03 Apr 2004 |
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| An Assault to our shared humanity “The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them; that is the essence of inhumanity.” - George Bernard Shaw The Devil’s Disciple It is now impossible to view the AIDS pandemic solely from the vantage point of its health ramifications. Like a tornado wreaking havoc to everything in its path, AIDS has also torn the social, economic and political fabric of several societies to shreds.[i] In January, 2000, while speaking at the UN Security Council session, James Wolfensohn, President of the World Bank, stated: “Many of us used to think of AIDS as a health issue. We were wrong…nothing we have seen is a greater challenge to the peace and stability of African societies (and much of the world) than the epidemic of AIDS...we face a major development crisis, and more than that, a security crisis”[ii]. Four years and more than eight million deaths later, an equally passionate and resolute Kofi Annan, the UN Secretary General, spoke to the BBC and described AIDS as “a real weapon of mass destruction” and bemoaned the world’s relative inaction to combat this pandemic as “callousness that one would not have expected in the 21st century”…for which history would judge us all “harshly, very harshly”.[iii] It might appear that Annan and Wolfensohn were echoing an ancient declaration of Bantu philosophers: “Umuntu ngumuntu ngabantu - a human is a human because of other humans”. This proclamation “represents an African communal aspiration which teaches us that our humanity is contingent on the humanity of our fellows…and that no person or group can be human alone. We rise above the animal together or not at all”[iv] Our collective record on AIDS, clearly suggests that we have not yet tamed this ‘animal’, and should compel us to hire many more ‘animal trainers’ to rescue the world’s most vulnerable groups from the clutches of this infectious holocaust. The Modern Day Plague “When was such a disaster ever seen? Even heard? Houses were emptied, cities abandoned, country sides untilled, fields heaped with corpses, and a vast dreadful silence settled over all the world”. The Italian writer Francesco Petrarch wrote these immortal words in the 14th century about the Black Death or Bubonic Plague, an epidemic that eventually wiped out one fourth of Europe’s population. He could very well have been writing about the modern day plague AIDS, a pandemic that has already claimed 21 million lives around the world and promises to decimate scores of millions more. Today, there are over 42 million people worldwide infected with HIV, the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Three quarters of that number or 31.5 million people live on the African continent. Last year, there were 5 million new cases of HIV infection across the globe. Of the 3.1 million people that died of this scourge in the past 12 months, 2 million were African. In several Southern African countries such as Botswana, Lesotho, Swaziland, South Africa and Zimbabwe, up to a third of the population bears the burden of HIV infection.[v] What this means is that in the absence of safer sexual interventions, a sexually active young adult growing up in this part of the world where the life expectancy is now only about 44 years, has close to 80 % chance of dying from this dreaded disease. A recent UN policy document provides this spine chilling snap shot of the magnitude of the devastation: “22,000 people in the mainland SADC (Southern African Development Community) region are dying every week from AIDS”.[vi] The tentacles of this deadly disease extend beyond the African continent. Peter Piot, Director of UNAIDS (The joint UN program on HIV/AIDS) informs us that “AIDS is traveling along social fault lines and exploiting weakness, hurting both lives and economies” all over the world.[vii] The countries of Central Europe and the former “Communist block” such as Romania stand at the precipice of a looming AIDS catastrophe. In this region, the number of HIV infections has increased by nearly 25% over the past 12 months![viii] Some of the most severely affected countries include the Baltic States of Estonia, Latvia and Lithuania as well as the Ukraine. In the Russian Federation, estimates currently place between 600,000 to 1.5 million people infected by this virulent pathogen. More recent epidemics have been reported in Kyrgyzstan and Uzbekistan, while the dissemination of HIV continues unabated in Moldova and Kazakhstan.[ix] Asia has seen HIV cases leap by 10%. There, the two most populous countries China and India, now account for nearly 5 million of the world total. Unfortunately, several experts believe that the statistics out of ‘closed societies’ such as North Korea are a gross underestimation of the true picture of HIV prevalence[x] in this region.[xi] In Latin America and the Caribbean, there are now over 2 million people whose lives have been forever altered by HIV. The developed world has about 1.6 million HIV cases. In the wealthiest of nations, the USA, 1 in 250 people (or just about 1 million individuals) bear this yoke, although only half of this number is aware of their condition![xii] Save the Children The face of AIDS/HIV belongs to our youth, women and girls – three groups that bear the burden of the pandemic. Adolescents and young adults 15-24 in age account for half of the 5 million new cases of HIV infection worldwide, as well as a third of the world’s total population of HIV positive individuals - 11.8 million people. To place this in frightening, vivid context: 7000 youth a day or one every 14 seconds become infected with HIV around the world![xiii] Orphans: ‘The Cruel Legacy of AIDS’ Contributing to this almost cataclysmic picture is the exploding population of orphans left behind as casualties of AIDS deadly toll. When Charles Dickens crafted his perennial classic Oliver Twist, a harrowing social commentary about an English orphan in 19th century England, he could not have possibly imagined that a disease called AIDS would emerge, and make the difficulties depicted in his astounding novel seem like “a walk in the park”. Today, there are about 13.4 million children worldwide who have lost one or both parents to the AIDS pandemic. This number is expected to nearly double to 25 million by 2010.[xiv] Asia with 65 million orphans, 2 million from AIDS, has the greatest number of orphans. Latin America and the Caribbean are home to about half a million AIDS orphans. Two countries alone in this region - Haiti and Brazil – possess more than 60% of this total. Proportionately, however, Africa faces the brunt of this crisis. The continent has 34 million orphans - a number that is expected to increase to 42 million by 2010. AIDS orphans account for a third of this total or 11 million children. Over the next 7 years, in the absence of much needed assistance, we may watch helplessly as 12 % of all the children on that continent – 20 million – join this statistic.[xv] Three of Sub Saharan Africa’s most populous nations - Nigeria, Ethiopia and the Democratic Republic of Congo - will supply the greatest number of children to this pool. However, Zimbabwe, Lesotho, Swaziland and Botswana, are on a trajectory to witness an almost insurmountable exponential increase in the population of AIDS orphans over the next decade, as the third of their populations already infected with HIV, make the transition to AIDS, and sadly, death.[xvi] Orphans are often cared for by extended family members such as grandparents ill prepared physically, financially and socially for this new challenge. As a consequence, these children face grim prospects. They are often stigmatized by society, live in poverty, are more likely to be malnourished, attend school less frequently than their peers, and have a greater incidence of psychological illnesses such as Post traumatic Stress Disorder, Major Depression, Anxiety and Behavioral problems.