The Coming Plague (136 page)
Authors: Laurie Garrett
34
M. Over, S. Bertozzi, J. Chin, et al., “The Direct and Indirect Cost of HIV Infection in Developing Countries: The Cases of Zaire and Tanzania,” presentation to the Fourth International Conference on AIDS, Stockholm. June 12â16, 1988.
35
Using similar calculations, the average 1988 AIDS patient cost the United States three years of per capita GNP, and as the American epidemic increasingly shifted into communities of extreme poverty that cold value fell further. Using these admittedly crude early attempts at pricing out the AIDS epidemic, 250,000 U.S. cases of AIDS might cost the economy 750,000 years of per capita GNP. But 250,000 Zairian cases would tax that economy to the tune of 4,750,000 years of per capita GNP. See also M. Over, S. Bertozzi, and J. Chin, “A Proposed Approach to Making Preliminary Estimates of the Cost of HIV Infection in a Developing Country,” presentation to the Third International Conference on AIDS and Associated Cancers in Africa, Arusha, Tanzania, September 16, 1988.
36
S. K. Lwangwa and J. Chin. “Projections of Non-Paediatric HIV Infection and AIDS in Pattern II Areas,” presentation to the Fifth International Conference on AIDS, Montreal, June 4â9, 1989.
37
For a sense of the mood in the Global Programme on AIDS, see S. Kingman, “AIDS Brings Health into Focus,”
New Scientist,
May 20, 1989: 37â42; J. M. Mann, “Global AIDS: Into the 1990s,” presentation to the Fifth International Conference on AIDS, Montreal, June 4â9, 1989; and World Health Organization, “Global Programme on AIDS,” prepared for Delegates at the Fifth International Conference on AIDS, Montreal, June 4â9, 1989.
New Scientist,
May 20, 1989: 37â42; J. M. Mann, “Global AIDS: Into the 1990s,” presentation to the Fifth International Conference on AIDS, Montreal, June 4â9, 1989; and World Health Organization, “Global Programme on AIDS,” prepared for Delegates at the Fifth International Conference on AIDS, Montreal, June 4â9, 1989.
38
World Health Organization, “The Global AIDS Situation,”
In Point of Fact
68, 1990; and
World Health Organization, “WHO Revises Global Estimates of HIV Infection,” WHO Press, WHO/ 38, July 31, 1990.
In Point of Fact
68, 1990; and
World Health Organization, “WHO Revises Global Estimates of HIV Infection,” WHO Press, WHO/ 38, July 31, 1990.
39
M. Over and P. Piot, “HIV Infection and Other Sexually Transmitted Diseases,” Chapter 10 in D. T. Jamison and W. H. Mosley, eds.,
World Health Report
(Washington, D.C.: World Bank, 1990).
World Health Report
(Washington, D.C.: World Bank, 1990).
40
H. M. Ntaba, “Access to Health CareâAIDS in the Developing World,” presentation to the Sixth International Conference on AIDS, San Francisco, June 20â24, 1990.
41
E. M. Kiereini, “Women and Children in Africa: AIDS Impact,” presentation to the Sixth International Conference on AIDS, San Francisco, June 20â24, 1990.
42
The role of women in African societies and its relationship to AIDS proved to be the greatest stumbling block to efforts to control the expanding epidemic. Women could not in most African societies insist that their partners use condoms. To do so could mean death, for wives were often of such low status compared with their husbands that they had little right to question any of his sexual practices. Even after a man had been diagnosed as having AIDS, in many African countries he might legally insist that his wife yield to unprotected intercourse. Such rights have been challenged of late in the courts of Zambia, Zimbabwe, Kenya, Côte d'Ivoire, Nigeria, and other countries on the continent.
Thankfully, much has been written over the last five years about this subject, and the once taboo issue of women's rights is becoming the subject of discussion for Africa.
For further insight, see L. Garrett, “AIDS in Africa,”
Newsday,
December 26 and 27, 1988: Al; L. Garrett, “AIDS: What Women Don't Know,”
Elle
, December 1992: 86â96; Global Programme on AIDS, “International Conference on the Implications of AIDS for Mothers and Children: Technical Statements and Selected Presentations,” Paris, November 27â30, 1989; B. Grundfest-Schoepf, W. Engundu, R. waNkera, et al., “Research on Women with AIDS,” presentation to the First International Conference on AIDS Education and Information, Ixtapa, Mexico, October 16, 1989; C. G. Moreno and L. C. Rodrigues, “Safer Sex and Women in Africa,”
Lancet
340 (1992): 57â58; E. Ojulu, “Uganda Prostitutes Are Now Wiser,”
New African,
September 1988: 34; Panos Dossier,
Triple Jeopardy
â
Women and AIDS
(Washington, D.C.: Panos Institute, 1990); J. Perlez, “Toll of AIDS on Uganda's Women Puts Their Roles and Rights in Question,”
New York Times,
October 26, 1990: A14; A. Petras-Barvazian and M. Merson, “Women and AIDS: A Challenge for Humanity,”
World Health,
November-December 1990: 1â32; and “Women and Prevention Strategies,”
AIDS Newsletter,
1992: Item 16, Item 515.
