Magazine article Monthly Review

Africa and AIDS: Dependent Development, Sexism, and Racism

Magazine article Monthly Review

Africa and AIDS: Dependent Development, Sexism, and Racism

Article excerpt


Acquired Immune Deficiency Syndrome (AIDS) is epidemic in the United States, but AIDS is more than just an epidemic. AIDS is a pandemic, meaning that it is worldwide in distribution and began in a number of areas in the world almost simultaneously. In fact, by March 1987, 44,652 cases of AIDS had been reported in 99 countries and on every continent in the world. It has appeared in the Pacific Oceania complex of islands and Australia, in South and Central America, and, although delayed in its appearance, it is also now present in Asia. Nowhere, however, is its appearance more ominous than in Africa.

It is extremely difficult to judge the exact extent of AIDS in Africa although it has been estimated that between one and five million persons may carry the AIDS virus in Central and Southern Africa, the most heavily affected regions of the continent. The countries of Rwanda, Zaire, Zambia, and Uganda seem to be particularly hard hit.

AIDS was first discovered to be present in Africa when it was diagnosed in upper-class Africans traveling to, and seeking treatment in, European hospitals. The first African cases were diagnosed in Europe shortly after the first diagnosis of AIDS occurred in the U.S. There are two unusual aspects of African AIDS, however, when it is compared to the AIDS epidemic in the United States.

First, the sex ratio of those who have AIDS in Africa is approximately 1:1, an equal number of females having AIDS as males. This is in stark contrast to the 16:1 ratio of males to females in European and U.S. AIDS cases. The sex ratio disparity is related to the very different risk patterns associated with African and North American AIDS cases. In Africa homosexuality or IV drug use is not associated with AIDS or as a means of transmission of the AIDS virus.

When the illness is studied epidemiologically, to see who in the African population contracts AIDS, it is primarily sexually active heterosexuals who evidence the highest incidence of AIDS. Females who have AIDS in Africa tend to be younger than the males and are often single. There appears to be a higher incidence of AIDS among prostitutes than among African women generally. Because women contract AIDS in Africa much more often than in North America, and because AIDS can be transmitted across the placenta from the infected mother to the fetus, there are many more children with AIDS in Africa than in the U.S. In common with the U.S. cases, AIDS appears to occur much more frequently in large cities than in the rural areas of Africa, at least at the present (although this may also be a reporting bias). In common with European and U.S. cases, those who are discovered to have the AIDS virus frequently have a medical history of previous venereal diseases and appear to be more sexually active than those without AIDS.

There is a second unusual aspect of AIDS in Africa. In the United States or Europe a definite series of "opportunistic" infections occur with AIDS such as Kaposi's sarcoma (a skin cancer), toxoplasmosis (a parasitic disease spread by cats and chickens which is usually harmless for those not suffering AIDS), or a type of pneumonia. In africa, in contrast, the opportunistic infections usually do not include any of these. Usually the infections from which AIDS patients in Africa suffer involve the stomach or digestive system, skin diseases, tuberculosis, and meningitis. AIDS in Africa is epidemiologically and clinically quite distinct from AIDS in the European or North American setting. In fact, "the definition of AIDS used in the West needs to be broadened for use in Africa."

If the biological agent of the disease is the same in North America and Europe, and research has proven that it is, then why does the occurrence of AIDS in Africa and AIDS in the U.S. look and act so differently? Why does the same biological cause produce such different demographic and clinical results. …

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