[xvii] All this portends a bleak future for these ‘parents and leaders of tomorrow’. The Executive Director of UNICEF, Carol Bellamy believes that “we must respond to the devastating statistics by addressing the needs and rights of both orphans and vulnerable children whose parents are still living”. One novel strategy would be to shore up the treasuries of several of the more than 75 programs, NGOs and organizations in 22 countries such as Save the Children that work with children affected by AIDS. The Exploitation of Children and the spread of HIV Symbolism is employed to paint a brilliant picture of the transformation of mankind -represented by children - from innocence and civilization to anarchy and savagery in an environment devoid of the rule of law in William Golding’s Lord of the Flies. The conflicts in Sierra Leone and Liberia may very well be ‘life imitating art’. There, international human rights groups detailed atrocities such as rape, body mutilation, and torture. New reports now indicate that a number of the most violent crimes were committed by child soldiers. These children, victims themselves of broken down societies, are now at the center of an upsurge of HIV cases being reported in war ravaged countries as diverse as Angola, Sierra Leone and Cote D’Ivoire.[xviii] In recent years, insidious, criminal and potentially implosive practices such as Child trafficking and prostitution have gradually been mixed into this already murky, grim, pediatric milieu. Over a million children, many of them AIDS orphans, are trafficked each year and exploited as slave laborers, sex slaves and soldiers across the planet. The UN estimates this racket generates $7-10 billion annually for the traffickers. ‘This practice is endemic in certain parts of Southeast Asia such as Cambodia, Burma, Vietnam and Thailand where young women and girls are trafficked for the sex industry’.[xix] The countries of the former ‘Iron curtain’ such as Romania are particularly vulnerable. After a quarter century under the despot Ceausescu, this impoverished nation has been overwhelmed by its population of Pediatric AIDS patients and orphans. Some estimates place the number of orphans and street children as high as 200,000. These children have progressively become prey to an international roaster of pedophiles and pimps. Child Rights Advocates warn that child sex peddling and trafficking will destroy the social and political framework of several societies and fuel the HIV pandemic with catastrophic results![xx] A Gender under Siege: the assault of AIDS on Girls and Women There’s been a death in the opposite house, as lately as to-day. I know it by the numb look, such houses have always……..Death is like the insect menacing the tree, competent to kill it, but decoyed may be…. - Emily Dickinson Women now comprise 50% of those infected with HIV across the globe. On the African continent that figure is 58%. Women and girls under the age of 24 now make up nearly two thirds of those living with AIDS worldwide.[xxi] In the United States, women of color account for the majority of new AIDS cases. African American women and Latinas comprise 31% of US female population, yet they represent 77% of AIDS cases in women. As of December 2000, AIDS had become the leading cause of death for African American women in the 25-44 year bracket![xxii] Most of these infections occur during unprotected heterosexual intercourse, a practice that bears the risk of sexually transmitted Infections (STIs) such as Gonorrhea, Chlamydia, Herpes, Syphilis as well as Hepatitis B and C. These infections in turn, can dramatically augment the probability of HIV transmission. “Biologically, the risk of HIV infection during unprotected sex is 2-4 times higher for women than men. Young women and girls are even more vulnerable because their reproductive tracts are still maturing and tears in the tissue allow easy access to infection”[xxiii] Increased exposure to HIV amongst women and girls could also mean amplified numbers of HIV positive pregnancies and an escalating risk of pediatric AIDS cases through vertical transmission (mother to child) or during breast feeding. This is already the case in many parts of Africa. Geeta Gupta, president of the International Center for Research on Women, believes that women are limited in their ability to control these infections because of their low social status in many societies and the power men yield over their sexuality.[xxiv] She explains: “In many countries the power imbalance in heterosexual interactions leads to a culture of silence that surrounds women’s sexuality. This restricts women’s access to information about their bodies and about sex, which in turn contributes to their inability to protect themselves against HIV infection.”[xxv] It is little wonder, therefore, that marriage does not always protect women from these risks. ‘In Pune, India, a study in an STI clinic found that 25% of the 4000 women attending the clinic were infected with an STI and 14% were HIV positive. 91% of these women had only one partner - their husbands!’[xxvi] Studies out of Kisumu, Kenya and Ndola, Zambia and released by UNICEF, indicate that ‘teenage brides 15-19 in age in these African countries are becoming infected with HIV at higher rates than sexually active unmarried girls of similar ages. The studies found that HIV rates in the husbands, who were frequently much older than their brides, were higher than in the boyfriends of sexually active teenage girls’. Several studies in East Africa and amongst sex industry workers in Thailand have shown the precipitous drop in the rate of STIs with enhanced education of women.[xxvii] The race to halt the deadly march of AIDS across the globe could very well lie, in part, in addressing one of its core causes – ‘gender inequality’.[xxviii] Empowering our women and girls with education and the means to protect themselves from HIV – the choice of sexual abstinence, female condoms, male condoms, microbicides, routine STI check ups etc is particularly salient. Other important strategies that involve the media in this battle, as well as the funding of local women’s groups and experienced NGOs could prove not only novel but timely. This multi-pronged effort may turn out to be a key ingredient in saving the species from this infectious nightmare. Worrisome Trends The Next Wave of AIDS – Nigeria, Ethiopia, Russia, China and India We are in the midst of an anticipated decade long increase in the number of HIV cases worldwide. Five of the world’s most populous nations - Nigeria, Ethiopia, Russia, India and China are expected to fuel this explosion. In these countries, HIV positive cases will more than double from 14-23 million combined currently, to an estimated 50-75 million by 2010. This will eclipse the 30-35 million HIV infected individuals living in Southern and Central Africa, an area considered the epicenter of the pandemic![xxix] By decade’s end, China will house between 10-15 million HIV positive individuals, Russia 5 to 8 million; Nigeria 10-15 million and Ethiopia 7-10 million people infected with the deadly virus. India will possibly be home to 20-25 million HIV positive persons by 2010, making it the highest projected increase of any country![xxx] In almost all the countries, a number of factors will fuel these projected increases. Risky sexual behavior, poor public services, complacency, misinformation and the wall of silence among the leadership surrounding AIDS, ineffectual or non-existent government policies, limited resources, and uncertain, often unstable political and social infrastructures, are among the factors that will help to drive the infection rates skyward. COUNTRY PROFILE - Nigeria: “A disaster waiting to happen” With a population of about 130 million inhabitants, Nigeria is Africa's most populous country. One in seven Africans is a Nigerian as is one in ten blacks on the planet. ‘It’s total area of 923,768 sq. km, makes it is slightly larger than twice the size of California.’