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More than a goat at Christmas.

By Madeleine Bunting Since HIV/Aids was first diagnosed nearly 25 years ago, more money has been put into combating this disease than probably any other in human history. It's not hard to see why: No other disease has ever threatened such a devastating impact as it attacks the generation whose labor and child-rearing is pivotal to the functioning of any human society. But the latest figures from UNAids ahead of World Aids Day on Thursday show that despite the billions of dollars (perhaps $22 billion since the 80s), prevalence in most of southern Africa is still rising--Swaziland has now crossed the 40 percent mark, while Botswana, at 37 percent, is heading that way, and South Africa is close to 30 percent. So just why has Africa been hit so hard? And why has all the money invested in prevention programs had so little success in Africa (apart from the striking and oft-cited exception of Uganda)? Part of the answer to both questions was offered by 30-year-old Josina, in a clinic in Maputo, the capital of Mozambique, earlier this month. She looked younger than her age despite being HIV-positive and having three children and another on the way. Dressed in a halter-neck T-shirt dress and woolly hat, she shyly explained her position. Twice, she'd had boyfriends but they left her when she got pregnant, she now had a boyfriend, but he was in prison so she had found another boyfriend who had offered to help get him out. What she described was a network of relationships, sometimes overlapping, on which she relied to feed her children. Often she ended up abandoned or betrayed. There are two characteristics to Josina's painful story which are replicated across Africa. Firstly, what's known as "concurrence". Research indicates that the number of sexual partners in Africa and the west is broadly similar, the difference is that across Africa, many men and some women have two, three or more long-term relationships at the same time, whereas in the west, the dominant pattern is of serial monogamy--one at a time with the occasional one-off. The problem is that concurrence is uniquely susceptible to spreading HIV/Aids; transmission is more likely to happen in ongoing sexual relationships than in one-off encounters, and once one person is infected, they will infect the whole network. Secondly, concurrence is reinforced by inequality. This is a disease that is feeding off desperate poverty. If you're worried about where your child's next meal is coming from, or how you are going to avoid being thrown out of your shack for not paying rent, longer-term risks such as dying of Aids carry little weight. The hope was that prevention was simply a matter of making Josina aware of the risks she is taking; information and free condoms would be enough to induce behavior change. But in many places it hasn't worked; Botswana has been swamped in condoms, but they've had little appreciable effect, as Helen Epstein, a molecular biologist at Princeton, points out. Those advocating behavior change still dominate American policy on Aids, and the US--the biggest donor to HIV/Aids programs in Africa--wields huge influence as to how the world sees this disease and how it should respond. The anger among experts is that America's neuroses about its own sexual mores are being projected on to Africa's crisis. Professor Tony Barnett, of the London School of Economics, argues that it is absurd to focus on how people behave without understanding the economic and social context that drives behavior; is Josina's quest for boyfriends a sign of promiscuity, or a rational response to desperate times? HIV/Aids is both a cause and a consequence of the continent's poverty, and it threatens to lock some of the worst-affected countries into a vicious downward spiral. Steel yourself, the worst is still to come: In 10 years those infected today will be very sick, dying or in a desperate search for anti-retrovirals. How does 40 percent of a country die? What kind of societies do you have when children bring up children? It is these kinds of nightmare scenarios that are galvanizing the global effort to scale up anti-retroviral treatment. Complex drug regimes developed in the West are being pared down to the most rudimentary level to be rolled out for millions of people. African governments will need help to build clinics, find nurses and train doctors--to build up a healthcare system, in many places from scratch. The scale of the challenge is daunting. And the challenge here in the West is no less so. How do you engage people in this crisis to commit to the long term? This year's Make Poverty History/Live8 campaign claimed that what was needed was "your voice, not your money". It's not true; both are needed. And we're not talking about a one-off cheque, a goat for Christmas. What this disease requires of us is an unprecedented level of ongoing commitment and ethical imagination. Think of it as the first global tax: Each of us pays for one person's drugs. For the rest of our lifetime, Africans will be struggling with this catastrophe. We can't leave them to it. The GuardianMore than a goat at Christmas

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Publication:The Star (Amman, Jordan)
Date:Dec 3, 2005
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