HIV/AIDS and Poverty
HIV/AIDS is the deadliest and fastest spreading of the diseases
of sex and reproduction. It poses a greater threat to development
prospects in poor countries than any other disease. The impact
is hardest among the poor, who have no economic cushion and the
weakest social support of any group.
Twenty years after the first clinical evidence of AIDS, it has
become the most devastating disease yet faced by humanity,
striking, on average, 14,000 men, women and children daily, the
leading cause of death in sub-Saharan Africa and the world's
fourth biggest killer.
The disease spreads through infected blood products and drug
abuse, but overwhelmingly by sexual contact, predominantly
between men and women. Women are more vulnerable to infection
for physiological and social reasons, and sex workers are far more
likely than the population at large to be infected. But the sexual
behaviour of men is largely responsible for spreading the disease.
More than 60 million people have
been infected with HIV, and AIDS has already killed
more than 20 million people, according to the Joint
United Nations Programme on HIV/AIDS (UNAIDS) and WHO
(1). In sub-Saharan
Africa alone, 3.5 million were newly infected in 2001.
An estimated 40 million people
are living with the virus, over 28 million in Africa
and almost 95 per cent in developing countries. It is
spreading most rapidly now in Eastern Europe and Central
Asia, where most new infections are among injecting
drug users (2). India
may have more than 4 million infected. Its prevalence
in China is unknown, but it may be far more than the
official estimate of about a million. Some estimates
are as high as 6 million, with a possible 10 million
by the end of the decade (3).
HIV can also be passed in utero from infected mothers to
their children. About a third of infected mothers pass the disease
to their children in this way.
UNAIDS and WHO now estimate that more than 4 million
children under the age of 15 have been infected with HIV. Over 90
per cent were infants born to HIV-positive mothers and acquired
the virus before or during birth or through breastfeeding.
These infections have resulted
in an unprecedented increase in infant mortality, because
HIV infection progresses quickly to AIDS in children
and many of these children have died. Of the 580,000
children under the age of 15 who died of AIDS in 2001,
500,000-nearly nine out of ten-were African (4).
Half of new HIV infections are
among young people aged 15-24, many of whom have no
information or prevention services and are still ignorant
about the epidemic and how to protect themselves. In
studies of sexually active 15-19 year-olds in seven
African countries, at least 40 per cent did not believe
that they were at risk. In one country the figure was
87 per cent. At least 30 per cent of young people in
22 countries surveyed recently by UNICEF had never heard
of AIDS; in 17 countries surveyed, over half of adolescents
could not name a single method of protecting themselves
against HIV. In all surveys, young women know less than
young men, though young women are more vulnerable to
In developing countries HIV/AIDS
is destroying lives and livelihoods alike, wiping out
decades of progress. Even in the industrial countries
most infections are among the poor. No developed country
has an AIDS epidemic even approaching those of the poor
"Economic and social changes …
have created an enabling environment that places tens
of millions of people at risk of HIV infection." (7)
Initiatives that only "seek to change behaviour are
insufficient to stem the epidemic. Determinants of the
epidemic go far beyond individual volition." We will
not stop the pandemic by treating it only as a disease.
HIV/AIDS accompanies poverty, is spread by poverty and
produces poverty in its turn.
The relationship between poverty and HIV transmission is not
simple. If it were, South Africa might not have Africa's largest
epidemic, for South Africa is rich by African standards. Botswana
is also relatively rich, yet this country has the highest levels of
infection in the world. While most people with HIV/AIDS are poor,
many others are infected.
Poverty's companions encourage
the infection: undernourishment; lack of clean water,
sanitation and hygienic living conditions; generally
low levels of health, compromised immune systems, high
incidence of other infections, including genital infections,
and exposure to diseases such as tuberculosis and malaria;
inadequate public health services; illiteracy and ignorance;
pressures encouraging high-risk behaviour, from labour
migration to alcohol abuse and gender violence; an inadequate
leadership response to either HIV/AIDS or the problems
of the poor; and finally, lack of confidence or hope
for the future (8).
Individuals, households and communities living with HIV/AIDS
find that lost earnings, lost crops and missing treatment make
them weaker, make their poverty deeper and push the vulnerable
into poverty. The cycle intensifies.
Inequality sharpens the impact of poverty, and a mixture
of poverty and inequality may be driving the epidemic. A South
African truck driver is not well paid compared to the executives
who run his company, but he is rich in comparison to the
people in the rural areas he drives through. For the woman at a
truck stop, a man with 50 rand ($10) is wealthy; her desperate
need for money to feed her family may buy him unprotected sex,
although she knows the risks.