Causes of the HIV Epidemic in South Africa

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23rd Sep 2019 Health Reference this

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What has led to the Endless HIV Epidemic in South Africa?

” It is bad enough that people are dying of AIDS but no one should die of ignorance.” Elizabeth Taylor

Every human has the right to acquire and access optimal health. Over the past centuries, medicine has advanced exceptionally with more cures; however,  the closer we get to the panacea, the further it appears within reach due to the emergence of new calamities. Many epidemics have broken out in the past wiping out populations. However, the advancement of technology and medicine have enabled new methodologies to detect and diagnose diseases and have introduced innovative arrangements for effective treatment plans. Thus, the only defense for viruses is our immune system that laid the underlying foundation for the discovery of vaccines that contributed to the decrease in the mortality rate and inoculated many epidemics. Consequently, the development of vaccines provided preliminary protection as it builds up memory cells that prepare the body to fight the disease when exposed to it.  The greatest limitation to the development of vaccines has been the limited resources that are available for research and development. With all the viruses scientists have encountered to date, HIV (Human Immunodeficiency Virus) which progresses into AIDS has caused one of the greatest fatalities, first causing a pandemic then confining into an epidemic in several countries. Known as the “silent killer”, HIV starts of asymptomatic with a degradation of the immune system and the antibody test can only be taken after 3 months of acquiring the infection. It is one of the top 5 leading causes of death in South Africa with 7.2 million people affected, placing it 4th on the list of countries with the highest rates, 18.9%, of HIV/AIDS. This has caused an epidemic in the country causing numerous fatalities and lowering the quality of life. However, with proper social education and medical facilities, these rates can be drastically decreased and prevented.  Although  HIV/AIDS  fatalities have decreased in many countries,  the numbers of cases seem to escalate continuously in South Africa. Disease epidemic is a social process caused by a combination of different factors that have contributed to the manifestation of the HIV epidemic in South Africa.

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The distal factors are intermediates that facilitate HIV transmission but do not act directly on it. They are the channels that expedite pathways of HIV transmission and prevalence. The proliferation in the cases is due to the misconception and perception expressed in the society regarding the virus. It all starts with a hierarchal figure whereas associated thoughts and beliefs are the norms of society. The president of South Africa stated in a UN Assembly: “When you ask the question ‘Does HIV cause AIDS?’, the question is: ‘Does a virus cause a syndrome?’. It can’t….A virus cannot cause a syndrome. The syndrome is a group of diseases as a result of immune deficiency, of the acquired immune deficiency syndrome.”  A president who states such erroneous declaration in front of the whole world gives us an insight into the decisiveness that inhabits the ideology of the South African people’s thoughts and beliefs. This denial of science has provoked and prolonged the epidemic in the country uncontrollably and cost the country the lives of millions.  This falsification and ignorance regressed the resolution to overcome HIV and led to the epidemic the country is facing. 

 Looking back at history, there are a series of events that have escalated to this attitude and discrimination towards HIV infected individuals. Firstly, it’s believed that HIV/AIDS originated among homosexuals (males), prostitutes and drug injection users and if you did not associate yourself with these groups you would not acquire the disease.  Moreover, it was a disease of choice and the people were blamed for having control over the acquirement and transmission of the virus. Being the only one responsible, their diagnosis was labelled as a deviant act which devalued and dehumanized an individual creating scathing stigmatization among the society. Stigmatization not only dehumanizes them but creates this barrier that impedes and deprives them of receiving medical treatment and diagnosis.  Numerous studies of HIV/AIDS-related stigma have been conducted to portray the beliefs and ignorance that disseminates the country and regressed the decline of the virus. One study conducted the traditional beliefs associated with the cause of AIDS and their attitudes towards the syndrome. Lack of education programs and isolation from the modern world has manifested beliefs among communities. 11% of those surveyed believed AIDS was caused by a supernatural power. This traditional belief states that if you enrage the spirits of ancestors or God, they will send illnesses to the individual or withdraw their protection.  Consequently, this brings a sense of repulsion and injustice of social sanctions towards the afflicted. As a conclusion, ignorance has been correlated with the negative HIV/AIDS-related stigmatization which has hindered testing and treatment. Another study focuses on the correlation of discussion and knowledge of the virus with stigmatization. The study shows that living in high prevalence areas provides greater exposure to People Living with HIV/AIDS (PLHA) and a channel of communication between the infected person and an individual. This exchange will reveal the reality of living with the virus and the present knowledge of treatment, perceived availability of antiretroviral drugs, and prevention services provided to battle and manage the disease. Furthermore, decreased fear, misunderstanding and blame are found among individuals who had personal/direct contact with PLHA not expressing the negative HIV-related stigmatization present in the society. On the contrary, areas with low prevalence expressed the highest negative attitudes towards PLHA affecting the availability of the treatment program (ARV) and hastening the spread of the virus. Unsupportive communities dehumanize the infected individual disrupting their daily lives as their disfiguring symptoms progress with no aid.

