Nations estimates that the number of orphans will reach 25 million by the year 2010. Only in rare cases do these children have access to clean water, food, shelter, and education. Furthermore, the orphans who have been infected with HIV by their parents do not have access to adequate treatment options. The number of orphans is so high and resources are so limited that unfortunately most of these children fall through the cracks of society, succumbing to poverty, abuse and even death. Some of these orphans are relatively lucky and have healthy grandparents to care for them. It is not uncommon to find 75-80 year old grandparents who are already living under the critical poverty level taking care of three or four AIDS orphans, and wondering who will care for their grandchildren when they pass away.
Success against the HIV/AIDS epidemic cannot be accomplished only with scientific and medical means. Preventive education plays a key role in the battle against HIV/ AIDS. The first step in preventive HIV/AIDS education is to inform individuals about the disease and answer their questions, such as, â€śWhat causes AIDS?â€ť, â€śHow is HIV/AIDS spread?â€ť, â€śWhat are the preventive measures to be taken?â€ť If one is already infected with HIV then one must ask â€śWhat are the treatment options?â€ť
Preventive education for risk groups who are not aware of HIV/ AIDS and the consequences of the infection helps to decrease the overall number of new infections, particularly those in developing countries. However, another issue appears as education level increases: according to current studies, the number of people who continue risk-taking behavior is increasing in spite of the knowledge they have about HIV/ AIDS prevention and the consequences of the disease. This suggests overthat effective HIV/AIDS prevention should include not only education about the facts of the illness, but also education that focuses on teaching people to avoid behavior that puts them at high risk. It is also worth noting that the widespread dissemination of information by governmental organizations may not be effective on its own, and that different types of intervention may be necessary by groups with the potential to motivate people on a personal level. In other words, it is important to individually instill a sense of consequence and personal responsibility within those at risk, rather than broadly reminding them of the dangers that they face. As a result of recent thinking along these lines, various institutions, professional groups, and government organizations have realized the need for strong collaborative efforts and have aligned themselves in order to begin taking the steps necessary to effect this type of change.
Around the globe, government agencies have been initiating and sponsoring several efforts aimedat HIV-prevention. However, the complexity of the HIV epidemic and the involvement of many sociologic and behavioral factors require a shared commitment among government agencies and civil society organizations. For example, the Center for Disease Control (CDC) is the leading federal agency in HIV prevention in the United States. In their strategic plan for HIV prevention in 2005, the CDC admits that the HIV epidemic is not a matter that can be handled by only one agency, group, or organization. Therefore, for success in HIV prevention the CDC recognizes the need for other domestic partners, such as:
~ Other federal agencies;
~ State and local health and education departments;
~ HIV prevention community planning groups;
~ Community-based organizations;
~ Academic institutions;
~ The private sector;
~ Faith-based groups and
~ Foundations and nonprofit groups
(Centers for Disease Control and Prevention HIV Prevention Strategic Plan Through 2005)
In addition to domestic partnership, worldwide cross-cultural and cross-faith collaborations are establishing a strong global response to eradicate HIV/AIDS. People from all over the world should contribute, in whatever capacity and with whatever resources they can, to the solution; their involvement is critical. The World Health Organization, UNICEF, UNESCO, and similar organizations are doing their parts to bring multinational aid to the hardest hit regions. Additionally, many faith-based national and international organizations around the globe have started working in collaboration towards the eradication of HIV/AIDS. Among these faithbased efforts there are recent examples of interfaith partnerships. The Africa HIV/AIDS Faith Initiative, a successful example of this type of collaboration, has been active since 2001 in five African countries: The Ivory Coast, Kenya, Nigeria, Tanzania and Zimbabwe. One of their noticeable accomplishments is promoting interfaith dialogue in these countries where ethnic and religious variations often cause serious clashes. A report from The Global Health Council lays the power of Interfaith partnership before our eyes:
â€ś In Kenya, the Supreme Council of Kenya Muslims, the Anglican Church of Kenya and the Pentecostal Churches of Eastlands, a low socioeconomic community outside Nairobi, have teamed up to reach bishops, pastors, men, women, youth, children and people infected with HIV/AIDS through education and service initiatives. In Tanzania, the national staffs of the Episcopal, Christian and Muslim HIV/AIDS offices meet monthly to exchange ideas and plan together for the effective development, implementation and coordination of HIV education and service interventions.
But it is in Nigeria, with its welldocumented history of religious conflict and recent violence, where the partnering of Christians and Muslims is most remarkable. Observing the establishment of separate offices in each of the four other countries, Nigeriaâ€™s religious leadership said â€śit wonâ€™t work here,â€ť and charged The Balm In Gilead to set up the Interfaith HIV/AIDS Coalition of Nigeria. Christian and Muslim clerics going out on the street together can draw curious crowds, and â€śpeople will come into the office just to see us working together,â€ť said one reverend.
Nigerian faith institutions involved in this historical decision included the Episcopal Conference of Nigeria, Christian Association of Nigeria, the Christian Health Association of Nigeria and the Supreme Council of Islamic Affairs. This interfaith approach in Nigeria is being seen as a model that can be replicated by other countries. The Kenyan Muslim leaders have already requested that it be presented as a best practice model and replicated in other parts of the continent.â€ť http:// www.globalhealth.org/reports/ text.php3?id=194
We have witnessed many harsh discussions, questions and speculations about HIV/AIDS such as, â€śHow and where did HIV/AIDS start?â€ť, â€śWhose fault was that?â€ť, â€śWhy donâ€™t people simply stay away from risky behavior and put a stop to it?â€ť, â€śWhat are the roles of faith traditions, family values and public wisdom in terms of preventing and fighting against HIV/AIDS?â€ť, â€śIf I am not involved with certain risky behavioral elements am I safe? Are my children safe from HIV?â€ť, â€śIs contributing to the solution for HIV the same as trying to legitimize the life-style preferences which are the primary cause of the spread of HIV in the first place?â€ť
As a matter of fact, how this epidemic started, whose fault it was, why precautions were not taken on time does not matter that much anymore. What matters is that hundreds of people are dying, thousands of children have been orphaned, and millions of mothers are crying in desperation everyday. We do not have the luxury to sit back in our comfortable seats and be the judge who decides who is right and who is wrong in this drama. We are all humanâ€¦ we are citizens of the earthâ€¦ we breath the same air, sleep under the same sky. When we cut ourselves, our blood runs red, our tears are salty. Pain is painâ€¦ a cry is a cryâ€¦ desperation is desperationâ€¦No matter where we go, what language we speak, or how we live our livesâ€¦ We are obliged to put the differences to one side and to become a part of the solutionâ€¦to think about itâ€¦ to talk about itâ€¦ to do something about itâ€¦ or at least with a sore heart cry and pray for our HUMAN sisters and brothers who are suffering from HIV/AIDSâ€¦ who might not be able to do much for themselves.
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