Health Affairs Examines HIV/AIDS Epidemic in Southern Africa, China and U.S. Response
The May/June issue of the health policy journal Health Affairs contains several papers that examine the effect of HIV/AIDS throughout the world, most notably in Southern Africa and China. In the first paper, Jeff Gow, a research associate in the health economics and HIV/AIDS research division at the University of Natal in Durban, South Africa, examines the impact of the HIV/AIDS epidemic on Africa and the effect the epidemic has on U.S. political, economic and national security policies. Gow describes how the epidemic has moved through Africa and what steps -- both successful and unsuccessful -- African leaders have taken to address the disease. He states that the majority of nations in the region are still in denial over HIV/AIDS. Botswana, Nigeria, Namibia and Malawi have recognized the problem, whereas Senegal and Uganda are the only nations that have truly mobilized to fight the disease and have been largely successful using a "combination of early and aggressive control efforts," Gow says. Denial is the biggest factor keeping other nations from mounting similarly effective efforts against the disease, Gow states, noting that the lack of leadership ties into a "lack of public dialogue" on the disease. Gow notes that political will and commitment are the "key ingredient[s]" to fighting the disease successfully in Africa; by speaking out, leaders demystify the disease and can permanently alter the "norms, values and traditions that are fueling the epidemic." Changing such behavior is especially important in Africa because of its limited resources for medical interventions.
The U.S. Role
Gow notes that HIV/AIDS in Africa received "little direct U.S. attention outside of health-based organizations" until the late 1990s. Since then, the U.S. government has taken a "more holistic" approach to fighting the disease, including examining its impact on development, economic, social and political levels. The government has realized that HIV/AIDS "has the potential to destabilize societies, economies and governments" by reducing life expectancy and economic productivity and by altering the capacity of governments to "cope and respond" to various crises. This instability could affect U.S. economic and security interests, Gow says. The government has also realized that high HIV prevalence in other parts of the world could lead to a resurgence of the virus among Americans due to increased foreign travel and immigration. To combat this, the government has increased international HIV/AIDS funding and has approached the issue with a greater international focus, Gow says, noting that the Office of National AIDS Policy now has an "explicit international focus." Gow notes that more resources "should be forthcoming" to fight HIV/AIDS in Africa because it is "in the self-interest of the United States and other Western countries to attempt to reduce the worst impacts of the epidemic" (Gow, Health Affairs, May/June 2002).
AIDS in South Africa and China
Two other papers examine aspects of HIV/AIDS in South Africa and China. Summaries of the articles are provided below:
- South Africa: Fitzhugh Mullan, a physician and clinical professor of pediatrics and public health at George Washington University, profiles the loveLife initiative in South Africa. A combined effort of the South African government, the Kaiser Family Foundation and the Bill & Melinda Gates Foundation, the "bold, controversial" initiative seeks to prevent HIV infections among young people between the ages of 12 and 17 through a "comprehensive message of positive self-image, sex education, sexual protection and personal motivation." The initiative uses regional youth centers, called "Y-Centers," radio programs, "tabloid-format" newspaper inserts and a national youth tournament called the loveLife Games to spread its message (Mullan, Health Affairs, May/June 2002).
- China: Kyna Rubin, an expert on China and an associate editor of Health Affairs, examines the differing levels of HIV/AIDS awareness among China's gay population. About 1.25 million Chinese are HIV-positive, according to estimates made by international health experts, but most Chinese know little about the disease. The majority of HIV cases resulted from tainted blood transfusions and unsanitary donations and intravenous drug use, not through sexual intercourse. However, Rubin states that a combination of ignorance about HIV/AIDS and the closeted lifestyles of most of China's 36 to 48 million men who have sex with men could lead to an epidemic among men who have sex with men and their female partners (Rubin, Health Affairs, May/June 2002).