Economic deprivation has forced women to sell their bodies for basic human survival disregarding any risk of sexually transmitted infections that they may contract. This desperation for survival, to get food, pay rent, raise their children, have urged women to renounce their human rights to male dominance. Moreover, the subservient role of women is a social convention that is socially punishable by the community. There will be social, physical and economic costs to pay for violating men’s power,  the local norm; this includes abuse, loss of financial support, stigmatization, shame and sometimes their lives. Men exploit women’s economic vulnerability to impose risky sexual behaviors that strip’s women’s health and integrity.  This subjects women to unsafe sex as the men reject using a condom, making them highly susceptible. Masculinity is defined by “flesh to flesh” sex as it is necessary for good health, to maintain the blood/sperm within the body. Informants spoke about the dangers of sperm accumulation that leads to a range of mental and physical problems. Furthermore, they emphasized “flesh to flesh” sex was the only pleasurable way to meeting sexual desires and masculinity discouraging the use of condoms.  Moreover, violence and force are factors that prove their masculinity that they have to impose on women.  However, sex is the currency which will outweigh all the pain and violence women endure. Disobedience will cost them abuse, stigmatization and social rejection.

A study was conducted to examine the psycho-social context of HIV transmission among commercial sex workers in a gold mining district. Most of these men have migrated and left their families in order to make a living and support themselves. However, this puts them in dire situations in which they are housed in single sex hostels. This has attracted commercial sex workers to settle in shacks to accommodate these single men. In a recent survey, 25% of the Miners and 69% of sex workers were HIV positive (Williams,1999).  According to social norms, men should maintain their masculinity and health by seeking intimacy and engaging “flesh to flesh” sex. Moreover, it serves as a coping mechanism for the risks and dangers of their everyday working lives. The business is treated as a supply and demand with the customer always being right; women can only comply. Women contract all sorts of STI’s, including HIV, as men refuse to use condoms and shortly they will be at their death bed. The desperation of money outweighs the life-threatening danger HIV compelling women to risk their health and life.

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Dry sex is another social tradition exercised for men’s pleasure. This process involves women insert herbal aphrodisiacs, household detergents, and antiseptics into their vaginas before sex, to ensure they are “hot, tight, and dry”. Men oblige this practice as it makes their partners/sex worker feel like “virgins.” Young women have an immature genital tract with fewer mucous membranes so dry sex will increase the friction making them more susceptible to tearing. Additionally, the introduction of chemicals in the sensitive area causes irreversible damage to the female genitalia.  Furthermore, semen fluid has a higher viral load than vaginal fluid which increases the contraction receptivity. However, women are willing to take the pain and risk of HIV due to two reasons: more clients as it provides higher sexual satisfaction and vaginal discharge is seen as a sign of sickness. “Men do not like loose vaginas. If sex is wet the man thinks I have had sex with someone else and then he won’t pay me.”

