What Can Be Done to Stop the Spread of AIDS Among African Children?
Rashini Wijesinghe Kannangara
The AIDS epidemic is devastating communities all over the world, especially in the African region, in many ways. This research paper addresses the question: What can African governments do to stop the spread of AIDS among African children? First, I have presented an overview of the HIV virus; then I have discussed different ways African children get exposed to this deadly disease. Later, I have explained the factors that contribute to the rapid spread of AIDS among African children. Then, I have described physical, psychological, and social problems faced by children. In the conclusion, I have mentioned some ways that local governments can get involved in order to end this devastation.
AIDS was first discovered almost two decades ago; since then it has rapidly spread around the globe. Now, almost every country in the world is battling this deadly epidemic. It is reported that 2.8 million people died of AIDS in 2005, and 4.1 million people got infected with this deadly disease (UNAIDS, 2006c, p.8). By the end of 2005, approximately 38.6 million people were living with AIDS around the world. Consequently, AIDS has affected millions of people in the world physically, psychologically, and socially; it continues to affect people of all age groups and of all social and economic status (“HIV and AIDS”, n.d.). And the effects of AIDS are much worse in Africa than in any other region of the world.
Sub-Saharan Africa is home to only 10% of the world’s population, but approximately 64% of the world’s AIDS population lives in this region (UNAIDS, 2006c, p.15). By the end of 2005, 24.5 million people in sub-Saharan Africa were living with AIDS, and another 2.7 million people became infected with AIDS (“HIV and AIDS”, n.d.). Southern Africa is mostly affected by this epidemic, and approximately 43% of children in this region are HIV infected. Nine out of ten children infected with AIDS live in sub-Saharan Africa, which is approximately 2 million children (UNAIDS, 2006c, p.15). According to “Children, HIV” (n.d.), children are affected by AIDS in several different ways. Many children in Africa become orphans when one or both of their parents die of AIDS or AIDS related infections. Many others have to take care of their parents and relatives who are infected with AIDS. Other children get infected with AIDS, and most of them die due to lack of treatment (n.p.).
Many people think that children do not get infected with AIDS because it is a sexually transmitted disease (“Children, HIV”, n.d.). But the sad reality is that every day approximately forty children die of AIDS, and by the beginning of 2007, 2.3 million children worldwide have been infected with AIDS. Every year 380,000 children die of AIDS (“Stop AIDS”, n.d.). According to “Children, HIV” (n.d.), most children infected with AIDS die before the age of five. Children in developed countries rarely get infected with AIDS because mothers and babies there get necessary treatment to prevent the transmission of this disease (UNAIDS, 2001, p.9). On the other hand, children in Africa get infected with AIDS every year due to various reasons (“Children, HIV”, n.d.).
In recent years, the global response to the AIDS epidemic has increased, but the epidemic still continues (“Children, HIV”, n.d.). Most AIDS infections in African children could have been prevented if necessary initiatives would have been taken. Since AIDS is increasingly affecting the African children in many ways, it is high time measures should be taken to control or stop the further spread of this disease among African parents and their children. This paper will inform governments about essential steps that need to be taken in order to prevent the further spread of AIDS among African children. Through this research paper, I am hoping to address the following issues:
- What is the HIV virus?
- How do African children get infected with HIV?
- Why do so many children infected with AIDS live in Africa?
- What are the problems African children and their families face because of AIDS?
What Is the HIV Virus?
Acquired immunodeficiency syndrome (AIDS) is caused by human immunodeficiency virus (HIV) (Smith, 2001, p.327). HIV is a lentivirus, which is a subgroup of retrovirus, but HIV contains more genes than a regular retrovirus. CD4+ cells in the immune system are affected by HIV; the human immune system is unable to eradicate the HIV virus from the body as completely as it does when other viruses enter the body. After entering the body, the HIV virus continuously replicates, and subsequently HIV infected cells outnumber the number of CD4+ cells in the body. HIV spreads throughout the body very rapidly. Two types of HIV viruses are HIV-1 and HIV-2. The spread of HIV-2 is limited to West Africa, while HIV-1 is found all over the globe. HIV replicates through an unusual mechanism. First, the enzyme reverse transcriptase converts single stranded RNA (ssRNA) into single stranded DNA (ssDNA) (pp.328-329). Then it produces the complementary strand to the ssDNA and facilitates the incorporation of virus DNA into the host cell genome. After that, the host cell produces viral DNA (p.329).
