AIM OF ARTICLE
To provide you with general knowledge on HIV/AIDS;
To provide you with insight into some of the difficulties in controlling the incidence and spread of the epidemic in Ghana/Africa.
INTRODUCTION
In human history, perhaps besides the Black Death (epizoonotics of rats -1348-1894), HIV is one pandemic that has brought unimaginable catastrophe across the globe;
It has and continues to cause pain, grief, fear and uncertainty;
No remedy seems to be in sight;
Most importantly, it affects the cream of a nation’s population (15-45 years).
According to UNAIDS/ WHO an estimated 33 million people are currently living with HIV/AIDS up from 29.5 ml in 2007;
Since 1981 more than 25 million have died of AIDS;
16,000 people are infected daily;
By the end of 2005, 10 million children had lost one or both of their parents.
While cases have been reported in all regions of the world, almost 96% of cases live in low- and middle-income countries, especially sub-Saharan Africa.
Most people with the disease have no access to care and treatment.
HIV primarily affects those in their productive years: more than half of new cases are among those age 25 years
The HIV epidemic not only affects the health of individuals, it impacts on households, communities and the development and economic growth of nations. Many nations hardest hit by HIV also suffer from other infectious diseases, food insecurity and other serious socio-economic problems. No where has the impact of HIV/AIDS been more severe than in sub-Saharan Africa.
In 2004, South Africa alone had about 4.7 million PLWA;
In 2005, over 40% of pregnant women in Botswana were PLWAs;
In Zimbabwe, the average life span of 55 years at independence has been reduced to 35 years and many professionals (doctors, teachers, etc) have died.
In Zambia, 20% of the adult population is sero-positive;
About 25% of Swaziland’s one million people are infected with HIV.
In West Africa, Ivory Coast is the most endemic.
While the statistics are frightening, they do not tell the true picture.
WHAT IS HIV?
In the early 1980s US doctors noticed increasing frequency of an unusual form of pneumonia simply known as ‘PNEUMOCYSTIS PNEUMONIA –LOS ANGELES.’
The sudden appearance of many cases of this and also of a rare skin cancer (Kaposi’s Sarcoma) among young gays, gave the name ‘Gay-Related Immune Deficiency Syndrome’ (GRIDS) to the new disease.
In May 1983, Prof. Montagnier of Pasteur Institute in Paris announced that the killer virus was LYMPHOADENOPATHY ASSOCIATED VIRUS (LAV) associated with gay AIDS patients.
Then in May 1984, Dr. Robert Gallo of the National Cancer Institute in Maryland also discovered a similar virus and named it HUMAN T-CELL LYMPHOTROPIC VIRUS TYPE III or HTLV-III.
Just around the same time, one Dr. Levy in San Francisco also isolated a similar virus but called it AIDS-RLATED-T VIRUS (ARV)
However, in order to bring uniformity in the nomenclature of the AIDS virus, the International Committee on the Taxonomy of Viruses suggested that the virus be simply referred to as HIV.
HIV AS IMMUNOSUPPRESSANT
The HIV as a virus simply attacks the human immune system;
The human immune system has 2 important cells B and T.;
The main duty of the B cell is to monitor and inform the T cell about the movement of any invasive organism (it works like the CIA). The T cell (soldiers) then attacks and destroys the invaders;
With HIV, the body’s immune system is destroyed exposing the body to nosocomial (opportunistic) infections;
Thus, the HIV does not kill but it is the nosocomial infections that do.
ORIGIN OF HIV
The question has often been asked: What is the origin of this disease?
No one knows for sure but there are a number of theories to explain this:
The African connection has existed since 1981. Scientists working on this pointed to the frequency of occurrence of a strange skin cancer in east and central Africa known as KAPOSI’S SARCOMA.
This theory was later abandoned when no connection was established between KS and HIV in the US.
A new theory was invented which posited that the long-tail African green monkey was the origin of HIV because this monkey is a carrier of many diseases that can be transmitted to human beings.
While this theory had not been settled, another group of scientists proposed a Haitian connection. It was argued that between 1960 and 1970 about 14,000 went to Zaire to assist with national reconstruction after independence. These were said to be the possible carriers of HIV to North and South America. This has been debunked in several literature.
Other less popular theories are that Americans brought HIV from the moon or that it was manufactured in the US through genetic engineering for future biological warfare
So far none of these theories has been proved right
SIGNS AND SYMPTONS
Major
Persistent cough (more than a month);
Persistent and chronic diarrhoea;
Sudden significant weight loss (10% body weight loss in 2 months).
Minor
Persistent cough
Persistent skin infections including Kaposi’s sarcoma)
Oral thrush (candidiasis)
Shingles and enlargement of the lymph glands
STAGES OF HIV/AIDS
Stage One: Window Period (1-6 months).
At this stage an infected person looks and tests asymptomatic (very dangerous period);
Stage Two: Major and minor signs begin to appear;
Stages Three and Four: The terminal stages if no ART is accessed.
