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December 2000

Staff Editorial
There is hope in an era of Bush.
by the PERSPECTIVE staff

UC Endorsement
Steve Smith and James Coleman are the liberal's choice.
by the PERSPECTIVE staff

Canadian Comrades
It really is better up there.
by Danny Schlozman

Triumph or Tragedy?
Clinton's legacy is one of calculated compromise.
by Jeffrey Theodore

Buying Survival
Africa needs money, now.
by Ved Lekic and Alexandra Neuhaus-Follini

Students for What?
Folic acid has a hidden message.
by Shelby Meyerhoff

Greens Take Root
PERSPECTIVE talks to Cliff Ginn.
by Dev Purkayastha

A Year to Remember
A year from Seattle, the WTO protests go on.
by Bob Elliott

Cry Freedom
America's ideal of freedom is questionable.
by Nikhil Jaikumar

Introspective
In Defense of Money
by Brad Hershbein

Salmagundi

The Back Page
Keeping Christmas
by Julia Silvis

Why do Americans seem to think that the AIDS crisis is subsiding? Maybe it's those posters in subway stations encouraging pregnant women to get HIV tests because new drugs can reduce the risk of passing the infection on to their babies. Maybe it's the images of a robust and healthy-looking Magic Johnson on TV and in magazines. Or maybe it's the fact that our middle-class friends and acquaintances are living longer, better lives with AIDS.

Regardless of the reason for this frightening tendency toward misperception, people all over the world are suffering from AIDS. HIV has infected more than 50 million people, nearly one percent of the human race. 16 million of them are already dead. AIDS has become the deadliest infectious disease in the world; this year alone, 2.6 million people have died of AIDS, more than ever before. Yet many Americans seem to think that the AIDS crisis is subsiding.

In the 1980's, when the AIDS epidemic was a new phenomenon, Americans regarded the issues surrounding the prevention and treatment of AIDS with a sense of urgency. As the novelty of the AIDS epidemic wears off, though, many Americans seem to be unaware that, especially in disadvantaged communities in the United States and in Africa and parts of Eastern Europe, AIDS is wiping out entire populations.

In the United States, the number of AIDS-related deaths is declining. This good news is due in large part to the advent of more effective drugs, highly active anti-retroviral therapies. These therapies are combinations of drugs that attack the virus at various points in its cycle. But these new cocktails are not the cure-alls that many Americans perceive them to be. While it is known that these cocktails are effective in suppressing symptoms, their long term efficacies have not yet been established, since the medications are so new. Furthermore, these drugs do not eliminate the virus from the body or prevent transmission.

The cocktails are also an incredible burden on AIDS patients, who are required to take up to 20 pills per day, often with severe side effects. The financial burdens are even more extreme; the most effective cocktails cost individuals in the United States about 10 thousand dollars per year, making them unavailable to a large number of HIV-positive Americans. The absence of universal health care does little to alleviate this problem.

While in the general population, AIDS is not spreading as fast as it did in the 80's, it is infecting disadvantaged minority populations at an alarming rate. The AIDS incidence rate (the number of new AIDS cases) is more than four times higher among Hispanics than among whites and eight times higher among African Americans than among whites. The statistics are even more unsettling with regard to young African American women, who are 50% more likely to be infected than their male counterparts. What's more, the rate of infection for these groups has been increasing in recent years.

"Africa is dying," said the representative of Tongo speaking before the UN General Assembly on behalf of the Organization of African Unity. Africa, primarily sub-Saharan Africa, is the region most dramatically affected by AIDS. Currently, there are 24.5 million people infected with the disease in the region, and one in ten adults is HIV-positive. The disease is the continent's number one killer. In Botswana, for example, more than one third of the population is infected. And in sub-Saharan Africa, effective drug treatments are not nearly as available as in the United States. Mortality rates due to AIDS are therefore extremely high, leading to a staggering number of orphans. Of the 11.2 million children who have been orphaned by AIDS, nine in ten live in Africa.

Part of the reason for the incredibly high rate of infection in Africa is that AIDS education there is sorely lacking. For years, the social stigma attached to the disease has helped to perpetuate myths and stereotypes. The social environment offers little support for victims of the disease. Many church leaders characterize AIDS as a disease of sinners, and some have even organized rallies where condoms and brochures containing AIDS information were burned. Misinformation about transmission and treatment of the disease continues to be widespread, and lore in some areas insists that having sex with a virgin will cure an infected man of AIDS.