How Do African Children Get Infected with HIV?
The first discovery of AIDS was shocking to doctors and medical professionals. Dr. Samuel Border said, “In June of 1981 we saw a young gay man with the most devastating immune deficiency we had ever seen. We said, ‘We don’t know what this is, but we hope we don’t ever see another case like it again’” (WHO, 1994, in UNAIDS, 2006a, p.1). Now, AIDS has spread to all corners of the world, but some countries have been affected worse than others. HIV transmits mainly through sexual interactions, but it can also transmit through blood or contaminated needles etc. used by the AIDS patients (“Children, HIV”, n.d.). Fortunately, HIV is not a virus which transmits through casual contact, through saliva or tears of an infected person. However, HIV/AIDS can be transmitted from an infected mother to her child (Smith, 2001, p.132).
A child is a person who is under the age of fifteen (“Children, HIV”, n.d.). It is reported that 90% of AIDS-infected children get AIDS through pregnancy, birth, or breast feeding. Approximately 15-30% of children born to HIV-positive mothers get the disease (“Preventing Mother”, n.d.). In the year 2005, around 700,000 children became infected with AIDS through Mother to Child Transmission (MTCT). UNAIDS (2006d) reported that sub-Saharan Africa is home to nearly 90% of AIDS-infected children (p.132). Previous studies have shown that one in three children die before the age of one; one in two die before the age of two, and most of them die before the age of five (“Children, HIV”, n.d.). Children can also become infected with AIDS through breast feeding. If a mother infected with HIV feeds her baby, that baby has a 5-20% chance of getting this deadly disease (“Preventing Mother”, n.d.). This suggests that an increase in AIDS-infected women will directly impact the HIV rates among children (Smith, 2001, p.132).
According to “Children, HIV” (n.d.), although children mainly get infected through their mothers, they can also become infected through sexual abuse and during treatment in medical facilities. Previous statistics have shown that sexual abuse directly impacts the AIDS transmission among children. “Children, HIV” (n.d.) states, “In parts of Africa, the myth that HIV can be cured through sex with a virgin has led to a large number of rapes - sometimes of very young children - by infected men” (n.p.). The article further says that HIV transmission may occur due to young people who engage in sexual activities. Many children in this region become sexually active at a very young age. Unsterilized medical equipment and blood transfusions are also responsible for increasing the number of HIV-infected children. In most developed countries, HIV transmission through medical facilities has been eliminated, and it suggests that it is possible to avoid transmission via medical facilities (n.p.).
Why Do So Many Children Infected with AIDS Live in Africa?
MTCT can be easily prevented by providing antiretroviral drugs. HIV-positive women are advised to take antiretroviral drugs to prevent MTCT. This treatment is also given to newborn babies for a short time to reduce the chance of getting infected (“Preventing Mother”, n.d.). Antiretroviral drugs have proven to decrease the rate of MTCT from 20-45% to less than 2% in many western countries (“Children, HIV”, n.d.). According to the recently released report of UNAIDS (2006c), between the years 2003-2005 antiretroviral drug availability has increased by eight times (p.9). But in sub-Saharan Africa, only 17% of people have the opportunity to receive these drugs (p.15). Although drugs like intrapartum and neonatal nevirapine have proven to reduce HIV transmission by approximately 40%, studies have shown women who consume these drugs could develop resistance (UNAIDS, 2006d, p.133). Occurrence of MTCT in developed countries is very rare because the necessary initiatives have been taken to prevent it (UNAIDS, 2001, p.9). On the contrary, UNAIDS (2006d) reports that by 2005 only 6% of pregnant mothers in Africa received necessary services to prevent MTCT; this suggests that more work has to be done to make more affordable and effective drugs (p.133).