Mother to child transmission (MTCT) has contributed to the high mortality rates and high prevalence rates in children. The maternal viral load directly affects the fetus/child through intrauterine, intrapartum and breast feeding; the higher the viral load, the higher the transmission rate compared to low viral load as it indicates a higher possibility. Breast-feeding has the highest risk of transmission rate ranging from 25-45%.  However, there have been many social barriers that made adherence to drug regimens or infant-feeding guidelines difficult. Firstly, HIV infected mothers have low levels of disclosure as they fear stigmatization, abandonment and violence among their community. Secondly, women have to hide the truth with using formula milk as it will expose their HIV condition. Thirdly, there are mixed messages confusing the mother’s conception of infant-feeding as posters of both breast-feeding and formula-feeding are found in the health facility. Moreover, some women entrenched with the concept of “breast milk is best”, tend to outweigh the perceived risk of HIV transmission through breast milk. Lastly, the limited access to formula feeding set by certain dates sometimes urges mothers to breast-feed as they run out of formula feeding. No mother should undergo such ruthless stigmatization that puts her and her child’s health at risk. Unity and support of their family and friends will be the only cure to overcoming this hardship.

The WHO defined Health promotion as “ enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.” HIV has transformed from a deadly disease to a manageable disease. Yet, South Africa still has the most cases of HIV infection in the world prolonging the epidemic in the region. This is fueled by the social construction that acquired the epicenter of the disease epidemic. It is like a domino effect, if you under-estimate its impact and disregarded it in the early stages, you stimulated the endless domino-effect. From 100s to 1000s to millions, the rate of HIV infected individuals peaked making it harder to control the eruption. The hard part is reversing the psychological torture and social ignorance the society implanted among its community.  Controlling the disease will require good governance for health, health literacy and healthy cities. Presidents should support the advancement of science and display factual statistics to their people and accepting the progression of AIDS.  Moreover, there should be access to health care systems and antiretroviral drugs. The most challenging task is to change the perception, stigmatization and beliefs about HIV. HIV infected individuals suffer severe discrimination that demotivates others to be tested so they don’t have to go through the humiliation and shame. There should be a renegotiation of the social and sexual identities regarding those PLHA and towards sexual behaviors. Moreover, there should be a change concerning the control of health which has been proven and achieved by the Bandura Experiment ( children are able to learn through the observation of adult behavior). Educating the young people about the prevention, treatment and transmission of the virus is essential for lowering susceptibility for contracting the virus.   However, this does not assure compliance as they have to transform it into a shared belief to conform among themselves; they should act on a community-level and not on the individualized level. In addition, condom use should be encouraged among sexually active individuals and the “flesh to flesh” masculinity social norm should be eradicated.  Unity is the key to overcoming the epidemic and the community should stand beside each other to defeat the tragedy it is experiencing and not stand against each other discriminating and dehumanizing the unfortunate. Furthermore, women should embrace their confidence, dignity and self-efficacy and not let their impoverished lifestyle coerce them into the deadly business. “Communication leads to community, that is, to understanding, intimacy and mutual valuing” Rollo May (1998)

Citations:

What has led to the Endless HIV Epidemic in South Africa?

” It is bad enough that people are dying of AIDS but no one should die of ignorance.” Elizabeth Taylor

Every human has the right to acquire and access optimal health. Over the past centuries, medicine has advanced exceptionally with more cures; however,  the closer we get to the panacea, the further it appears within reach due to the emergence of new calamities. Many epidemics have broken out in the past wiping out populations. However, the advancement of technology and medicine have enabled new methodologies to detect and diagnose diseases and have introduced innovative arrangements for effective treatment plans. Thus, the only defense for viruses is our immune system that laid the underlying foundation for the discovery of vaccines that contributed to the decrease in the mortality rate and inoculated many epidemics. Consequently, the development of vaccines provided preliminary protection as it builds up memory cells that prepare the body to fight the disease when exposed to it.  The greatest limitation to the development of vaccines has been the limited resources that are available for research and development. With all the viruses scientists have encountered to date, HIV (Human Immunodeficiency Virus) which progresses into AIDS has caused one of the greatest fatalities, first causing a pandemic then confining into an epidemic in several countries. Known as the “silent killer”, HIV starts of asymptomatic with a degradation of the immune system and the antibody test can only be taken after 3 months of acquiring the infection. It is one of the top 5 leading causes of death in South Africa with 7.2 million people affected, placing it 4th on the list of countries with the highest rates, 18.9%, of HIV/AIDS. This has caused an epidemic in the country causing numerous fatalities and lowering the quality of life. However, with proper social education and medical facilities, these rates can be drastically decreased and prevented.  Although  HIV/AIDS  fatalities have decreased in many countries,  the numbers of cases seem to escalate continuously in South Africa. Disease epidemic is a social process caused by a combination of different factors that have contributed to the manifestation of the HIV epidemic in South Africa.