Newsday,
December 26 and 27, 1988: Al; L. Garrett, “AIDS: What Women Don't Know,”
Elle
, December 1992: 86â96; Global Programme on AIDS, “International Conference on the Implications of AIDS for Mothers and Children: Technical Statements and Selected Presentations,” Paris, November 27â30, 1989; B. Grundfest-Schoepf, W. Engundu, R. waNkera, et al., “Research on Women with AIDS,” presentation to the First International Conference on AIDS Education and Information, Ixtapa, Mexico, October 16, 1989; C. G. Moreno and L. C. Rodrigues, “Safer Sex and Women in Africa,”
Lancet
340 (1992): 57â58; E. Ojulu, “Uganda Prostitutes Are Now Wiser,”
New African,
September 1988: 34; Panos Dossier,
Triple Jeopardy
â
Women and AIDS
(Washington, D.C.: Panos Institute, 1990); J. Perlez, “Toll of AIDS on Uganda's Women Puts Their Roles and Rights in Question,”
New York Times,
October 26, 1990: A14; A. Petras-Barvazian and M. Merson, “Women and AIDS: A Challenge for Humanity,”
World Health,
November-December 1990: 1â32; and “Women and Prevention Strategies,”
AIDS Newsletter,
1992: Item 16, Item 515.
43
C. P. Lindan, S. Allen, A. Serufilira, et al., “Predictors of Mortality Among HIV-Infected Women in Kigali, Rwanda,”
Annals of Internal Medicine
116 (1992): 320â28.
Annals of Internal Medicine
116 (1992): 320â28.
44
J. Decosas, “Demographic AIDS Trap for Women in Africa,” presentation to the Seventh International Conference on AIDS, Florence, June 16â21, 1991.
45
See Food and Agriculture Organization (FAO) publications, 1991 to 1993, by David Norse. They are varied and available upon request to FAO, Rome, Italy.
46
S. Armstrong, “South Africa Wakes Up to the Threat of AIDS,”
New Scientist
, February 16, 1991: 19.
New Scientist
, February 16, 1991: 19.
47
C. Hemery, “Spectaculaire Propagation du SIDA en Ethiopie,”
Afrique Nouvelle,
JulyâAugust 1993: 38â39.
Afrique Nouvelle,
JulyâAugust 1993: 38â39.
48
R. M. Anderson, R. M. May, M. C. Boily. et al., “The Spread of HIV-1 in Africa: Sexual Contact Patterns and the Predicted Demographic Impact of AIDS,”
Nature
352 (1991): 581â89.
Nature
352 (1991): 581â89.
49
World Bank, “The Economic Impact of Fatal Adult Illness from AIDS and Other Causes in Sub-Saharan Africa,” Research Project, World Bank, Washington, D.C., 1991.
50
M. King and R. Hall, “AIDS Soon to Overtake Malaria,”
Lancet
337 (1991): 166.
Lancet
337 (1991): 166.
51
The Delphi approach, like Chin's model at GPA, tried to factor for the enormous discrepancy between the numbers of officially reported AIDS cases and HIV infections in the world, on the one hand, and elusive reality, on the other. Chin's approach involved creation of mathematical models of various types of national epidemics and infection spread rates. The Global AIDS Policy Coalition used Delphi techniques of surveying local experts all over the world. Prominent AIDS scientists and physicians were asked to give low- and highball estimates of their country's epidemics, regional pandemics, and the global situation. Statistical methods were used to derive a regional range of estimated pandemic size and future proportions.
Neither technique was perfect. Both lacked crucial data and had to be considered educated guesses.
52
J. Mann, D. J. M. Tarantola, and T. W. Netter, “The Impact of the Pandemic,”
AIDS in the World
(Cambridge, MA: Harvard University Press, 1992), 9â132.
AIDS in the World
(Cambridge, MA: Harvard University Press, 1992), 9â132.
53
United Nations Development Program,
Human Development Report 1993
(New York: Oxford University Press, 1993).
Human Development Report 1993
(New York: Oxford University Press, 1993).
54
World Bank, World Development Report 1993: Investing in Health (New York: Oxford University Press, 1993).