According to “Preventing Mother” (n.d.), most Western countries perform caesarean sections on HIV positive mothers because caesareans have proven to decrease the baby’s exposure to the mother’s body fluid. However, caesareans are very rare in developing countries. HIV-positive mothers in western countries give their babies a substitute for breast milk, but mothers in poor countries cannot afford these expensive formulas. Another problem is that babies may not get the necessary nutrients from the formula as found in breast milk. Unless prepared properly, formulas can make babies sick. So it’s essential to educate women about breast milk substitutions. In some parts of Africa clean water necessary to prepare baby formulas is rarely found (n.p.). So, governments have to develop infrastructures, provide basic necessities, and improve medical services to eradicate HIV in Africa.
In some parts of Africa, 59% of adults infected with AIDS are women (UNAIDS, 2006c, p.15). There is a shortage of testing facilities in the African regions, which leads to increasing numbers of HIV infection there (“HIV and AIDS”, n.d.). I believe it is essential to identify the women infected with AIDS because it will help to decrease the number of babies getting infected in pregnancy. According to “Children, HIV” (n.d.), the increasing number of young women infected with AIDS is a barrier to reducing the number of children infected with AIDS; this is because there is a greater risk for a baby to get the disease from an HIV-infected mother. Girls are more vulnerable to AIDS infection than any other group in Africa, and this directly affects the rate of MTCT because these girls are the future mothers (UNAIDS, 2006d, p.136). Also, ignorant mothers are more vulnerable to this deadly disease than others.
Education is very important in preventing the transmission of AIDS. Only 64% of children in Africa are enrolled in primary schools, and this percentage is much lower in AIDS-affected regions (UNAIDS, 2006b, p.97). According to UNAIDS (2006d), girls do not get a proper education, which is a vital tool for them to know about this epidemic. Previous studies have shown that educated girls are less likely to get infected with AIDS compared to others. It further says that girls with higher education will marry later than others, will have more knowledge about HIV and other sexually transmitted diseases, and are more likely to get help and necessary services. This is because students in schools learn about HIV infection, transmission, prevention, and treatment; as such, they become well-informed and conscious (p.136). Being uninformed and ignorant, illiterate people are less likely to get help from necessary agencies than literate people. They are also more likely to become victims of AIDS. This shows that governments have to do more work if they want to control this epidemic.
Although AIDS is prevalent in Africa, discrimination against patients is relatively high (McElrath, 2002, p.205). HIV-positive women are afraid to go for the HIV test due to discrimination (UNAIDS, 2006d, p.134). Women who already know their status are less likely to attend any counseling or treatment sessions (“Preventing Mother”, n.d.). Gender inequality in the African region also leads to discrimination against women (McElrath, 2002, p.205). According to McElrath, a couple of years ago, a South African woman was killed by the local community because she was HIV-positive. In some African countries, many women get HIV after marriage because of their husbands (UNAIDS, 2006d, p.136). In many African cultures, men are allowed to have more than one wife, and most of those men do not use condoms; this can increase the risk of infection among women. So governments need to make contraceptives available. They also should improve women’s social status if they want to control HIV transmission among children.
According to “Children, HIV” (n.d.), lack of healthcare facilities and trained healthcare workers also contributes to the increasing number of AIDS positive children in Africa. Lack of healthcare workers makes it difficult for children to access healthcare. African countries have a poor doctor-to-patient ratio. Furthermore, medical facilities must be improved by enhancing medical technology. Most children infected with AIDS die at a young age, but children who are treated with therapy live longer. Approximately 10% of African children who require antiretroviral drugs receive them. Another problem is that most available drugs are not suitable for children. Most drugs designed for children exist only as tablets, but children cannot swallow them. Since these drugs do not exist as syrups or powders, caregivers tend to break adult tablets and give them to children. This results in children getting too little or too much dosage per day (n.p.).
What Are the Problems African Children and Their Families Face Because of AIDS?
In Africa the AIDS morality rate is very high (“HIV and AIDS”, n.d.). Also, life expectancy of a person living in sub-Saharan Africa is around 47 years, but if HIV were not prevalent in Africa, it would be around 62 years. Approximately 85% of children infected with AIDS live in sub-Saharan Africa (UNAIDS, 2006d, p.132). Children who get infected with AIDS have to suffer a lot through the rest of their lives. According to Smith (2001), approximately 15% of children die by the age of one, but the death rate decreases after the age of two (p.133). Most children (75-90 %) who get HIV from their mothers will show symptoms before the age of one, while others will show symptoms after ten years. These children are also going to face opportunistic infections such as tuberculosis, which will cause serious health effects due to weak immune systems (“Children, HIV”, n.d.). According to “Stop AIDS” (n.d.), if the local governments do not do anything to control this epidemic, the AIDS mortality rate will continue to rise.