[xxxi] ‘Half of the country identifies itself as Muslim, 40% as Christian. Animists and those with other beliefs comprise 10% of the population. Nigeria is made up of more than 250 ethnic groups. The following are the most populous and politically influential: Hausa and Fulani 29%, Yoruba 21%, Igbo (Ibo) 18%, Ijaw 10%, Kanuri 4%, Ibibio 3.5%, and Tiv 2.5%.’[xxxii] Nigeria is the 9th largest oil producer in the world and the principal oil producer in sub-Saharan Africa. The Nigerian economy is heavily dependent on the oil sector, which accounts for around 80% of government revenues, 90-95% of export revenues, and over 90% of foreign exchange earnings.[xxxiii] The HIV epidemic threatens the social, political and economic vitality of Africa’s second largest economy and most densely populated country. The National Intelligence Council – an agency that advices the US government and the CIA – believes that “the disease is likely to negatively impact almost all sectors of Nigeria’s economy by 2010. AIDS will take a heavy economic toll by robbing the country of many key government, professional and business elites and by discouraging foreign investment, although the oil sector is unlikely to be hurt significantly”[xxxiv]. Current estimates place the spread of HIV in Nigeria at the rate of one person per minute! Prevalence of HIV[xxxv] infection in Nigeria stands at about 5.8%. This moderately low statistic (as compared to other African countries), which is expected to double in less than a decade, may hide the fact that Nigeria currently has over 4 million people living with HIV! ‘Heterosexual transmission of the HIV virus is the primary mode of spread in Nigeria and infections appear to be as numerous in the rural areas as in the cities.’[xxxvi] Like much of the developing world, the sexually active 15-24 year demographic appears to be the most vulnerable to HIV infection, with prevalence as high as 12% in some States.[xxxvii] Simmering under the radar screen and shielded by a cloak of denial, is the homosexual transmission of the virus particularly in certain metropolitan areas, same sex (male) boarding institutions, the prisons, and the military. ‘The Economic Commission for Africa (ECA) estimates that 15-20% of Nigerian soldiers live with HIV/AIDS’[xxxviii] which is 3 times the national average! Other studies indicate that “the HIV/AIDS epidemic in Nigeria is significantly ahead of that in India, China, and Russia – already advancing well beyond high risk groups and into the general population”[xxxix] In the next 10 years, it is predicted that Nigeria will have between 10 and 15 million individuals infected. Experts warn that if aggressive action is not taken to combat HIV, Nigeria will almost certainly take over from South Africa as the country with the most HIV cases on the African continent! What this means is that Nigeria will have more HIV cases than the combined total in Mozambique, Zimbabwe, Zambia, Botswana, Namibia, Lesotho, Swaziland, and Uganda today! HIV prevalence[xl] differs widely from region to region and from State to State in Nigeria. The North in general, has the lowest HIV prevalence in the entire country. At 0-2.5 %, Jigawa State has the lowest recorded HIV positive inhabitants in the nation. However, the North Central Zone in which the Federal Capital Territory of Abuja is situated has an HIV prevalence of about 7%. Garki, a suburb of Abuja, holds the dubious distinction as the home of the nation’s highest documented municipal prevalence for HIV, estimated at or above 10%.[xli] Benue State, where some estimates place the HIV prevalence in certain villages and towns as high as 20%, is believed to have the highest prevalence of HIV of all the states in the country. Akwa Ibom State also has an HIV prevalence that exceeds 10%. Equally disturbing is new data about HIV in the 6-10% prevalence range or higher out of Cross River, Plateau, Gombe, sections of Rivers State around Port Harcourt as well as parts of Lagos State. Lagos, the nation’s commercial capital with an abundance of Red light districts, has an HIV prevalence of 6.7%.[xlii] According to the USAID, HIV prevalence among sex workers in Lagos rose from 2% in 1988-89 to as much as 70% by 1995-96![xliii] Kaduna, Bauchi, Taraba, Kogi, Enugu, Ebonyi, Bayelsa, Edo, and Delta States have HIV prevalence in the 5 - 7.5% bracket. Imo, Abia, The Southwest and much of the extreme north have recorded HIV prevalence of about 2.5- 5% (mean of 4.2 %).[xliv] International Prostitution and the augmented threat of HIV/AIDS in Nigeria Since 1992, Italian authorities have compiled data on the upsurge of Nigerian women and girls who have been trafficked to that country for the purposes of prostitution.[xlv] Their documents have unraveled an elaborate scheme that has exploited these women and girls for sex, often with the blessings of their families: “Nigerian girls and women are contracted in the suburbs of cities such as Benin City, and towns and villages all over Edo, Lagos and Delta States in particular, and in the countryside throughout the South in general. Street prostitution of Nigerian women and girls is controlled by Nigerian ‘business men’ in conjunction with the Italian underground. There are 3 levels of organization in the trafficking of Nigerian women and girls: The first centers around the ‘Mama’ living in the country of origin; the second centers around the ‘Nigerian Mama’ in Italy; and the third, the ‘messengers’, the persons (usually men) transferring the money from Italy to Nigeria. Madams act as ‘go-betweens’ for the girls and women and the traffickers. Money is sent to the madam to pay the debt to the traffickers and to the girls’ families.”[xlvi] By 1996, Nigerian sex workers had become the largest group of migrant women working as street prostitutes.[xlvii] A confirmation of this fact was brought vividly to light in 2000, when 3000 Nigerian prostitutes were reportedly threatened by Italian authorities with deportation for ‘sex crimes’, a reproach that was buttressed by the arrival of plane loads of Nigerian daughters, sisters and mothers from Italy at Nigerian airports. Despite campaigns by Nigerian authorities, international exploitation of Nigerian sex workers has spread unabated. In France and Spain in 2003, authorities in those countries smashed elaborate prostitution rings with bases in Nigerian and Morocco, which supplied a steady stream of Nigerian girls and women for prostitution throughout the European Union.[xlviii] Public health experts throughout the world have for years been concerned about the devastating social, political and health ramifications of international sex trafficking on Nigeria and its young women. A Nigerian physician based at Yale University Medical Center, vividly describes what this development portends for Nigeria: “Nigeria already has 1 million female sex workers…that is 1 for every 60 men…..Abuja alone has over 15,000…. Increased prostitution of all kinds will mean increased cases of STIs and HIV, because we are dealing with a clientele where over 60% refuse to have sex with condoms. Intermingled in all of this are gender inequality and exploitation issues, the breakdown of family values, erosion of human dignity… For the HIV/AIDS projections: ‘think of it as throwing dynamite into a Bonfire’.....”[xlix] Several other factors have contributed to the rapid spread of HIV infection in Nigeria. Some of these include “high prevalence of untreated sexually transmitted infections (STIs), low condom use, poverty, illiteracy, and the dismal quality of the health system. Some others include lack of effective leadership and/or political complacency, gender inequality, stigmatization and denial of HIV risk among vulnerable groups”.