There is no single Aids epidemic in Africa, says Hein Marais, until recently the chief writer for the United Nations Joint Programme on HIV/Aids (UNAids). There are many. And reasons for these different patterns may range far from medical territory into the realms of economics and history.
The South African author and journalist is due to speak on Thursday at a seminar co-hosted by the University of Cape Town’s Centre for Social Science Research and the sociology department.
”It is patently untrue that all of Africa is collapsing under the weight of Aids,” he points out. ”There are at least six African countries where HIV prevalence is as low as in several Latin-American and Caribbean countries.”
Although one of the countries with low levels of HIV/Aids infections is the island of Madagascar, all the others are in West Africa.
”This is a geographic pattern which is not simply explained by saying it’s a younger or an older epidemic, and I don’t think it’s explained simply by the virus subtypes,” says Marais, who is now based in Geneva in Switzerland.
”And there is absolutely no basis for saying that the lower numbers will automatically progress to higher levels because prevalence has been staying steady for five and in some countries for eight years, since 1997/98. So we need to look at other factors as well.”
In grim contrast, there are 10 African countries where the epidemic is so intense that at least one in 10 adults is estimated to be infected, according to UNAids statistics. All but one of those countries are in Southern Africa, where ”the epidemic has risen at such a steep angle that it often leaves us speechless”, he says.
In addition, the only African country outside this region with equally high figures is the Central African Republic, where data is so sketchy that the actual figures may vary widely.
”This is the big challenge, to get a clearer grip on why we get epidemics on the scale and severity of Southern Africa when in countries in the Sahel, on the southern strip of the Sahara — Mauritania, Mali and Chad — have among the lowest HIV prevalence [levels] on the continent.”
Marais believes that to explain these differences, aside from looking at biological factors — virus sub-types, other sexually transmitted diseases and protection offered by circumcision — we need to examine social and economic disruption dating back to the colonial era.
”The mystery of why HIV/Aids is so low in one part of Africa and so high in another … for an answer to that question we have to look at the last 100, 120 years of our history. I don’t blame it all on colonialism but go back to [the] Berlin Conference of 1883 [which divided up Africa] and look at how societies were distorted and mutated by the sheer force of colonial modes of capital accumulation, many of which continued under other guises up to today,” he argues.
”Unfortunately there exists a template of medical and sociological factors and dynamics in Southern Africa and parts of East Africa which seems absolutely ideal for a virus of this nature, which makes our efforts to prevent its spread or turn the epidemic around so much more difficult.”
Meanwhile, it’s little comfort that some of the most disturbing news about the epidemic is coming from outside Africa.
”We have global epidemics, plural, moving at distinct paces and driven by often quite divergent factors and dynamics,” he notes. ”The two most dynamic regions are at the moment Asia and Eastern Europe. This is where the epidemics are really racing ahead at a quick pace and with huge potential for adapting to changing social conditions.”
Marais has received praise for his numerous Aids publications, including the annual epidemic updates. He also wrote South Africa: Limits to Change, which has been called ”an important and original book … better than any recent book on the political economy of South Africa’s transition” by Prof John Sender at the department of economics at the University of London.
His seminar runs from 1pm to 2pm on March 10 in the 2B lecture theatre in the Leslie Social Science building on the University of Cape Town upper campus. A day later sees the start of a two-day workshop at the Centre for Social Science Research on the first wave of information flowing from the long-term Cape Area Panel Study into the behaviour and issues — including Aids — facing Cape Town’s teenagers and young adults. For more information, go to www.cssr.uct.ac.za.
Christina Scott works for the Science and Development Network, online at www.scidev.net. She writes this in her personal capacity