Something is wrong with our strategy against hiv/aids

This week on December 1, Rwanda and the world commemorated the International AIDS Day. It is a day to commemorate the Victims, reinvigorate our willingness to fight the pandemic and renew our commitments against the disease and support the infected and affected. This year’s theme is “Condoms for dual protection. Let us talk about it, access it and use it as a fundamental right for all”.

This week on December 1, Rwanda and the world commemorated the International AIDS Day. It is a day to commemorate the Victims, reinvigorate our willingness to fight the pandemic and renew our commitments against the disease and support the infected and affected. This year’s theme is “Condoms for dual protection. Let us talk about it, access it and use it as a fundamental right for all”.

It is estimated that there are 33 million people living with HIV/AIDS and of these 22 million live in Sub-Saharan Africa, possibly the most underdeveloped region of the world. Information about HIV/AIDS became public almost three decades ago and yet new infections continue today.

Some of the gains in the fight against the pandemic are at times eclipsed by the sheer numbers of new infections many of which go unreported. The numbers of new infections may continue to rise unless there is a fundamental shift in the approach in the fight against HIV/AIDS. 

Uganda the erstwhile success story in the fight against the disease has seen a resurgence in new infections that has baffled many observers.  After successfully bringing prevalence down from more than 20 percent in the 1980s to about 6 percent by 2000, Uganda’s HIV levels have stagnated, showing a marginal increase in prevalence over the past few years.

There are currently an estimated 940,000 people living with HIV in Uganda, and a further 1.2 million children who have been orphaned by AIDS. In 2000 the Ugandan health ministry estimated that 800,000 people had died of an AIDS-related illness since the beginning of AIDS related causes.

According to a recent study, 37 percent of new Ugandan HIV infections are attributable to multiple partnerships, 35 percent occur within discordant monogamous couples, 18 percent are due to mother-to-child transmission, and 9 percent occur through commercial sex networks.

The prevalence rate in Rwanda is currently 3% with as high as 7% in urban areas. In many countries south of the Sahara the prevalence rate is in double digits with South Africa’s running in 30s.

There is belief that with antiretroviral therapy making the lives of infected persons, many people no longer equate HIV infection with a death sentence and have “lowered their guard” against the disease.

On February 28, 2003, four patients with HIV at the Biryogo Medical and Social Centre became the first patients in Rwanda to receive antiretroviral therapy through a project funded by the U.S. Agency for International Development (USAID) and its contractor, Family Health International (FHI).

The cost of treating victims of the virus has been estimated at 11,000 US Dollars per individual for a year. In a poor country like Rwanda such a cost can only be met with assistance from donor countries which is not sustainable in the long run as long as new infections occur.

Donors attach strings to the donated funds which may not necessarily rhyme with national priorities or tested methodologies. For example Uganda’s success against HIV/AIDS in the nineties was attributed to the strategy dubbed ABC: Abstinence, Be Faithful, and ‘Condomise’.

According to Stephen Lewis UN Special Envoy for HIV/AIDS in Africa; “PEPFAR’s emphasis on abstinence above condom distribution is a distortion of the preventive apparatus and is resulting in great damage and undoubtedly will cause significant numbers of infections which should never have occurred.

There is no question that the condom crisis in Uganda is being driven and exacerbated by PEPFAR and by the extreme policies that the administration in the United States is now pursuing”.

No amount of donor money will solve the problem of HIV/AIDS in Africa even if the money and the will to commit it towards the pandemic are there.

 It maybe time policy makers and activists looked for different solutions and strategies particularly homemade and tested ones.

The starting point may be: why are there incidences of high prevalence and new infections in Sub Saharan Africa than any other part of the world.

Are Africans in Africa south of the Sahara more promiscuous than human beings elsewhere? Do Africans in sub Saharan Africa have higher libido than people elsewhere? Is it true that HIV is more likely to attack black skinned people than non black?

Is it true that black Africans are less prone to casual sex and more than one sex partner? Is it true that Africans because of poverty care less for life and therefore less likely to consider the risk posed by HIV/AIDS?

None of the above statements is true and people of all races are as much at risk of HIV as Africans. The question is why is there high incidence and prevalence of HIV/AIDS in sub Saharan Africa compared to Asia, Europe, the Americas and certainly the Maghreb.

 There may be other factors but the major one for the high prevalence and continued infections of HIV in sub Saharan Africa is that this part of Africa is caught between modernity and traditionalism.

We have one foot in westernized Judeo- Christian belief and another in traditional African beliefs and values. Our policy and law makers have been influenced by ancient Middle Eastern traditions and beliefs to put in laws and policies to guide Rwandans in the 21st Century.

 Religious leaders have put less emphasis on the spiritual welfare of their charges than on politics and wealth accumulation.

As a result many people live “double lives”: the life we want the community to see and the life we live hidden from the community so that we appear morally and religiously upright. It is the life we lead hidden from the community that is causing the high prevalence.

Our laws are made by “morally high” people who recognize only monogamous union of men and women; consequently many men keep secret concubines (side dishes?).

These relationships contribute to the spread of HIV because there is “trust” between the parties and no condoms are used.  

 Research has indicated that in Rwanda some of our youth become sexually active at the age of 15 and yet Rwandan laws require that someone can only marry at the age of 21! In the Western world boyfriend/girlfriend relationships are normal and expected, in Rwanda hell will break loose if a son/daughter introduced such a friend to his/her parents.

Therefore such relationships are kept secret. Society places importance to material wealth irrespective of the source which makes younger women to keep senior men as a source of money and their peers as friends which creates cross generational spread of HIV.

 We carry out western style weddings and then demand bride price. Society shuns widows remarrying so our husbands visit them in wee hours of the night. We frown at divorcees but are happy when they give birth to children whose fathers may be our husbands.

We must take a stand if the war against HIV is to be won. Under the law a spouse who suspects her/his partner to be unfaithful should have her/his case for divorce disposed of as quickly as putting out a fire. Bride price should be banned by law. Professional social counsellors should be encouraged. Society should shun expensive weddings.

Widows should be encouraged to get married and have families. Marriage should be encouraged with incentives where possible. Religious leaders should not make marriage between two consenting adults difficult. The age of consent should be 18 years.  And finally Polygamy should not be looked down upon.