Saturday is World AIDS day. Southern Africa has some of the highest rates of HIV infection in the world. Efforts to fight the spread of AIDS in the region are hampered by grinding poverty, war and political instability, and in some cases, by the governments themselves.
Roughly 70 percent of the world's AIDS patients are found in sub-Saharan Africa. The AIDS crisis has forced governments to make tough choices about how best to fight the disease. Allocating resources is never easy, and the scale of the public-health crisis seems utterly overwhelming at times.
The South African government has come under fire for its AIDS policy from all corners - from AIDS activists to health care providers to religious leaders. On Monday (Nov. 26), it found itself in court responding to a lawsuit by the Treatment Action Campaign. The group is demanding that the government allow public hospitals to distribute the drug Nevirapine, which can prevent mother-to-child transmission of HIV, the virus that causes AIDS. The government says the drug still needs testing.
Nonhlanhla Simelane works for a support and advocacy group called the AIDS Consortium. She was one of hundreds of protesters who gathered outside the Pretoria courthouse as the trial began. "Why do we have to start all over again and waste time, and have people dying? I supposed that would be my question to the government, why waste time? Don't they know anyone who is dying of AIDS? Wouldn't they like to help them? Because, obviously, this isn't the people on the ground's problem - this is everyone's problem," he said.
One-in-nine South Africans is infected with HIV. But however bad the AIDS crisis is here, South Africa does not have the highest HIV infection rate in the region. That dubious honor belongs to Botswana, where roughly 35 percent of the adult population is believed to be infected - the highest rate in the world.
In a groundbreaking move, Botswana has recently announced plans to make anti-retroviral drugs available to anyone who needs them. But Botswana is a relatively wealthy country, with rich diamond resources. To help fight AIDS, it has also received a $100 million dollar grant from Microsoft Chairman Bill Gates and the pharmaceutical company Merck.
Other countries in the region are not so lucky. Very few have the resources to buy costly AIDS medicines. Even if they did, their health care systems are not advanced enough to administer them properly.
And so most experts say prevention is the key to stemming the epidemic in Africa. Recent studies show Zambia is beginning to reduce the number of new infections, in part thanks to a massive AIDS awareness campaign, sponsored by the government. Young urban Zambians, unlike many of their neighbors, are beginning to change their sexual behaviors, they are reporting [they have] fewer sexual partners and increased use of condoms.
But there is another problem haunting southern Africa - war. Military conflict and AIDS intersect in a very deadly way. Graca Machel is the former first lady of both South Africa and Mozambique. She was married to the Mozambican president, Samora Machel, before his death, and later married then-South African President Nelson Mandela. She has headed a U.N. research project on children and conflict, and has recently written a book called, The Impact of War on Children.
We should remember that over the past five years, HIV-AIDS has become the single most powerful new factor compounding the dangers for children in a conflict. And while HIV-AIDS has been recognized as a threat to global peace and security, the urgent actions that must be taken to address these threats in situations of conflict have been sadly lacking.
In southern Africa, that problem is most evident in Angola. It has been split by civil war for nearly 30 years. On paper, it has one of the lowest HIV infection rates in the region. But experts say the ongoing conflict makes it hard to really measure the number of people affected. Soldiers themselves can spread the disease to different parts of the country. And the war also makes it incredibly hard for health workers to cope with the epidemic.
Kimberly Gamble-Payne is the U.N. Children's Fund representative in Lesotho. She is also advising Mrs. Machel on her Children and Conflict project. "We know that, in order to respond to the epidemic, people must have access to health care; they must have access to reproductive health services; they must have access to accurate information; they must be supported in using information to change behavior; communities must be supported in caring for family members affected by HIV and AIDS. And we also know that none of those things is possible in situations of armed conflict," she said.
War also affects efforts to fight AIDS outside the conflict zones. Although Zambia itself is at peace, it is surrounded by war and instability. It borders on Angola to the west, the Democratic Republic of Congo to the north, and Zimbabwe to the south. Zambia hosts more refugees than any other country in southern Africa.
Graca Machel says the pressures of day-to-day survival in refugee camps and war zones can also contribute to the spread of HIV. "When you have people who are living in extreme situations, in displaced camps, people have nothing to do. There are thousands of people just moving around the whole day. Even among the civilians, HIV - it spreads very easily, not only because of the militaries, but also because civilians among themselves - they have nothing to do," he said.
The AIDS crisis has spared no country in southern Africa. In the tiny kingdom of Swaziland, one out of every four adults is HIV positive. King Mswati recently banned young women from having sex for five years, hoping to stop the spread of the disease among young people. It is a noble objective, but some urban Swazi girls say they feel the policy is unfair to them, and will not work.
The king's plan backfired on him after he chose a 17-year-old schoolgirl to be his eighth wife. Under the policy, she should have remained celibate for five years. The king ended up having to pay the official fine of one cow for breaking his own ban.