This represented a marked policy shift for the World Bank. Just five years earlier Bank management, still unable to see how the AIDS epidemic imperiled development, withheld a $15 million loan for AIDS education efforts in Zambia because the Kaunda government had fallen behind on repayment of other, non-AIDS loans.
55
According to World Population Profile: 1994 (Washington, D.C.: U.S. Census Bureau, Department of Commerce, 1994), population growth rates between 1994 and 2010 for the sixteen hardesthit countries would be as follows:
| Country | Projected Annual Without AIDS | Growth With AIDS |
|---|---|---|
| Brazil | 0.9% | 0.6% |
| Burkina Faso | 3.1 | 1.6 |
| Burundi | 3.0 | 1.9 |
| Cen. Afr. Rep. | 2.4 | 1.9 |
| Congo | 2.3 | 1.0 |
| C6te dâIvoire | 3.1 | 2.5 |
| Haiti | 2.1 | 1.3 |
| Kenya | 2.5 | 1.0 |
| Malawi | 3.2 | 1.6 |
| Rwanda | 3.5 | 1.7 |
| Tanzania | 3.0 | 1.5 |
| Thailand | 0.9 | -0.8 |
| Uganda | 3.3 | 1.5 |
| Zaire | 3.3 | 2.9 |
| Zambia | 3.4 | 1.4 |
| Zimbabwe | 2.1 | 0.5 |
56
A World Bank study demonstrated that families that absorbed AIDS orphans in Côte d'Ivoire were unlikely to provide the foster children with the same opportunities afforded to their own children. In a survey, foster children performed on average 20 percent more housework and 15 percent more fieldwork than their counterparts who were the natural offspring of the foster parents. And foster children were 30 percent less likely to be sent to school.
57
“Africa Will Suffer âMillions' of AIDS Orphans,”
New Scientist,
February 23, 1991: 23.
New Scientist,
February 23, 1991: 23.
58
E. A. Preble, “AIDS and African
Children, Social Science and Medicine
31 (1990); 671â80. Other estimates of the region's AIDS orphan burden include:
Children, Social Science and Medicine
31 (1990); 671â80. Other estimates of the region's AIDS orphan burden include:
59
Center for International Research,
World Population Profile
:
1994,
op. cit.
World Population Profile
:
1994,
op. cit.
60
J. Decosas,”Fighting AIDS or Responding to the Epidemic: Can Public Health Find Its Way?” Lancet 343 (1994): 1145â46.
61
J. McDermott,
Report to the Speaker of the House of Representatives: The AIDS Epidemic in Asia,
International AIDS Task Force, U.S. House of Representatives, June 6, 1991.
Report to the Speaker of the House of Representatives: The AIDS Epidemic in Asia,
International AIDS Task Force, U.S. House of Representatives, June 6, 1991.
62
AIDS in Asia
Cases Officially Reported by Respective Governments to the World Health Organization
The key exception was Japan. Though Japanese HIV infection rates had remained quite low, social response to AIDS was striking. Even before AIDS appeared on the public health radar screen, Japan had two cultural traditions in place that protected most of its citizens from emerging sexually transmissible microbes: condoms were the preferred mode of birth control, and very few Japanese ever had sex with a non-Japanese. Fear of AIDS only strengthened both those cultural traditions. See T. Kurima, “AIDS in Japan,” presentation to the Conference of Asian Solidarity Against AIDS, Florence, June 18, 1991; K. M. Chysler, “Japan, Alarmed at Arrival of AIDS, Blames Outsiders,”
San Francisco Chronicle
, April 26, 1987: A22; D. Rosenheim, “Spread of AIDS Threatens Japan,”
San Francisco Chronicle,
December 8, 1986: A10; and L. Garrett, “AIDS in Asia,” Morning Edition, National Public Radio, November 23, 1986.
San Francisco Chronicle
, April 26, 1987: A22; D. Rosenheim, “Spread of AIDS Threatens Japan,”
San Francisco Chronicle,
December 8, 1986: A10; and L. Garrett, “AIDS in Asia,” Morning Edition, National Public Radio, November 23, 1986.
Other books
NightWhere by John Everson
WIth a Twist: (The Club #9) by Stratton, M., The Club Book Series
Mom & Me & Mom by Maya Angelou
The Secret of the Soldier's Gold by Franklin W. Dixon
Chasing Sylvia Beach by Cynthia Morris
Hiss of Death: A Mrs. Murphy Mystery by Rita Mae Brown and Sneaky Pie Brown
Desert Bound (Cambio Springs) by Elizabeth Hunter
The Eye of God by James Rollins
The Kind One by Tom Epperson
Accidentally Catty by Dakota Cassidy
