AIDS/HIV

On January 24, we were given a presentation regarding HIV/AIDS in Africa, generally, and Tanzania, specifically. It was a fairly sobering conversation. The discussion was led by a Nun who is also an MD. She was a very impressive woman, and proved to be more progressive in her thinking than her status as a nun might otherwise suggest.

While Africa comprises 1/3 of the world’s population, 2/3 of the world’s cases of HIV/AIDS are in Sub-Saharan Africa. Tanzania, relatively speaking is doing ok, with a prevalence rate of 7%, in contrast to, for instance, South Africa’s 20% to 30% prevalence rate. The demographic group most at risk in Tanzania is 15 to 24 year old woman. I learned a number of interesting things:

1. There has been prevalent myth perpetrated by traditional healers that if an HIV infected male has sex with a virgin or, in some cases, an elderly woman, the man will be cured. This has given rise to sexual assault in Tanzania, previously a very rare occurrence, and an increase in the spread of the virus.
2. Rich men who become infected conclude that they’re unwilling to die alone and engage in a concerted effort to spread the disease as broadly as possible.
3. Despite now being illegal, female genital mutilation continues to occur. It is done in a non-sterile manner, with shared instruments, providing an ideal opportunity for transmission of the virus.
4. There is social and economic pressure for woman to breast feed, which results in the transmission of the virus to an infected mother’s baby. So, women who have avoided giving the virus to their babies through pregnancy and in the hospital get home and are pressured by their family members breast feed. The women then have the choice of either revealing that they are infected, subjecting themselves to shame and stigma, or subjecting their newborn to AIDS/HIV. To make matters worse, the economic reality is without breast milk, many children would simply starve to death.
5. Until recently Tanzanians would not get tested for the simple reason that treatments were not available or were too expensive. So, in their minds, there was no point in testing. The only reason to do so was to advise you of a death sentence and subject you to horrible stigma about which you could do nothing. Obviously, the result of this was the continued rampant transmission of the virus. Now that donor countries have made the drugs more available testing is becoming more common.
6. There is engrained cultural acceptance of men being unfaithful to their wives, which, of course, also results in further transmission.

The agreed-upon solution, as a matter of national policy, is ABC: abstinence, be faithful and condoms. Each of these has its deficiencies. For instance, in terms of condoms, it is not uncommon for condoms to be used repeatedly, shared and generally used incorrectly.

While I did not need to go to Africa to appreciate the staggering problem of AIDS/HIV here, gaining a preliminary understanding of some of the cultural challenges associated with this intractable problem has been illuminating and exceedingly depressing. You are also left, once again, with the crushing feeling that as devastating as the AIDS/HIV problem is, it must continue to compete with the overwhelming variety of other scourges Tanzania, and countries like it, face---poverty, lack of basic services and infrastructure and educational and vocational opportunities.