The distal factors are intermediates that facilitate HIV transmission but do not act directly on it. They are the channels that expedite pathways of HIV transmission and prevalence. The proliferation in the cases is due to the misconception and perception expressed in the society regarding the virus. It all starts with a hierarchal figure whereas associated thoughts and beliefs are the norms of society. The president of South Africa stated in a UN Assembly: “When you ask the question ‘Does HIV cause AIDS?’, the question is: ‘Does a virus cause a syndrome?’. It can’t….A virus cannot cause a syndrome. The syndrome is a group of diseases as a result of immune deficiency, of the acquired immune deficiency syndrome.”  A president who states such erroneous declaration in front of the whole world gives us an insight into the decisiveness that inhabits the ideology of the South African people’s thoughts and beliefs. This denial of science has provoked and prolonged the epidemic in the country uncontrollably and cost the country the lives of millions.  This falsification and ignorance regressed the resolution to overcome HIV and led to the epidemic the country is facing. 

 Looking back at history, there are a series of events that have escalated to this attitude and discrimination towards HIV infected individuals. Firstly, it’s believed that HIV/AIDS originated among homosexuals (males), prostitutes and drug injection users and if you did not associate yourself with these groups you would not acquire the disease.  Moreover, it was a disease of choice and the people were blamed for having control over the acquirement and transmission of the virus. Being the only one responsible, their diagnosis was labelled as a deviant act which devalued and dehumanized an individual creating scathing stigmatization among the society. Stigmatization not only dehumanizes them but creates this barrier that impedes and deprives them of receiving medical treatment and diagnosis.  Numerous studies of HIV/AIDS-related stigma have been conducted to portray the beliefs and ignorance that disseminates the country and regressed the decline of the virus. One study conducted the traditional beliefs associated with the cause of AIDS and their attitudes towards the syndrome. Lack of education programs and isolation from the modern world has manifested beliefs among communities. 11% of those surveyed believed AIDS was caused by a supernatural power. This traditional belief states that if you enrage the spirits of ancestors or God, they will send illnesses to the individual or withdraw their protection.  Consequently, this brings a sense of repulsion and injustice of social sanctions towards the afflicted. As a conclusion, ignorance has been correlated with the negative HIV/AIDS-related stigmatization which has hindered testing and treatment. Another study focuses on the correlation of discussion and knowledge of the virus with stigmatization. The study shows that living in high prevalence areas provides greater exposure to People Living with HIV/AIDS (PLHA) and a channel of communication between the infected person and an individual. This exchange will reveal the reality of living with the virus and the present knowledge of treatment, perceived availability of antiretroviral drugs, and prevention services provided to battle and manage the disease. Furthermore, decreased fear, misunderstanding and blame are found among individuals who had personal/direct contact with PLHA not expressing the negative HIV-related stigmatization present in the society. On the contrary, areas with low prevalence expressed the highest negative attitudes towards PLHA affecting the availability of the treatment program (ARV) and hastening the spread of the virus. Unsupportive communities dehumanize the infected individual disrupting their daily lives as their disfiguring symptoms progress with no aid.

Economic deprivation has forced women to sell their bodies for basic human survival disregarding any risk of sexually transmitted infections that they may contract. This desperation for survival, to get food, pay rent, raise their children, have urged women to renounce their human rights to male dominance. Moreover, the subservient role of women is a social convention that is socially punishable by the community. There will be social, physical and economic costs to pay for violating men’s power,  the local norm; this includes abuse, loss of financial support, stigmatization, shame and sometimes their lives. Men exploit women’s economic vulnerability to impose risky sexual behaviors that strip’s women’s health and integrity.  This subjects women to unsafe sex as the men reject using a condom, making them highly susceptible. Masculinity is defined by “flesh to flesh” sex as it is necessary for good health, to maintain the blood/sperm within the body. Informants spoke about the dangers of sperm accumulation that leads to a range of mental and physical problems. Furthermore, they emphasized “flesh to flesh” sex was the only pleasurable way to meeting sexual desires and masculinity discouraging the use of condoms.  Moreover, violence and force are factors that prove their masculinity that they have to impose on women.  However, sex is the currency which will outweigh all the pain and violence women endure. Disobedience will cost them abuse, stigmatization and social rejection.