[l] In addition, “only 60% of Nigerians have even heard of the disease (AIDS)”[li].Nigeria also has one of the worst blood transfusion safety records in the world! Dr Chinua Akukwe’s expert analysis on this subject points out that “Nigeria has one of the highest unsafe blood transfusion rates in the world, at 14%....In some hospitals in Nigeria, 60% of blood transfusions may not undergo internationally acceptable screenings!”.[lii] Strategies to combat the epidemic in Nigeria will involve some if not all of the following: strong political leadership, effective policy and advocacy; effective, concerted media campaigns; well organized HIV surveillance and creation of a reliable data base for HIV/AIDS programming; improved STI intervention and treatment; Sex worker health and education programs; National condom program; empowerment of women and women’s groups; promoting high risk behavior change; improving the health care system; stimulating HIV/AIDS research; local production of Anti retroviral medication; increased local and international funding for AIDS prevention and treatment; as well as safer sex prevention and education programs. (Also see What Can be Done for further discussion of Solution strategies) The Triple Threat: AIDS, TB and Malaria By progressively destroying the immune system, HIV weakens the body’s ability to fight disease, rendering it prone to ‘opportunistic infections’ - infections which are rarely seen in those with a normal immune system but pose a deadly threat to AIDS patients. One of these infections is Tuberculosis, an ancient infection that is ‘enjoying a resurgence’ as the leading cause of death of AIDS patients worldwide. There are over 8 million new cases of TB each year, a disease that claims over 2 million lives annually. Most of these infections occur in 23 developing countries. Recent studies indicate that TB infection may accelerate the progression of HIV to AIDS. In addition, HIV infected people are 30 times more likely to develop active TB! [liii] Worldwide, one third of AIDS patients are infected with Tuberculosis (TB), a figure that approaches 70% in certain parts of Sub-Saharan Africa.[liv] In Asia, home to over three-fifths of the world’s TB cases, health experts warn of a looming concurrent HIV and TB epidemic. There, TB accounts for about 40% of the total mortality from AIDS. In the Russian Federation and former Soviet States, the twin epidemics of HIV and TB have taken on a frightening, synergistic dimension, and may be partly driven by a growing problem of multi-drug resistant TB. These ‘super bugs’ created by years of inappropriate and inadequate medical treatment of TB, have been repeatedly isolated in the prisons in this part of the world. Infectious Disease experts fear that this development may pose “a microbial challenge on a scale that the world has never seen”[lv]. ‘Malaria is the most common life threatening infection in the world. It claims a child’s life every 30 seconds, most under the age of 5, and causes more than 500 million infections and 1 million deaths annually.’[lvi] The debilitated immune systems of HIV/AIDS patients render them particularly susceptible to this parasitic infection. In a tragic twist of fate, 90 % of Malaria deaths also occur in Sub-Saharan Africa, the same region that has become the epicenter of the HIV pandemic. Fighting HIV/AIDS will, therefore, require a concomitant fight against TB and Malaria. Important strategies to combat this triple threat should as always, incorporate prevention plans: insect sterilization research to reduce the population of the disease carrying vectors (the mosquito); the use of ecologically sensitive and biodegradable insecticides and larvicides; as well as protective, insecticide coated, mosquito nets during sleep. Efforts to improve sanitation and the removal of stagnant water sites, which reduces breeding areas for the Anopheles mosquito, the carrier of the Plasmodium parasite that causes Malaria, will pay off handsomely[lvii]. Education programs particularly in schools to combat the spread of HIV, TB and Malaria would be part of this envisioned effort. The highly successful DOT (Direct Observed Treatment) programs – a strategy for treating TB - should be expanded to cover most of the globe affected by this ancient disease. Research geared toward developing ‘rapid, low-cost diagnostics and cost-effective drugs’ are extremely important. Finally, a great financial commitment, particularly from the world’s wealthiest nations, will be required to contain or even eradicate HIV, TB, and Malaria from the face of the earth.[lviii] HIV and Intravenous (IV) Drug Abuse According to the UN, up to 10% of all HIV infections across the planet are contracted from contaminated needles or other injecting equipment. 22% of the world’s HIV/AIDS population injects drugs. In North America and Europe, Intravenous (IV) drug abuse has long been one of the 3 major ‘engines for the spread of the AIDS epidemic’.[lix] There are about 700,000 North Americans who currently abuse IV drugs. Over 3 million Americans have used IV drugs at some point in their lives. In Eastern Europe, IV drug use has emerged as the main ‘driving force in the spread of HIV’. In just 10 years, the Russian Federation has witnesses a 10 fold increase in the number of individuals using IV drugs, from 64,000 addicts to just about 700,000 today! In the rest of Europe, IV drug associated AID cases increased by 52% in the mid 1990s. Happily, several Western European countries have elaborate Methadone and clean needle and syringe programs that have led to a plateau of the infection rates with some declines recorded. These programs, which will require great funding, should urgently be replicated around the world.[lx] In Asia, where IV drug abuse is rife in Cambodia, Myanmar, Malaysia, Vietnam, Yunan province of China, Manipur state of India and Thailand, HIV prevalence has risen dramatically over the past decade. In China, ‘as much as 80% of IV drug users in Xingjian, and about 20% of addicts in Guangdong’,[lxi] are believed to be HIV positive. Patterns of infection are also linked to proximity of several of these countries to an area of heroin production between Laos, Myanmar and Thailand known as the ‘Golden Triangle’. A similar area of high risk for an HIV epidemic, is the territory bordering the “Golden crescent’ – a territory where Pakistan’s North West frontier converges with the Badarkhstan area of Afghanistan and Baluchistan area of Iran - one of the world’s largest heroin producing zones. Although HIV rates are relatively low in this region at the present time, without aggressive preventive measures, experts believe the stage is set for a disastrous upsurge of HIV cases.[lxii] A cocaine smuggling route traverses the state of Mato Grosso do Sul, in the South Western region of Brazil, where injectable cocaine has become a public health emergency and HIV cases increased five fold over a 5 year period in the early 1990s. Similar concurrent drug related epidemics are being witnessed in Argentina, Colombia (a major cocaine producer), the Caribbean and Central America. Africa has not witnessed an IV drug epidemic like many other parts of the world, although the populations of Nigeria, the Ivory Coast – intermittent transit countries for heroine- as well as Gabon, Uganda, Zambia and South Africa appear vulnerable.[lxiii] Condom Fatigue There is a growing, dangerous apathy concerning condom use amongst young as well as elderly sexually active adults in many developed parts of the world and indeed across the globe. Devoid of recent memories of AIDS deaths as a result of the availability of ARVs (antiretroviral medications) that are prolonging the lives of many patients, the sexually active population has been increasingly complacent about avoiding HIV infection.