Tuesday, May 20, 2008

Social Components of HIV/AIDS Transmission in Mwandi, Zambia

I'm Dominique Maietta.

Mwandi is a relatively rural village in the South-Western corner of Zambia. The town is home to the Mwandi Christian Hospital, which has a catchment area of approximately 25,000 individuals. During the summer of 2006, I traveled to Mwandi in order to study the psychological and social components associated with HIV/AIDS there. Here I will talk about some of my findings.

The incidence of HIV in the village is around 30-40% and the percentage of HIV positive people is larger within the Mission Hospital patient population according to interviews with medical officers on the hospital staff. The majority of the interviewees expressed their feelings that economic hardship is a major social component of the spread of HIV in Mwandi, just as it is in the rest of Sub-Saharan Africa. Despite the influx of education and knowledge regarding HIV and it’s spread, including mandatory classes in the schools and public service campaigns around the country, the low financial status of the Mwandi community is the root cause for many of the risky behaviors associated with HIV transmission, such as multiple partners and non-use of condoms. This need to engage in risky behaviors appeared to be a particular problem for women and girls who have no other way of making an income other than through sex. Sex for them is not about emotion, but instead about survival.

The problem of poverty affecting HIV rates in Mwandi has further been exacerbated by the construction of a new paved road linking this relatively rural village to other towns and countries. The relatively recent accessibility of Mwandi to the outside world has introduced truckers and migrant workers as passer-bys to the village, and thus created a uniquely new set of problems for HIV transmission in Mwandi. These migrant individuals provide both a source of income for the impoverished village, but also a ready supply of HIV positive individuals to transmit the disease to villagers. As one social worker explained to me, when people come, they come looking for women. Thus the presence of the road, and the truckers from neighboring countries provide a source of income for destitute women and girls with no other means of providing income for their families. Interestingly, the use of sex for money in Mwandi is not so much acceptable, but merely a behavior that occurs, and according to one nurse I spoke with, “this is one of the poorer parts of Zambia, and if a woman has to keep her family, especially if her husband is not around, she will do it somehow”.

Gender disparity issues, then, apart from womanizing on the part of men, is also seen as a major social component of HIV transmission in Mwandi. While men have the power and social standing to hold jobs and make money, women and children have no similar means of providing for their families. Furthermore, although some male orphaned heads of household are given governmental support such as fishing nets which can be used to make a living, young females in similar situations are given minimal support. Thus when husbands die or children are left orphans due to the death of their parents, (generally as a result of AIDS), there is little those children or women can do to raise money other than to fall back to prostitution.

The lack of finances for much of the Mwandi community was also linked by many of the people I spoke with to excessive alcohol consumption, which contributes to promiscuous sexual behavior among Mwandi townspeople. A majority of village leaders perceived that the paucity of jobs and alternative activities in Mwandi village led to the abuse of alcohol followed by unscrupulous sexual activity, (especially by men), which in turn exacerbated the already present problem of HIV transmission. The custom of casual sex and multiple partners was prevalent among men before the HIV pandemic, and is viewed in Mwandi as the “normal mode of boy existence”. This acceptance of male promiscuity also appears to be a key contributor to the continuance of HIV transmission in Mwandi. Lack of sexual control exerted by women, (especially wives), combined with a lax view of expected fidelity in men has resulted in a growth of HIV transmission as husbands will sleep with several partners, become infected, and then infect their wives.

Although it was generally recognized that women lacked the social dominance and power necessary to prevent their husbands from suffering the results of their risky behavior, there were conflicting views as to whose behavior was “responsible” for the spread of HIV. Many of the male interviewees implicated the social behaviors of young people and prostitutes in the spread of HIV. In Mwandi many traditional family cultural values are being challenged with the introduction of the “modern life. As a result, many perceive that young people and their rampant and unprotected sexual behavior is a major social problem contributing to the spread of HIV. This behavior is most often the result of children behaving in a manner mimicking their adult counterparts.