A study was conducted to examine the psycho-social context of HIV transmission among commercial sex workers in a gold mining district. Most of these men have migrated and left their families in order to make a living and support themselves. However, this puts them in dire situations in which they are housed in single sex hostels. This has attracted commercial sex workers to settle in shacks to accommodate these single men. In a recent survey, 25% of the Miners and 69% of sex workers were HIV positive (Williams,1999).  According to social norms, men should maintain their masculinity and health by seeking intimacy and engaging “flesh to flesh” sex. Moreover, it serves as a coping mechanism for the risks and dangers of their everyday working lives. The business is treated as a supply and demand with the customer always being right; women can only comply. Women contract all sorts of STI’s, including HIV, as men refuse to use condoms and shortly they will be at their death bed. The desperation of money outweighs the life-threatening danger HIV compelling women to risk their health and life.

Dry sex is another social tradition exercised for men’s pleasure. This process involves women insert herbal aphrodisiacs, household detergents, and antiseptics into their vaginas before sex, to ensure they are “hot, tight, and dry”. Men oblige this practice as it makes their partners/sex worker feel like “virgins.” Young women have an immature genital tract with fewer mucous membranes so dry sex will increase the friction making them more susceptible to tearing. Additionally, the introduction of chemicals in the sensitive area causes irreversible damage to the female genitalia.  Furthermore, semen fluid has a higher viral load than vaginal fluid which increases the contraction receptivity. However, women are willing to take the pain and risk of HIV due to two reasons: more clients as it provides higher sexual satisfaction and vaginal discharge is seen as a sign of sickness. “Men do not like loose vaginas. If sex is wet the man thinks I have had sex with someone else and then he won’t pay me.”

Mother to child transmission (MTCT) has contributed to the high mortality rates and high prevalence rates in children. The maternal viral load directly affects the fetus/child through intrauterine, intrapartum and breast feeding; the higher the viral load, the higher the transmission rate compared to low viral load as it indicates a higher possibility. Breast-feeding has the highest risk of transmission rate ranging from 25-45%.  However, there have been many social barriers that made adherence to drug regimens or infant-feeding guidelines difficult. Firstly, HIV infected mothers have low levels of disclosure as they fear stigmatization, abandonment and violence among their community. Secondly, women have to hide the truth with using formula milk as it will expose their HIV condition. Thirdly, there are mixed messages confusing the mother’s conception of infant-feeding as posters of both breast-feeding and formula-feeding are found in the health facility. Moreover, some women entrenched with the concept of “breast milk is best”, tend to outweigh the perceived risk of HIV transmission through breast milk. Lastly, the limited access to formula feeding set by certain dates sometimes urges mothers to breast-feed as they run out of formula feeding. No mother should undergo such ruthless stigmatization that puts her and her child’s health at risk. Unity and support of their family and friends will be the only cure to overcoming this hardship.