[lxiv] This high risk sexual behavior has also been driven by pleasure seeking, an invincibility complex, impatience and resurgent recreational drug use particularly amongst the young. Dr Marjorie Hill, New York City’s commissioner for HIV and AIDS, cautions that this laxity could lead to a new epidemic. Of particular concern is the increasing number of the elderly with HIV. Gay men who are engaged in this risky behavior, in a community where the infection rate has held steady at 2.5 % for more than a decade, constitute a worrisome demographic. Equally alarming, is the fact that heterosexual men have not been successfully reached by safer sex public health messages as anticipated.[lxv] A Spider Web’s Complexity: How AIDS threatens world Stability  The distinguished AIDS economist Alan Whiteside informs us that the AIDS pandemic’s impact on the world is extensive, showcases a great complexity, and may require a hawk’s expansive visual acuity to fully comprehend. What is clear, however, is the noose of health, economic, political, and social devastation that AIDS ties around the necks of the world’s most vulnerable and often impoverished peoples and nations. Having touched on the health and social ramifications of AIDS, I now wish to briefly turn our attention to some of the political and economic corollaries of this pandemic. Political effects of AIDS  In several countries, AIDS has claimed the lives of several key government, professional and economic elites, robbing these countries of some of the best and brightest minds essential for development. By destabilizing economies, the HIV/AIDS pandemic also helps to set the stage for political volatility and the evolution of social strife and conflict. Some of the countries most severely affected by HIV/AIDS are also those consumed by war. These armed disputes further promote the pandemic’s dissemination by casting a wider net for unsafe sexual proclivity, death and destruction. Military institutions are particularly at risk. Throughout Africa, HIV prevalence within the military ranks range between 15-60%. In Malawi where about 50% of the officers in the military are HIV positive, there is a growing concern that the country’s national security is at stake. These enervated armies place their countries at risk for domestic political instability and foreign attack. In countries run by a military juntas or former members of the military echelon, this point is particularly significant.[i]. States that unravel under the pressure of disease also produce large numbers of refugees that create regional and international tensions. P.W. Singer reminds the world that “perhaps the most important point is that failed states can become havens for the new enemies of global order…Decaying states give extremist groups freedom of operation…serve as critical nodes in the fundraising efforts of these terrorist groups….. with dangerous resulting consequences a world away”[ii] Economic Impact of AIDS In the most severely affected African countries, experts have noted a reversal of annual economic growth by 1-2 percentage points over the past decade.[iii] This development foretells more serious economic difficulty for the future, not just for Africa but for much of the developing world. By 2020, some predictions anticipate a drop in economic wealth or Gross National Product (GNP) – the sum total of all goods and services produced within a country in dollar terms in a calendar year - in the hardest hit areas by as much as 40%.[iv] The 2 major economic effects of AIDS – reduction in labor supply and increased costs -will be felt on several different economic levels of many of the world’s poorest and most severely afflicted countries already surviving on a few meager dollars a day.[v] Economic Impact of AIDS on Households AIDS destabilizes households because it is often contracted by the most economically productive of its members in the 15-40 age group who are often at the peak of their earning potential. Illness amongst these members leads to precipitous drops in family income and hence standards of living. Studies out of Thailand, Uganda, Tanzania and Ethiopia, indicate that when one of the ‘the breadwinners’ is befallen by AIDS; there is a concomitant drop of as great as 80% in the family’s earnings.[vi] Further compounding the financial crunch is the drain on family savings and increased expenditure for health related services and products to care for the sick loved one. To cope, these families often reduce their own consumption of goods and services by up to 50%[vii]. Some family members such as children miss school to care for the sick (often parents), further dimming the family’s future economic prospects. These same families later face financial ruin as a result of costs accrued during elaborate funeral ceremonies. The lasting effect is a spiraling downward cycle of poverty, penury and despair.[viii] Impact of AIDS on the Health Sector AIDS will place an especially heavy burden on the health sector in most of the worst affected countries by increasing the number of patients seeking care who will often require long term, extensive and expensive treatments; and by requiring increasing portions of the government budget to support the system. Some countries such as Malawi, Botswana and Namibia already find that up to ‘50% of all hospital resources are absorbed by HIV/AIDS treatment.’[ix] In Malawi 25-50% of health care workers are projected to succumb to this deadly disease.[x]These countries will have to increasingly make strategic choices about where their resources will be spent, a dilemma that will often mean choosing between food and medicines for AIDS. Maintaining a healthy population is essential for economic growth and development, a goal that will become progressively more difficult to achieve for many countries devastated by AIDS. Impact of AIDS on Agriculture In his book Poverty and Famines: An Essay on Entitlement and Deprivation, published in 1981, Professor Amartya Kumar Sen argued against the view that a shortage of food was the most important explanation for famines, but suggested the interplay of several factors to elucidate this phenomenon. The age of AIDS has made the Nobel Laureate’s argument remarkably crystal clear. Over the past 20 years, 7 million agricultural workers have succumbed to AIDS in 25 of the most severely affected African countries.[xi] Today, ‘the prospect of wide spread famine is very real for 6 Southern African countries – Swaziland, Zambia, Zimbabwe, Malawi, Mozambique and Lesotho’ – the epicenter of the AIDS pandemic in Africa where upwards of a third of the population is HIV positive. ‘This dreaded infection has combined with drought, floods and poor national and international planning and policies to create one of the worst agricultural yields in several decades.’ Peter Piot of UNAIDS tells more: “An AIDS related death in a farm household causes crop output to plummet – often by up to 60%. House hold incomes also shrink, leaving people with less money to buy food. Multiply this by millions and famine is not far behind.”[xii] In other countries with moderate prevalence of HIV, AIDS has also led to loss of labor supply and a reduction in remittance income and government revenue. Several affected regions have seen farmers switching to less labor intensive crops as a consequence of AIDS. This development could affect both cash and food crop production and spell future economic and nutritional difficulty for these nations.