The Human Side of HIV/AIDS

By Judy Fish

You can”t see it with the naked eye.

Few of us encounter it on a daily basis.

It”s not partial to one race of people, or age, or gender.

And at a glance, for those newly infected, it”s impossible to know who carries the virus and who doesn”t.

From its arrival in 1981, when it affected only certain groups of people in a few countries, HIV has grown into a global pandemic, and now claims the most lives of any infectious disease (see the box on page 5).

For the developed world, HIV is primarily a disease among homosexuals and IV drug abusers. In the developing African nations, the mode of transmission is different. Of those 33.2 million people globally living with HIV, 68 percent of them live in Sub-Saharan Africa (SSA), where AIDS remains the leading cause of death.

Last year, of the 2.1 million AIDS deaths worldwide, 76 percent occurred in Sub-Saharan Africa. And this is the reality: for every adult person who dies, there are usually 6 to 10 family members directly affected by that loss: loss of labor, loss of income, loss of leadership in the family, and drained or strained resources. More often than not, the victim and family suffer shame and are ostracized by other family members, neighbors, and the community. An AIDS patient loses his dignity and is made to feel unworthy and of lesser value in the eyes of those around him””and even in his own eyes. This makes it more difficult for the patient and his or her family to deal effectively with the disease. Often because of the stigma and discrimination, infected people find it impossible to continue living.

While statistics should be discussed, let”s not focus on numbers and percentages, for numbers alone don”t tell the story. Let”s look at those souls and lives that have been turned upside down because of HIV. Let”s consider “The Human Side of HIV/AIDS.”

And within this topic, let”s look at those people living with HIV/AIDS (or those who are infected with the human immunodeficiency virus) and those who are affected by HIV. That pretty well covers everyone.

Souls and Lives

Fatou is an older Muslim woman. She is one of two wives, which is fairly common in much of Africa, and she is the older wife. Her husband is a fairly well-off trader who does a lot of traveling in his work. Though she says she has been faithful to her husband, she feels sure her husband has had sex with a number of women throughout their marriage.

After being severely beaten by her husband when she told him she was HIV-positive, she was kicked out of their house and has since been taken in by a sister. Even her family treats her as an outcast. She lives alone in a drafty lean-to in a corner of the courtyard away from the rest of the family. No one comes to visit her; the children of the family are told not to go near her.

A young girl (we call her our “little miss,”) was brought to our clinic by her aunt. Both her parents recently died, probably of AIDS. She tests positive, and so does her aunt. She arrived at the clinic severely malnourished, listless, with a high fever and persistent cough.

Women represent almost 60 percent of the adult HIV infections in Sub-Saharan Africa. Young women/girls are more vulnerable to the virus for a number of reasons. These are a few of the social, cultural, economic, and legal factors that compound the African woman”s risk for HIV.

Cultural Contributors

Unequal power relations between men and women, at the sexual level, put African women in a subordinate/submissive position to men. Little African girls are raised to be nonassertive and to accept their inferior status. Women have no say or control over the circumstances in which sex takes place.

Women, married women especially, often are abused and severely beaten if they demand condoms be used by their husbands or long-term partners. Even when the woman knows the husband has multiple partners, she faces violence for refusing sex with him.

In several countries the first sexual experience of young girls is often coerced or forced. Some become the bride of an older man. When a married woman comes to our clinic and is found to be HIV-positive, often she voices fear for her own life and also fear of her husband, if he finds out about her HIV status.

She may be the second or third wife. Polygamy, as an accepted cultural practice in Africa, carries with it the increased possibility of whole-family infections. This leaves our African sisters psychologically powerless to protect themselves against possible HIV infection from their own husbands.

Widow inheritance, where women are taken by one of their dead husband”s brothers, is a common practice in Africa. Sometimes she is given the choice of marrying the brother-in-law, but more often than not she is obligated to go with him. But consider her choices. Her own family””her parents””probably would not take her back because she and the children from the marriage are simply more mouths for her father to feed.

It”s not uncommon for a new widow to lose her home and whatever land, livestock, household goods, and money belonged to her and her husband. In other words, she is left destitute. This same thing happened to Fatou.

Another African sexual practice is female circumcision. This is an extreme form of “encouraging” women to be chaste; it makes sexual relations less enjoyable, and thus, the woman is thought less likely to wander from her husband. It is common today among some cultures and ethnic groups in a band that stretches from Senegal in West Africa to Ethiopia and Tanzania, East Africa. Obviously if this mutilation is performed in less than sterile situations, the blade or knife can transmit the HIV virus.

In the same manner, HIV can be spread through the cutting tool or needle during the practice of scarification in Africa. This practice is used as a form of initiation into adulthood, or to beautify the body, or as a sign of belonging to a particular village, tribe, or clan.

Compounding all of these cultural practices and restrictions is the burden African women bear regarding caregiving to the victims of HIV. It is the women who care for sick family members and orphans from their own extended families. Even if she is herself infected, or ailing from some other illness, a woman must continue to manage a household, provide care, produce food, and more often than not, generate an income. She may lack education because she has had to function at an early age as a wife. In poor countries, where a year”s supply of ART (antiretroviral therapy) may be $200 to $1,000, prices are still too high for her to receive treatment.

The Burden of Poverty

Poverty makes many even more vulnerable to HIV. The poor live for the present, often barely able to meet their basic, immediate needs. They may not see any future to protect from HIV.

November 2007 statistics from the United Nations Program on HIV/AIDS and the World Health Organization estimate there are 11.4 million orphans in Sub-Saharan Africa. Many have no relatives to take care of them. HIV-positive women may transmit HIV to their children during pregnancy, childbirth, or through breast-feeding. While ART significantly reduces the risk of mother-to-child transmission, only an estimated 5 percent of the women have access to the drugs. This is most likely what happened with our little miss, mentioned above.

The only way an HIV infection can be controlled once it has gained a foothold in the body is through a combination of antiretroviral drugs. More than a million people are now on ART, but it is still only available/accessible to one in four patients who need it. And for every person beginning ART, six people are newly infected.

Those children who are not fortunate enough to have relatives to care for them often must care for themselves and younger siblings. Without older family members to raise, educate, feed, or love them, they will be forced to look elsewhere for this support. Today, street children are one of the most vulnerable groups at risk for HIV/AIDS. Many prostitute themselves and contract HIV. They have never known a world without AIDS.

Only Christ knows the name of every person who has ever lived or died with AIDS. These are not soulless statistics to our Creator God.

Unfortunately the church has responded to the first 20 years of this global disease with silence, stigma, and discrimination. Brothers and sisters, we have the privilege, the responsibility to be complacently idle no longer in this battle.

“Let us not love with words or tongue, but with actions and truth” (1 John 3:18).

Judy Fish is a graduate of Indiana University School of Nursing and the School of Tropical Medicine and Public Health at Tulane University. She has served as a missionary with Christian Missionary Fellowship and Fellowship of Associates of Medical Evangelism in Ethiopia, Ivory Coast, and Ghana since 2000. Her primary roles have been in Community Health Evangelism. This article is adapted from a workshop she presented at the Indianapolis AIDS conference.