The WHO defined Health promotion as “ enables people to increase control over their own health. It covers a wide range of social and environmental interventions that are designed to benefit and protect individual people’s health and quality of life by addressing and preventing the root causes of ill health, not just focusing on treatment and cure.” HIV has transformed from a deadly disease to a manageable disease. Yet, South Africa still has the most cases of HIV infection in the world prolonging the epidemic in the region. This is fueled by the social construction that acquired the epicenter of the disease epidemic. It is like a domino effect, if you under-estimate its impact and disregarded it in the early stages, you stimulated the endless domino-effect. From 100s to 1000s to millions, the rate of HIV infected individuals peaked making it harder to control the eruption. The hard part is reversing the psychological torture and social ignorance the society implanted among its community.  Controlling the disease will require good governance for health, health literacy and healthy cities. Presidents should support the advancement of science and display factual statistics to their people and accepting the progression of AIDS.  Moreover, there should be access to health care systems and antiretroviral drugs. The most challenging task is to change the perception, stigmatization and beliefs about HIV. HIV infected individuals suffer severe discrimination that demotivates others to be tested so they don’t have to go through the humiliation and shame. There should be a renegotiation of the social and sexual identities regarding those PLHA and towards sexual behaviors. Moreover, there should be a change concerning the control of health which has been proven and achieved by the Bandura Experiment ( children are able to learn through the observation of adult behavior). Educating the young people about the prevention, treatment and transmission of the virus is essential for lowering susceptibility for contracting the virus.   However, this does not assure compliance as they have to transform it into a shared belief to conform among themselves; they should act on a community-level and not on the individualized level. In addition, condom use should be encouraged among sexually active individuals and the “flesh to flesh” masculinity social norm should be eradicated.  Unity is the key to overcoming the epidemic and the community should stand beside each other to defeat the tragedy it is experiencing and not stand against each other discriminating and dehumanizing the unfortunate. Furthermore, women should embrace their confidence, dignity and self-efficacy and not let their impoverished lifestyle coerce them into the deadly business. “Communication leads to community, that is, to understanding, intimacy and mutual valuing” Rollo May (1998)

Citations:

  1.   Campbell, Catherine. “Selling Sex in the Time of AIDS: the Psycho-Social Context of Condom Use by Sex Workers on a Southern African Mine.” Social Science & Medicine, vol. 50, no. 4, 2000, pp. 479–494., doi:10.1016/s0277-9536(99)00317-2.
  2.   Genberg, Becky L., et al. “A Comparison of HIV/AIDS-Related Stigma in Four Countries: Negative Attitudes and Perceived Acts of Discrimination towards People Living with HIV/AIDS.” Social Science & Medicine, vol. 68, no. 12, 2009, pp. 2279–2287., doi:10.1016/j.socscimed.2009.04.005.
  3.   Kalichman, S.c., and L. Simbayi. “Traditional Beliefs about the Cause of AIDS and AIDS-Related Stigma in South Africa.” AIDS Care, vol. 16, no. 5, 2004, pp. 572–580., doi:10.1080/09540120410001716360.
  4.   Mckinnon, Lyle R., and Quarraisha Abdool Karim. “Factors Driving the HIV Epidemic in Southern Africa.” Current HIV/AIDS Reports, vol. 13, no. 3, 2 May 2016, pp. 158–169., doi:10.1007/s11904-016-0314-z.
  5.   Dunham, Robert. “HIV AIDS 7 Unit: HIV Awareness in the Workplace.” www.corexcel.com/courses/hiv-aids-awareness-handout.pdf.
  6.   Wojcicki, Janet Maia, and Josephine Malala. “Condom Use, Power and HIV/AIDS Risk: Sex-Workers Bargain for Survival in Hillbrow/Joubert Park/Berea, Johannesburg.” Social Science & Medicine, vol. 53, no. 1, 2001, pp. 99–121., doi:10.1016/s0277-9536(00)00315-4.
  7.   “What Is Health Promotion?” World Health Organization, World Health Organization, 3 Aug. 2016, www.who.int/features/qa/health-promotion/en/.
  8.   “South Africa.” UNAIDS, 20 Nov. 2018, www.unaids.org/en/regionscountries/countries/southafrica
  9.   Baleta, Adele. “Concern Voiced over ‘Dry Sex’ Practices in South Africa.” The Lancet, vol. 352, no. 9136, 1998, p. 1292., doi:10.1016/s0140-6736(05)70507-9.
  10. Doherty, Tanya, et al. “Effect of the HIV Epidemic on Infant Feeding in South Africa: ‘When They See Me Coming with the Tins They Laugh at Me.’” Feb. 2006, doi: 04-019448.
  11. Walker, L (Liz); Reid, G (Graeme) and Cornell, M (Morna). Waiting to Happen . HIV/AIDS in South Africa: the Bigger Picture. Lynne Rienner, 2004.
  12. Karim, Quarraisha Abdool, and Abdool Karim S. S. Hiv/Aids in South Africa. Cambridge University Press, 2010.

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