[xiii] In Africa, AIDS increasingly is becoming a woman’s disease. In several of the agrarian societies on that continent, women perform most of the labor intensive work required for food production. Their physical and intellectual resilience in managing the affairs of the home as well as planting, harvesting and marketing food and food products make them an unacknowledged, indispensable, Herculean presence. Before they fall prey to this dreaded illness, these women often take care of their sick husbands who are frequently the ones that contract the infection first. The reduction in time she has to devote to agriculture places her family’s nutritional and financial status in jeopardy. When her spouse eventually succumbs to AIDS, the wife is often ‘deprived of credit, distribution networks or land rights’[xiv] which sinks the family left behind into deeper poverty. When she eventually dies, the entire family structure collapses. By attacking women disproportionately in these communities, the AIDS pandemic has clearly cast death’s shadow on the economic, social, political livelihood of millions. Impact of AIDS on Education AIDS will affect the quality of education in the many countries by depleting the pool of qualified teachers as well as putting a squeeze on the resources available for the educational sector. Some experts believe that upwards of 10% of all teachers on the African continent will be lost to AIDS.[xv] Absenteeism of pupils will erode their cumulative educational experience and mar the overall quality of graduates. Teenagers and young adults who have emerged as the most vulnerable demographic for acquiring HIV/AIDS, will lose pivotal career molding educational milestones due to illness, a development that is expected to bear severe economic, political, and social costs. Impact of AIDS on Businesses AIDS affects the business sector essentially by increasing health related expenditure, reducing the labor pool, and decreasing company revenue. According to Lori Bollinger and John Stover of the Futures group international, “factors that may lead to increased expenditure and decreased revenue include health care costs, burial fees, training and recruitment expenditures, absenteeism due to illness, time spent on training, labor turnover, and time taken off to attend funerals”.[xvi] Bollinger and Stover found several companies in Zambia that had AIDS related costs that were outstripping their profits in a fiscal year! The transportation and mining sectors are expected to be the most susceptible to AIDS. Sharp falls in productivity as a result of AIDS related illnesses particularly in the mining sector have been documented in Southern Africa. In Uganda, the Railway corporation’s employee turnover rate of 15% cut deeply into profits and efficiency. The result of the death of just one key employee could have disastrous results for small and medium size companies. In others, the impact may be minimal. The researchers believe that “with proactive management, these costs can be mitigated through effective prevention and management strategies”[xvii] What can be done?: Solutions and Strategies The leadership Challenge According to Jide Adeniyi-Jones ‘In most African nations and other developing countries, there is a huge gulf between the HIV rhetoric and reality; with the leadership either unwilling or incapable of dealing with the pandemic’[xviii] Some experts believe that a “Museveni type campaign waged in Uganda[xix] – an effort that has seen the 12th consecutive year of AIDS prevalence declines in that country – is needed at the leadership level. In Kampala, Uganda’s capital, HIV prevalence is now 8%, down from a high of 30% a decade ago.”[xx]These efforts should also be buttressed by massive education campaigns involving the media, schools, village/town development unions, traditional leaders, traders, local women’s groups and NGOs such as Women’s health Education and Development (WHED), agencies and ministries of health. The overall goal would be to ‘end the silence, stigma, and indifference to AIDS’ inorder to halt this epidemic. [xxi] The Bush Administration must be commended for its ‘5 year, $15 billion emergency relief plan for AIDS, TB and Malaria in 14 countries of Africa and the Caribbean’[xxii] Leaders in the most severely affected countries such as Nigeria’s Obasanjo and Thambo Mbeki of South Africa - who has come under fire from the medical community for his controversial stance on the etiology of AIDS - it is hoped, will rise more vigorously to the challenge of AIDS in their respective countries. Increased funding It is clear that more money should be allocated to eradicate AIDS and its co-morbidity threats TB, Malaria. In the past 12 months, about $4.7 billion was spent on AIDS treatment and prevention in the most affected countries, which is a 50% increase from last year[xxiii] This is still half of the projected $10 billion needed annually to fight the disease according to WHO. [xxiv] America has led the way by spending more than $32 billion on AIDS in one form or the other – research and development of medications, direct aid to countries, NGOs, programs, agencies and parastatals, since the pandemic began[xxv]. The Bill and Melinda Gates Foundation with its $26 billion endowment, has compassionately allocated billions towards this fight. Under James Wolfensohn, the World Bank has more than quadrupled its AIDS funding.[xxvi] The aforementioned $15 billion AIDS initiative announced by the Bush Administration further highlights America’s great generosity. Having said that, much more funding is needed. The twenty year old goal that the UN set of asking developed countries to spend 0.7% of GNP on foreign aid annually is reasonable. It still means that the US, with an 8 trillion dollar economy, could spend $56 billion comfortably every year for this purpose, i.e. it could allocate several billion dollars every single year to the fight against AIDS. The European Union and Japan, countries that benefited from the US backed largesse of the “Marshall Plan” after World War II, have, up till now, a dismal record of AIDS funding. With a combined GNP of over $11 trillion, these countries could easily afford $77 billion annually for foreign aid.[xxvii] A fraction of this amount will be enough to fund the much needed war against AIDS, TB and Malaria. As the G-8 meeting approaches later this year, and with the historically generous and compassionate Dutch taking over the helm of the EU, it is hoped that AIDS, TB and Malaria funding will take center stage of the global agenda.[xxviii]There is no better time than under these present circumstances to cancel Africa’s foreign debt. Finally, countries most severely affected by the pandemic must raise their own funds internally to fight HIV/AIDS and increasingly harness and utilize their resources efficiently. Prevention This is likely the most important aspect of the ongoing fight against HIV/AIDS. Dr. Helene D. Gayle, Director of the Bill and Melinda Gates Foundation’s HIV, STD and Reproductive Health program, believes that the battle against HIV must involved a process that “scales up treatment without forgetting prevention” a view that is shared by the Global HIV and Prevention Working Group. Here are a few suggestions: Launch HIV Education Campaigns: The goal here should be to produce high risk sexual behavior modification and provide HIV transmission education. Other objectives would include “ending the silence surrounding HIV/AIDS as well as explode myths and misconceptions about HIV/AIDS that translate into dangerous sexual practices.”