Countries in sub-Saharan Africa simply do not have the infrastructure or resources to mount effective campaigns against AIDS. Government-sponsored education efforts are virtually non-existent and health care systems are already overwhelmed with other problems, like malaria and famine. Currently, in many African countries, even limited efforts to provide the most basic treatment to AIDS patients are soaking up two percent of the GDP. This economic burden is preventing Africa from making strides in other areas, and is creating a financial crisis for the continent. The situation in Africa is bleak and without a major international effort, it seems unlikely that any real improvement is in store.

The situation in Eastern Europe is also worsening significantly each year. The region is currently experiencing an explosion of new AIDS cases; in the last year alone, the number of overall cases has more than doubled. Since the fall of communism in Eastern Europe, prostitution and drug use have been on the rise, contributing to the spread of HIV. The problem is compounded by the fact that economic upheaval has also precipitated a dramatic decline in the quality of health care available to the average individual.

Romania and Russia have particularly severe AIDS problems. Even hospitals in Bucharest, the Romanian capital, can no longer afford to buy AIDS medication and supplies. The cost of anti-retroviral medication is just too much for the country's beleaguered health care system. Hardest hit are young people, who are especially likely to exhibit risk behaviors. In Russia, intravenous drug use accounted for most of the new cases in the past year. These trends are unlikely to change without a significant change in the attitudes and actions of the world community.

AIDS has become a disease of the poor. Poor communities in the United States and poor countries overseas are being ravaged by the disease. Previously, AIDS wreaked havoc on the gay community, a community perhaps better equipped to combat such a costly and complicated disease. Now, the populations that are least able to deal with the AIDS crisis are most severely affected by it. The people with the least access to health care and education are infected with a disease that bed rest and spiritual healing cannot cure.

Without the proper, often expensive drugs, pregnant mothers can pass on the virus to their children, condemning them to death within several years. Even if the children are not infected before birth, they are often orphaned by their ailing parents. This scenario has been most destructive for the afflicted communities, as they are simply unable to cope with the burden of caring for the orphans. Indeed, Africa's millions of orphans threaten to destabilize entire nations and thus endanger the region as a whole.

The AIDS crisis is now, more than ever, a global social issue, as opposed to a strictly scientific one. A worldwide economic effort is required in order not only to provide medical care to infected people, but also to assist struggling countries whose economies are crumbling under the pressures of having to support sick and dying populations. Administrating programs that seek to accomplish these ends is problematic, though, because if local authorities are corrupt, ignorant, or weak the efforts will be ineffectual.

Global programs to fight AIDS do exist; UNAIDS is a United Nations-sponsored organization that seeks to combat AIDS by raising awareness about the disease. Although this organization has existed for over 12 years, and despite its noble goal, the AIDS pandemic continues to worsen. Education may be a powerful weapon in fighting the spread of the disease, but right now, what poor countries with high rates of infection really need is some cold, hard cash.

Recently, the US has launched some financial initiatives to help fight the AIDS epidemic. The World Bank is negotiating a deal with the Russian government to lend the Russians 150 million dollars to help fund the country's prevention and treatment efforts. Already, the World Bank has created a 500 million dollar fund from which African nations can borrow money to finance their fights against AIDS. However, for countries struggling to feed and clothe their people, such loans are a luxury that can barely be afforded. Furthermore, countries most in need of aid have already amassed enormous debts to foreign creditors, debts that deductions from this World Bank Fund will only increase.

The best offense against the AIDS pandemic is a three-pronged attack: scientific research to develop more effective, more affordable treatments and, eventually, a cure; prevention strategies, including education programs targeted at at risk groups; and economic efforts to provide aid to communities that are being ravaged. While all three of these types of aid would benefit from increased aid in the form of human effort and funding, the necessary economic initiatives are often overlooked. In order for poor countries and communities to establish the infrastructure they need to implement medical and educational programs, massive economic aid is required. But no progress will be made in fighting AIDS if we are fooled into thinking that the AIDS crisis has miraculously vanished./P>

Questions? Comments? Please contact perspy@hcs.harvard.edu