Thus, in Mwandi, extreme poverty combined with alcohol abuse, accessibility to outsiders, and a lack of role models attempting to change behavior are the main factors contributing to the spread of HIV. As the village and the rest of the world becomes more aware of these social factors, changes can be gradually made to stop those underlying social behaviors that support transmission of HIV. Already in Mwandi village leaders have begun to address the issues of poverty and gender disparity by supporting religious and governmental run support groups and clubs to promote sustainable income by women there. Furthermore, use of traditional drama has been incorporated in order to increase public knowledge about the connection between underlying social factors and the spread of HIV in order to stop the cycle of transmission. Although there is much work to be done, the residents of Mwandi are moving in the right direction to combat the social facets contributing to HIV transmission in Mwandi.

Tuesday, May 06, 2008

HIV/AIDS in China

In 2006, official estimates put the number of HIV-positive individuals in China at about 650,000. This figure – reached by the World Health Organization – means that China, holding roughly 1/6th of the world’s population, contributes to only 1/60th of the cases of HIV/AIDS globally. However, it has also been estimated that if rising infection rates are not curbed, the HIV-positive population could breach 10 million by 2010. This has sparked a more liberal attitude from Party leadership toward sex education, which until a year ago, made possession of a condom adequate evidence for prostitution charges.

In developed nations, MSM can account for 70% of HIV infections, while in sub-Saharan Africa, which bears the brunt of HIV infections, heterosexual contact is a major route of transmission. But China’s battle with HIV/AIDS is unique. When HIV first surfaced in China in the 1980’s, it was associated largely with drug use and other practices deemed to be of Western origin. AIDS was known as aizibing, meaning the “loving capitalism disease,” and Party officials did not deem it a serious threat to the general population.

When four hemophiliacs were infected with the virus in the late ‘80s by imported Factor VIII, the government prohibited the use of imported blood products. This allowed for the development of a new for-profit blood collection industry based on the exploitation of poor peasants. Throughout the 1990’s blood collection units popped up throughout rural villages in China, paying peasants the equivalent of $5 for blood. Some would give several pints a day in order to feed their families. In order to keep the donors from becoming anemic, blood was returned to donors after removing the plasma, but the blood of multiple donors was commonly mixed before returning it, and no tests for HIV were conducted. While conservative estimates put the number infected through this route of transmission at under 100,000, others argue that more than a million were infected in Henan province alone. To this day, no government officials have been punished, despite the fact that even police and military units would set up collection stations to raise money.

After the backlash to the SARS outbreak in 2003, government officials in Beijing have opened up slightly, but many activists believe official cover-ups are responsible for preventing treatment to millions of sick villagers. Chinese Premier Wen Jiabao visited Henan Province on World AIDS Day this year to help spread awareness about the disease, but many sick villagers claim they were put on house arrest in order to prevent him from seeing the true state of the epidemic. In some of the worst areas, the so-called “AIDS villages,” activists believe up to 80% of the residents are infected. Gao Yaojie, a retired physician who has won several human rights awards for her work on uncovering the HIV epidemic in China said this of the Chinese Government:

The government's AIDS policy is superficial. It cannot really be implemented. There is a saying in the countryside. The village tells lies to the township government; the township tells lies to the county government; the county tells lies to the state council; the state council issues a document; the document is read by all levels of the government. After they finish reading it, they go into a restaurant, and the document is never put into practice.

Gao Yaojie’s books on the Aids Villages are banned in Henan Province.

In 2003, the government announced the Four Frees and One Care Policy, promising, among other things, free access to anti-HIV drugs for those who could not afford them. But many of those affected claim that these policies do not make it to the level of local implementation. Villagers protest that many hospitals do not offer HIV testing, or that they sell the drugs for their own profit, but their protests fall on deaf ears. Zhou Xihong, a lawyer who has worked with families in Henan trying to access the promised drugs, complains that the courts routinely dismiss their pleas. “They said AIDS patients can get free treatment, so the court doesn’t have to process their cases,” he said.

The Chinese government is now at a crossroads; their desire to control information must be reckoned with their growing integration into the global community. Reports of police violence and strong-armed tactics to quell protests of HIV activists at the local level suggest that international pressure will be the key to tackling the epidemic among China’s peasants head on. Policy changes enacted early this year provide hope that this needed change may be coming. To allow for better coverage of the upcoming Beijing Olympics, resident correspondents no longer need a government OK to go on reporting trips to provinces. But according to some recent reports, villagers who grant interviews to discuss the HIV epidemic still face intimidation and threats from local officials.

Read more about Gao Yaojie’s efforts in China.