More than 12 million children in sub-Saharan Africa are AIDS orphans (“AIDS Orphans”, n.d.). In this region, 9% of children have lost at least one of their parents due to AIDS. In most countries in Africa, AIDS is responsible for more than half of the child orphans. Death of one or both parents or loved ones makes these children orphans. According to statistics of UNAIDS (2006b), many children who lose their parents are taken care of by their relatives; others live with strangers or alone (p.92). Although most children live with their relatives or guardians, they do not get the necessary affection and care that they would have gotten if they lived with their parents. They also do not get the same education, healthcare, and other necessities compared to other African children.
Children who are not orphans, but have one or both parents infected with AIDS, have to go through many financial and social difficulties (UNAIDS, 2006b, p.91). They have to take care of their sick parents, relatives, and siblings; they also have to contribute to the family economy. Due to AIDS, economic levels in homes decrease, so children have to work in order to earn money for the family (“Children, HIV”, n.d.). Most of these children work under harsh conditions that are inappropriate for their age. Some children also have to look after their younger brothers and sisters if their parents have died from AIDS or have been infected with AIDS. This raises serious questions since these children are not capable of supporting their siblings. Some children get separated from their siblings when their parents die, and this negatively impacts those children; this is partly because one guardian does not have the ability to care for many children (UNAIDS, 2006b, p.91).
A recent study shows that orphans have high levels of anger and depression compared to other children (“AIDS Orphans”, n.d.). This may lead to psychological problems later on in their lives. Children get emotionally affected after seeing their parents, teachers, and friends dying of or suffering from AIDS (UNAIDS, 2006b, p.92; Smith, 2001, p.134). Children who are infected with AIDS also face discrimination (Smith, 2001, p.213). These children do not get the sympathy that children infected with other diseases, like cancer or mental retardation, get ( Canosa, 1991) . The main reason for discrimination is that AIDS is a sexually transmitted disease, and in many parts of Africa, sex is considered a taboo (Smith, 2001, p.213).
HIV causes enrollment in schools to decrease. Children who get infected with AIDS will miss many days of school due to frequent illnesses (Smith, 2001, p.134). Some children stay at home to care for relatives who are infected with AIDS. Others miss school because they have to work or because they do not have enough money to pay for school. UNAIDS (2006b) reports that even in the same family, orphans are less likely to attend school compared to other children in the same house (p.92). A study has shown that orphans who live with their mothers are most likely to attend school, compared to orphans who live with their fathers (p.93). This may be because most fathers go to work in far away places, and they do not have time to care about their children’s education. In some instances, even children who can afford to go to school do not get a proper education because some of their teachers are also affected by this deadly disease (p.97). For example, 21% of teachers in their mid-twenties to mid-thirties and 13% of teachers in their mid-thirties to mid-forties in South Africa have been infected with AIDS. Most of the schools in the poor regions of Africa are run by one or two teachers, and when one of them gets infected with AIDS, many students do not get the opportunity to learn with their teachers.
Decrease in the further spread of AIDS in Africa is urgent. Africa has already been devastated by this deadly disease, and we cannot tolerate the further spread of it. Local governments have to take necessary actions since this epidemic has impacted African communities in many ways. Every day people are dying, and many more are left with painful experiences that HIV has left behind. When the bread winner of the family gets infected, the whole family faces the socio-economic complexities. Economies of most AIDS-affected countries, such as Cameroon, are falling down (“HIV and AIDS”, n.d.). Tourism falls down since no tourists will come to visit a country devastated by AIDS. Since millions of people are living with AIDS, the work force of these countries has greatly decreased (UNAIDS, 2006b, pp. 93-94). In the long run, governments will have huge debts, and at the same time they will have to take care of the sick and the orphans.