VULNERABLE GROUPS AND PERSONS
Although all of us are at risk, some are more at greater risk than others. These include:
Gays; intravenous drug users; heterosexual partners of seropositives; infants of mothers with HIV; haemophiliacs who receive infected blood products; commercial sex workers; heterosexuals with multiple partners; persons who share body piercing objects as in tattoo; long distance vehicle drivers, young and sexually active persons, etc.
GLOBAL RESPONSE
WHO’s Global Program on AIDS established in 1987;
In 1996, UNAIDS was created to galvanize world support and funding for AIDS
In 2000, UN Millennium Dev. Goal 6 to halt and reverse the spread by 2015. Also World Bank launched its Multi-Country AIDS Program (MAP)
In 2001, a UN General Assembly Session on HIV/AIDS (UNGASS) was convened and the Global Fund was created;
In 2006, UNAIDS launched a Universal Access Campaign to reach universal treatment by 2010.
As a result of global effort, total global spending on HIV rose from $300 ml in 1996 to $13.7 billion in 2008
Despite these increases, resource needs are still estimated to be much higher ($19.8 billion in 2009, rising to $25.1 billion in 2010 leaving a significant gap
HIV/AIDS IN GHANA
The first AIDS cases were reported in 1986. By December 2003, a total of 76,139 cases had been officially reported. Current estimates, however, put the number of affected close to 400,000 (4% of the population).
Today, almost every Ghanaian from about 14 years has heard of HIV/AIDS and knows at least one mode of its transmission and prevention.
National prevalence rate has reduced from 3.6% to about 1.5% today.
NATIONAL RESPONSE
In the early period of the epidemic, the MOH was put in charge of monitoring and advising government on the issue. However, in 2004 when it was realized that the epidemic was more than a health problem, the National AIDS Commission was established under the Presidency.
Today, there are VCT centres in all the regions and districts.
ART is subsidized. Annual cost per patient per year is about $1,120.21. About 70,000 patients need ART.
Patients pay about $5 per month for prescribed drugs.
REGIONAL PREVALENCE RATES
As at the end of 2005, the regional prevalence rates for the
Infected stood as follows:
Eastern: 6.6%
Central:5.4%
Ashanti: 5.0%
Greater Accra: 4.2%
Western: 4.0%
Brong Ahafo: 3.6%
Upper East: 3.2%
Northern: 2.1%
Volta: 2.0%
Upper West: 1.8%
HIV AND AGE AND SEX COHORTS
In Ghana, as in many countries, the age cohorts most affected are those in the 15 to 49 year group.
As obtains everywhere, these are the most sexually active group in the population and so are highly exposed to the risk of HIV infection.
Due to a combination of biological, social and cultural reasons, Ghanaian women are more affected than their male counterparts.
STAGES OF LIFE
MODE OF TRANSIMISSION
MILITATING FACTORS
Socio-cultural
Poverty levels are high leading to risky behaviours such as rural-urban migration, commercial sex work;
Low contraceptive prevalence rate (>13%);
Gender inequality (poverty of women leads to their dependence on men and to weak sex negotiation);
Tacit acceptance of male multiple relations (polygyny and leviratic practices);
Claims of indigenous healers and faith healers;
Belief that AIDS is a hoax (American Idea to Discourage Sex = AIDS);
Stigma and unwillingness to know status (‘all die be eye-close!’).
Many people do not follow-up after testing positive;
Testing positive means joblessness and social isolation;
The link between HIV/AIDS and sexual immorality in the minds of people;
The belief that nothing can be done to prevent it or that it is a punishment from God or the gods (Almighty Is Destroying Sinners);
Thus, spousal status disclosure is rare;
The belief that the disease can be cured by sleeping with virgins.
Healers’ claim to cure AIDS has not helped in the effort to reduce incidence of the disease.
Service Delivery
Health services for ART are not accessible to many patients (see next table);
Sometimes there are stocks-out.
ART facilities do not provide the needed privacy and secrecy;
Health services are already overstretched and adding HIV/AIDS patients to work load becomes unwelcome additional burden;
HIV/AIDS patients present nosocomial infections also;
One condition for accessing ART include the provision of a ‘buddy’ or confidant;
Many counsellors are not trained.
Stigma within the health institution (location and personnel behaviour)
Political
No strong political commitment from national leadership
Because government must depend on donors for the supply of ART, it must comply with donor conditions.
Under Bush, promoting ‘ABC’ was a condition for receiving support from the US.
Because of the strong relationship between the state and the church, promotion of contraceptives is not fully encouraged.
CONCLUSION
HIV/AIDS is not only a medical but also a developmental and a moral problem. High incidence means shorter lifespan and low productivity for the population. Until effective and low cost treatment regime is found, the state must use its meagre resources to treat the infected. The state’s effort is however not yielding the expected fruits because of a combination of socio-cultural, service-delivery and political factors. Dealing with the epidemic is a difficult task but it must be controlled through aggressive public education and committed political leadership if the future of this nation is to be guaranteed.
HAVE A GOOD DAY!