[xxix] Such an effort should involve a well organized and concerted media push – TV, Radio, billboards etc. as well as safer sex, HIV prevention and education programs in schools and public forums. Sex worker health and education programs are also an important component of this battle. Finally, the involvement of religious and cultural institutions where appropriate, can often prove to be particularly salient in the fight against HIV/AIDS, as has been seen in countries such as Senegal. As always, sexual abstinence should be provided as an option particularly for school children, teens and young adults. An AIDS vaccine: Preventive and Therapeutic Vaccines trials. The work of Dr David Baltimore, head of the National Institute of Health’s AIDS Vaccine Research Committee, and a number of other brilliant scientists such as Joseph M. McCune, Karen Slobod, Julie McElrath, Robert Gallo, and Bruce Walker et al hold promise for an HIV vaccine. However, such a vaccine is several years away if at all possible, given the morphological and immunological complexity of the HIV virus. National condom programs with appropriate distribution systems targeting high risk populations are particularly important. Public health advocates believe that for Africa alone, 1.9 billion condoms are needed annually to halt the spread of HIV.[xxx] Methadone and clean needle and syringe programs where appropriate will be a salient ingredient in the fight to prevent the spread of HIV amongst intravenous drug users. Affordable, rapid serum HIV testing kits for blood screening prior to transfusions, should be made available to most hospitals and clinics around the world particularly in the most severely affected countries. “Development assistance and policy reforms should address the social and economic conditions that increase vulnerability to, and facilitate the rapid spread of, HIV/AIDS”[xxxi] Targeted and appropriate STI (sexually transmitted Infections) surveillance and treatment particularly amongst high risk groups Empowerment and education of women and women’s groups: The importance of solving underpinning “gender inequality” issues that lead to the increasing HIV infections amongst women can not be over-emphasized. Also see section ‘A Gender under Siege: the assault of AIDS on Girls and Women’ Targeted funding for children and orphan care through the UN and NGOs such as Save the Children Other prevention strategies should involve appropriate HIV/AIDS surveillance, creation of a reliable data base for HIV/AIDS programming and continued research into new strategies and modalities for HIV prevention. Treatment WHO’s 3 x 5 Initiative Of the 5-6 million individuals infected with HIV in the developing world, only 400,000 have access to antiretroviral therapy (ART).[xxxii] The World Health Organization and UNAIDS have launched the laudable “the 3 by 5 Initiative” that aims to place 3 million HIV patients on ARTs by 2005”[xxxiii] Local production and/or distribution of Anti retroviral medication is crucial in the most severely affected countries. South Africa[xxxiv], Botswana and Nigeria (not very successfully), have started pilot programs aimed at providing these life sustaining medications to their HIV infected citizens. Research and development of new HIV therapies. New classes of drugs such as Non-nucleoside reverse transcriptase inhibitors (NNRTIs), as well as a new generation of protease inhibitors have shown great promise in the treatment of HIV. The Food and Drug Administration (FDA) last year announced the accelerated approval of a new class of medications called fusion inhibitors. Fuzeon (enfuvirtide), the first of what is expected to be several other drugs in this class, is designed to be used in combination with other anti-HIV medications to treat advanced HIV-1 infection in adults and children ages 6 years and older. Improved STI intervention and treatment (see above under prevention) Finally, the war against HIV/AIDS will require an integrated battle on all fronts - funding, leadership, prevention and treatment inorder to be truly successful. Without a concerted effort to aggressively curb this pandemic, one can expect cases of this dreaded disease to grow exponentially, leaving unimaginable death, despair and destitution in its wake. It is therefore essential that we strive to realize Dr. Peter Piot’s dream of a world where “the next generation, our children, are free of HIV and grow up in a world without AIDS; where those who are living with HIV receive the care and support that they are entitled to; and finally, where the stigma and discrimination against people living with HIV/AIDS is finally defeated”[xxxv] References: [i] Singer, P.W. AIDS and International Security, Brookings Institution Foreign Policy Studies Program. Survival, Vol. 44, No. 1, Spring 2002, pp 145-158 [ii] Ibid [iii] Communiqué from the Asia Pacific ministerial meeting, Melbourne, 2001. Original paper prepared for the Special Session of the General Assembly on HIV/AIDS, Round Table 3, Socio-Economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS. [iv] Ibid. Also UNDP (2001), HIV/AIDS: Implications for Poverty Reduction, background paper prepared for UN General Assembly, Special Session on HIV/AIDS, 25-27 June 2001. [v] Lori Bollinger and John Stover, The Economic Impact of AIDS, The Futures Group International, Glastonbury, CT, 1999, pg 1. [vi]Demeke, M The Potential Impact of HIV/AIDS on the Rural Sector of Ethiopia. Unpublished Manuscript, 1993. Also Communiqué from the Asia Pacific ministerial meeting, Melbourne, 2001. Original paper prepared for the Special Session of the General Assembly on HIV/AIDS, Round Table 3, Socio-Economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS. [vii] Ibid. [viii] Lori Bollinger and John Stover, The Economic Impact of AIDS, The Futures Group International, Glastonbury, CT, 1999, pg 1. [ix] Communiqué from the Asia Pacific ministerial meeting, Melbourne, 2001. Original paper prepared for the Special Session of the General Assembly on HIV/AIDS, Round Table 3, Socio-Economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS. [x] Singer, P.W. AIDS and International Security, Brookings Institution Foreign Policy Studies Program. Survival, Vol. 44, No. 1, Spring 2002, pp 145-158 [xi] UN Food and Agricultural Organization statistics. Also Peter Piot, (Director UNAIDS), Laying waste a continent, news article published in 2003 [xii] Ibid. [xiii] Lori Bollinger and John Stover, The Economic Impact of AIDS, The Futures Group International, Glastonbury, CT, 1999, pg 3. [xiv] Kofi Annan: In Africa, AIDS has a woman’s face- Global Policy Forum. New York Times, December 29, 2002 [xv] Singer, P.W. AIDS and International Security, Brookings Institution Foreign Policy Studies Program. Survival, Vol. 44, No. 1, Spring 2002, pp 145-158 [xvi] Lori Bollinger and John Stover, The Economic Impact of AIDS, The Futures Group International, Glastonbury, CT, 1999, pg 4. [xvii] Lori Bollinger and John Stover, The Economic Impact of AIDS, The Futures Group International, Glastonbury, CT, 1999, pg 6. [xviii] Jide Adeniyi-Jones: Introduction to AIDS photo gallery, HIV in Nigeria: Living on the Edge. ©All Africa 2004 [xix] President Museveni of Uganda essentially took on the AIDS epidemic head on traveling across his country addressing stadium capacity crowds about the disease. This effort took place concomitantly with a nation wide education campaign and has led to a leveling off and decline in HIV cases in that country – a true success story. [xx] David Brown, HIV Infected 5 million worldwide this Year, Washington Post, November 26, 2003, p A01 [xxi] Chinua Akukwe AIDS in Nigeria: The ticking Time Bomb © Africa Economic Analysis, 2001 http://www.afbis.com/analysis/aids_nigeria.htm [xxii] David Brown, HIV Infected 5 million worldwide this Year, Washington Post, November 26, 2003, p A01 [xxiii] Interview with Peter Piot, (Director UNAIDS), David Brown, HIV Infected 5 million worldwide this Year, Washington Post, November 26, 2003, p A01 [xxiv] Ibid [xxv] Department of Health and Human Services Data [xxvi] World Bank/UNAIDS/WHO data [xxvii] Independent Research [xxviii] Ibid [xxix] http://www.avert.org/worlstatinfo.htm [xxx] Global HIV and Prevention Working Group: Access to HIV Prevention: Closing the Gap, May 2003, page 9 [xxxi] Ibid, page 5 [xxxii] WHO and UNAIDS data [xxxiii] Ibid [xxxiv] Samantha Willan Briefing: Recent changes in the South African government’s HIV/AIDS policy and its implementation. African Affairs Volume 103, Number 410, January 2004, page 109-117 [xxxv] Peter Piot: Defeating HIV/AIDS: Africa is Changing Gear, Speech a the Closing Ceremony of the ICASA conference, 226 September, 2003, Nairobi, Kenya [i] Discussion with Mimi Okam MD, Hematology/Oncology Fellow, Yale University Hospital, New Haven, CT, March 2004. [ii] James Wolfensohn, “Impact of AIDS on Peace and Security in Africa,” Speech delivered to the UN Security Council Special Session, January 10, 2000. [iii] Africa Recovery, January 2004. Full interview can be heard on BBC website http://news.bbc.co.uk/2/hi/africa/3244564.stm [iv] Chinua Achebe, ‘Africa is People’: The World Bank Presidential Fellow Lecture Series, June 17, 1998. Also interview with Chinua Achebe, March 2004 ( © Chinua Achebe Foundation, 2004) [v] UNAIDS Statistics and data [vi] UNAIDS AIDS Epidemic Update, December 1, 2003 [vii] Peter Piot, (Director UNAIDS), Laying waste a continent, news article published in 2003 [viii] Ibid. [ix] UNAIDS statistics and data [x] Prevalence: The number of cases of HIV in a given population during a stipulated period of time, often resented as a proportion [xi] Ibid. [xii] Independent Research. Also UNAIDS statistics and data [xiii] Statistics from UNFPA http://www.unfpa.org/swp/2003/english/ch3/ [xiv] Children on the Brink: Study published jointly by USAID, UNAIDS and UNICEF in 2002 and released at the XIV International AIDS Conference in Barcelona, Spain. [xv] Africa’s orphaned generations, UNICEF publications, 2003 http://www.unicef.org/media/files/orphans.pdf [xvi] Ibid. [xvii] The Economist Global Agenda: A mixed Prognosis, December 1, 2003 http://www.economist.com/agenda/displayStory.cfm?story_id=2249371 [xviii] Independent research, interviews, documentaries [xix] UNICEF Data [xx] Independent Research [xxi] UNAIDS statistics [xxii] Statistics from the CDC [xxiii] Statistics from UNFPA http://www.unfpa.org/swp/2003/english/ch3/ [xxiv] Gupta, Rao Geeta: How men’s power over women fuels the HIV epidemic. BMJ Editorial 2002:324:183-184, January 26 [xxv] Ibid. [xxvi] http://www.unfpa.org/swp/2003/english/ch3/ [xxvii] Harvard School of Public Health Lecture Notes [xxviii] Gupta, Rao Geeta: How men’s power over women fuels the HIV epidemic. BMJ Editorial 2002:324:183-184, January 26 [xxix] National Intelligence Council: HIV/AIDS surge foreseen for Nigeria, Ethiopia, Russia, India, China. October 3, 2002 [xxx] Ibid. [xxxi] [xxxi] CIA World Fact Book –Nigeria (Website: http://www.cia.gov/cia/publications/factbook/geos/ni.html ) [xxxii] Ibid [xxxiii] World Bank and UN statistics [xxxiv] National Intelligence Council: The Next Wave of HIV/AIDS http://www.fas.org/irp/nic/hiv-aids.html [xxxv] Prevalence: The number of cases of HIV in a given population during a stipulated period of time, often resented as a proportion [xxxvi] National Intelligence Council: The Next Wave of HIV/AIDS http://www.fas.org/irp/nic/hiv-aids.html Extrapolated Data from HIV prevalence among women attending Prenatal clinics 2001. Some data may be skewed because fewer women may be seeking prenatal care due to mandatory HIV testing in several States. Also Data from Nigerian Ministry of Health, surveys on AIDS/HIV 1999-2002 [xxxvii] Ibid. Also comparable data from the British Council, USAID and independent research. [xxxviii] Chinua Akukwe AIDS in Nigeria: The ticking Time Bomb © Africa Economic Analysis, 2001 http://www.afbis.com/analysis/aids_nigeria.htm [xxxix] National Intelligence Council: The Next Wave of HIV/AIDS http://www.fas.org/irp/nic/hiv-aids.html [xl] The number of cases of HIV in a given population during a stipulated period of time, often presented as a proportion [xli] National Intelligence Council: The Next Wave of HIV/AIDS http://www.fas.org/irp/nic/hiv-aids.html Extrapolated Data from HIV prevalence among women attending Prenatal clinics 2001. Some data may be skewed because fewer women may be seeking prenatal care due to mandatory HIV testing in several States. Also Data from Nigerian Ministry of Health, surveys on AIDS/HIV 1999-2002 [xlii] Ibid [xliii] USAID Brief : HIV/AIDS in Nigeria, July 2002, Pg 1 http://www.usaid.gov/pop_health/aids [xliv] National Intelligence Council: The Next Wave of HIV/AIDS http://www.fas.org/irp/nic/hiv-aids.html Extrapolated Data from HIV prevalence among women attending Prenatal clinics 2001. Some data may be skewed because fewer women may be seeking prenatal care due to mandatory HIV testing in several States. Also Data from Nigerian Ministry of Health, surveys on AIDS/HIV 1999-2002 [xlv] European Race Audit Bulletin No.25, The Institute of Race Relations, London, UK, November 25, 1997 [xlvi] Migrant Information Programme, “Trafficking in Women for Sexual Exploitation to Italy”, IOM, June 1996 [xlvii] Licia Brussa, “Transnational AIDS/STD prevention among migrant prostitutes in Europe”, TAMPEP, 1996 [xlviii] AFB News service via Clarinet Spanish Smash Nigerian Prostitution Ring, Wednesday, 19 November,2003 Also AFB news service Vast Nigerian prostitution network smashed in France, Friday, September 13, 2002 [xlix] Interview of Mimi Okam MD, Hematology/Oncology Fellow, Yale University Hospital, New Haven, CT, March 2004. Dr Okam drew data from Stuart Graham, Nigeria: Prostitution Rife in Nigerian Capital as AIDS rates soar, Agence France Presse, December 15, 2003. Also information from Agnes Van Ardenne, AIDS: Let’s get Real, Publication of the Ministry of Development Corporation of the Netherlands, published by The Guardian Newspapers Limited © 2003-2004, Lagos, Nigeria; independent research and scholarship. [l] Ibid [li] Statement attributed to professor Babatunde Osotimehin, chairman of the National Action Committee on AIDS in Nigeria. The British Council, The Daily summit AIDS in Nigeria, December 2, 2003 http://www.dailysummit.net/english/archives/2003/12/02/aids_in_nigeria.asp [lii] Chinua Akukwe AIDS in Nigeria: The ticking Time Bomb © Africa Economic Analysis, 2001 http://www.afbis.com/analysis/aids_nigeria.htm [liii] USAID, UNAIDS, UNFPA Statistics. Independent research, Harvard School of Public Health Lecture Notes [liv] Ibid. [lv] USAID Information and Statistics. Also Harvard School of Public Health Lecture Notes and Information from Discussion with Mimi Okam MD, Yale University Medical Center Hematology/Oncology Fellow. [lvi] House of Representatives Committee on Energy and Commerce, Subcommittee on Health, HIV/AIDS, TB, and Malaria: Combating a Global Pandemic, Thursday March 20, 2003. Pg 1-2 [lvii] Volk, Benjamin, Kadner and Parsons: Essentials of Microbiology, 4th Edition, and J.B. Lippincott company, Philadelphia, 1991, pg 749-753. Also Harvard School of Public Health Lecture Notes [lviii] USAID Information and Statistics. Also Harvard School of Public Health Lecture Notes [lix] Panos AIDS Information Sheet, No 21, May 1998 with Updated information from 2003 Also independent Research and Harvard School of Public Health lecture notes. [lx] Ibid. [lxi] David Brown, HIV Infected 5 million worldwide this Year, Washington Post, November 26, 2003, p A01 [lxii] Panos AIDS Information Sheet, No 21, May 1998 with Updated information from 2003 Also independent Research: Harvard School of Public Health lecture notes. [lxiii] Panos AIDS Information Sheet, No 21, May 1998 with Updated information from 2003 Also independent Research and Harvard School of Public Health lecture notes. [lxiv] Discussion with Mimi Okam MD, Haematology/Oncology Fellow, Yale University Hospital, New Haven, CT, March 2004. [lxv] New Department of Public Health Data through 2002 as well as independent research. Dr Chidi Chike Achebe is the Medical Director of Whittier Street Health Center in Boston MA. Contact: C.Achebe@wshc.org |
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