The MTCT can be easily controlled if the number of AIDS infections among adults can be reduced. Children get this deadly disease through their mothers, so if we can reduce the number of HIV-positive pregnant women, the number of MTCT will eventually reduce (UNAIDS, 2006d, p.132.). In order to reduce the number of AIDS-infected mothers, governments should provide necessary medical services and counseling for pregnant women and mothers (p.133). Moreover, voluntary HIV testing for all women should be encouraged, and young girls should be educated in order to prevent unplanned pregnancies. Most women are afraid to get tested or to get help because of the fears of discrimination. Governments should come forward and make sure that every woman receives necessary services to prevent MTCT. Local officials should take necessary steps to educate pregnant women and HIV infected mothers about the steps that they should take to prevent any possible MTCT. Replacement of feeding and caesareans should be made mandatory if the mother is suspected to have HIV. Services to increase the nutrition levels of HIV-infected mothers and their babies should be implemented.
Most importantly, antiretroviral drugs should be provided to both mothers and newborn babies (UNAIDS, 2006d, p.133). Since drugs (powders and syrups) suitable for babies and young children have not yet reached African children, the government should take necessary actions to provide appropriate and low cost drugs for these children. HIV-infected children in developed countries get necessary treatments, which enable them to live longer, healthy lives (UNAIDS, 2001, p.9). On the other hand, children in many poor African countries die due to lack of treatment. Although antiretroviral drugs are available to patients in developed countries, patients in developing countries cannot afford those costly drugs. The local governments also should find ways to provide low cost generic drugs to mothers and children in order to prevent MTCT in Africa. More affordable and advanced drugs are needed; yet gender equality, economic reforms, and development of infrastructure are more essential.
Due to gender discrimination in Africa, women cannot protect themselves from HIV. Social attitudes toward HIV-infected women should be changed through increasing the awareness and knowledge about HIV in local communities. Rapes of young girls are common in the most parts of Africa, and the criminals do not face any legal charges. New legislation has to protect the rights of women and children and to ensure gender equality (UNAIIDS, 2006d, p.137). Although western women have reached higher positions in the society, women in Africa still live under primitive conditions, so it’s government’s responsibility to implement plans to increase the social status of women. Normally, African girls get less education than the boys do. This is partly due to gender discrimination, and this will result in lower socio-economic status among women. This will cause women to depend on men for all their needs.
When both parents die due to AIDS or AIDS-related infections, children get orphaned. When children get orphaned, the older children have to take care of their younger siblings. These children do not have the ability to fulfill healthcare and other essential needs of their younger siblings or even themselves. The governments should do something to find a home for these children and most importantly to provide medical treatment for them. Another problem is that sexual relationships are dominated by men (“HIV and AIDS”, n.d.). And many men in Africa do not use condoms because of the social beliefs prevalent in that society. So even though women do know their partners have HIV, they cannot do anything to prevent the transmission. This means it is essential to educate both men and women about HIV transmission and prevention.
Education will play a vital role in decreasing the number of AIDS cases in Africa. Enrollment of children in schools is very important because school is the primary institution to give the message about AIDS to children. It is important to begin sex education when children are young. Children should be educated about how to prevent getting infected with HIV and how they can utilize the services available if they get infected. Strict laws should be imposed in order to prevent young children from having sex (“Children, HIV”, n.d.). As I explained earlier, HIV causes enrollment in schools to decrease. It is government’s responsibility to find ways to get the education for these children who do not attend school. For example, they can begin a tutoring service targeting those children. According to UNAIDS (2006d), many studies have proven that AIDS education in schools is essential to have many successful outcomes (p.138). Through education, myths about HIV infection and infected people could be eradicated. Governments can also use mass media to educate people because now they are available even in the poorest regions of the world.
HIV affects healthcare, social, and economic systems of countries. Impacts of HIV/AIDS can be found everywhere in Africa. Further, HIV cannot be prevented solely through the efforts of African leaders; they need the help of the international community. HIV prevention will not succeed only through medications; many social reforms are also needed to combat the AIDS epidemic in Africa. HIV infection in Africa has become a humanitarian crisis, and we cannot end this in a couple of days. Although we are equipped with very sophisticated technology, even in the 21st century, Africa without AIDS seems to be a dream. We should try to develop an AIDS vaccine because deadly diseases like small pox were eradicated through vaccination. At this point of time, it seems to be the only way to get rid of this deadly disease. Until then, let’s work hard to prevent further spread of AIDS among African children.
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