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Millions of Africans are still vulnerable to HIV because they do not know the basic facts. People with or suspected of having HIV infection may be turned away by health care providers, denied jobs and housing, refused insurance and entry to foreign countries. In a city in South Africa with a high prevalence of HIV infection, one hospital runs a training program for providers of home-based care for the dying in which the word "AIDS" is never mentioned.
Millions of Africans are still vulnerable to HIV because they do not know the basic facts. People with or suspected of having HIV infection may be turned away by health care providers, denied jobs and housing, refused insurance and entry to foreign countries. In a city in South Africa with a high prevalence of HIV infection, one hospital runs a training program for providers of home-based care for the dying in which the word "AIDS" is never mentioned.
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Millions of Africans are still vulnerable to HIV because they do not know the basic facts. People with or suspected of having HIV infection may be turned away by health care providers, denied jobs and housing, refused insurance and entry to foreign countries. In a city in South Africa with a high prevalence of HIV infection, one hospital runs a training program for providers of home-based care for the dying in which the word "AIDS" is never mentioned.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme DOC, PDF, TXT ou lisez en ligne sur Scribd
The Epidemic and Possibilities for Intervention (Part One)
With 70% of the worlds HIV cases, there is no doubt that Africa is at the center of the global war against AIDS.
Despite generally high levels of basic knowledge, millions of Africans
are still vulnerable to HIV because they do not know the basic facts. Pockets of ignorance and misinformation survive even in the worst affected populations. In the South African town of Carletonville, for example, only 40% of men or women knew that an individual could live with the virus for many years without any outward sign of infection. Around a third of respondents were mistakenly convinced that all HIV- positive people would show symptoms of their infection, while a quarter had no idea what to expect.
In other places, ordinary citizens are still reluctant to acknowledge the
relevance of AIDS to their own lives because of the shame and fear that surround this fatal disease, and the discrimination directed at those affected. People with or suspected of having HIV infection may be turned away by health care providers, denied jobs and housing, refused insurance and entry to foreign countries, thrown out by their spouse or family, even murdered.
Not surprisingly, the great majority of individuals who suspect or know
they are infected do not wish to disclose their status publicly. In the absence of support for sharing the news, most people shrink from telling their spouse or partner that they have HIV. Families protect their loved ones from disclosure during and even after illness and death, and those who care for them often collude in the denial. In a city in South Africa with a high prevalence of HIV infection, one hospital runs a training program for providers of home-based care for the dying in which the word "AIDS" is never mentioned.
It takes no great leap of the imagination to see that, for individuals,
this wall of silence hinders both prevention and care. If people are so afraid to acknowledge or even find out that they are infected, they will lose precious opportunities for warding off or treating illnesses brought on by the infection. If couples cannot talk about risks that either one may have taken, it is hard for either partner to bring up the issue of condoms or HIV testing as a way of preventing further spread of the virus to the spouse or child.
This dilemma has particularly endangered African women of all ages,
who are more likely than men to become infected with HIV during unprotected vaginal intercourse. This vulnerability is especially marked in girls whose genital tract is still not fully mature.
Compounding their biological vulnerability, women often have a lower
status in African society at large and in sexual relationships in particular. This gender vulnerability, again, is particularly acute for young girls. It is the interplay of biological, cultural and economic factors that makes young girls particularly vulnerable to the sexual transmission of HIV. While both girls and boys engage in consensual sex, girls are more likely than boys to be uninformed about HIV, including their own biological vulnerability to infection if they start having sex very young. Girls are also far more likely than boys to be coerced or raped or to be enticed into sex by someone older, stronger or richer. Sometimes the power held over them is mainly that of greater physical strength.
Sometimes it is social pressure to acquiesce to elders. Sometimes it is
a combination of factors, as may be the case with older ‘sugar daddies’ who offer schoolgirls gifts or money for school fees in return for sex. In a recent comparison of HIV infection and behavior in two cities in East Africa with a high prevalence of infection and two in West Africa with a lower prevalence, few striking differences were found in the frequency of extramarital sex or condom use.
However, there was a major difference in the proportion of girls aged
15–19 who said they had started having sex before turning 15, an age at which virtually none are married. In areas where HIV is common, greater sexual activity during the early teens translates inexorably into a high prevalence of HIV among girls.
In South Africa, 10% of respondents in a study in six provinces said
they had started having sex at age 11 or younger. The study, commissioned by the South African Department of Health, recommended that sex education be introduced to children around the age of 12 if it was to reach most of them before they became sexually active. This policy is of particular importance because the other crucial factor pushing up HIV rates in young women is age-mixing. If the girls’ sole sex partners were boys their own age, they would run little risk of becoming infected; there are few if any HIV infections among boys before the late teens. However, girls also have sex with older men who have been sexually active for many years and who therefore tend to be more heavily infected than younger males.
In rural areas of the United Republic of Tanzania, some 17% of
unmarried teenagers reported having had sex with ‘a man at least 10 years older’ than themselves. In a nationwide study in Zambia, over a quarter of the men who had extramarital encounters had casual sex with women ‘10 years or more their junior.’ Men who have sex with younger women may also have other high-risk partners. Among men identified as clients of sex workers in a study in four African cities, for example, around one-third had also had casual sex with teenage girls. Clearly, it is important to complement education on AIDS and life skills with vigorous action against sexual abuse and rape and campaigns to discourage older men from seeking out young girls for sex. (to be continued)