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HIV pandemic is coming out as one of the most serious health problems of Africa. For instance, it has been hypothesized that HIV progression rates are higher in Africa as compared to industrialized nations. This paper identifies a problem, gives possible solutions to it and gives a solution that is better than the others.
The Problem: HIV and Young Children
Africa has been acutely hit. The HIV pandemic in this continent has had many consequences for the affected families and their children. For instance, the number of the orphans due to HIV pandemic in Africa, which was about 18.4 million in the year 2010, has kept going up. In these figures, children who are HIV positive as well as made vulnerable by HIV are not included. In a nutshell, these numbers may paint a bare picture, but the orphaned children’s proportion is more amazing. For instance, twelve percent of children were orphaned in Sub-Saharan Africa. For example, in the year 2003, one out of five families with children in South Africa was taking care of one or more orphans. Among people who have been orphaned in Africa, children under the age of six years make about 16%. Even without HIV, this age group is at high risk but the pandemic has increased the childhood vulnerabilities. In Africa children affected by HIV are facing the same challenges as the ones whose parents have died or suffer from other serious diseases. They face very difficult situations due to HIV. Discrimination and stigma are among these situations. There was a study carried out in Zambia and rates of school enrollment were lowest among the poor. Another study in Kenya determined that negative effects of parental death were more severe in household which possessed very few assets before the parents died (Garcia, 93-95).
Solutions to The Problem
Various government programs which usually come in form of basic literacy or post-literacy services, health education and extension programs should be used to reduce the HIV problem in Africa. For example, the programs that are offered at the basic level are meant to enable people to read and write in local languages. A few of the products of such programs move to the post level for the equivalent of formal primary education. The reason for the case of intervention in these programs is that, in large part, the governments are the major forces of intervention for awareness on HIV. The other types of literacy programs such as awareness-raising and oriented can be informed to infuse HIV content, should not be favored by the governments in Africa due to various ideological reasons. For instance, they are unsuitable for intervention for the purpose of promoting HIV. Health education programs such as hygiene, sanitation and family planning are the most suited for HIV intervention and reduction because the relevant HIV topics can be easily incorporated into the health subject matter at hand (Garcia, 211).
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In order to develop an Africa wide agenda for adult education’s response to HIV, various non-governmental bodies or organizations should be involved at local, national and international levels. These will include the institutions, role players and stakeholders, such as the United States and its agencies such as UNESCO, ILO and UNICEF; international and regional financial institutions, such as the International Monetary Fund, Africa Development Bank and the World Bank; regional and continental bodies such as the AU and the ECOWAS. Other interested development partners of Africa such as the Department for International Development, the USAID, the Swedish International Development Agency and the Canadian Agency for International Development should also intensify their involvement. These bodies could develop joint action plans on adult education to address HIV/AIDS in Africa in collaboration with relevant local organizations. Each of these bodies also may have an adult education for HIV/AIDS component in their education intervention and support program, as some of them, such as the World Bank, have already done. While the UN agencies can concentrate on program development and advocacy for policy reform regarding HIV adult education program, the other agencies may play a greater role in supplying funds, since not all African countries are able to provide adequate funds for adult education work. The use of funds which may be supplied needs to be closely supervised to avoid wastage or misapplication as was witnessed during the five-year support of over 8 million US dollars for mass literacy work in Nigeria. The funds were provided by the United Nations Development Program, while three tiers of government in Nigeria provided their own counterpart cash contribution and offered administrative support through the use of existing adult education organs and their personnel (Indabawa, Sabo and Stanley, 111-112).
Abstinence and lifelong mutually faithful monogamous relationships are vital in reducing the promiscuous sexual relations and should be promoted as one of the comprehensive prevention strategies. However, they should not be promoted to the exclusion of all else as abstinence and monogamy may not be an option for many, such as migrants, who are at risk of acquiring infection with HIV. Hence for those who are unable to, or fail to reduce their number of promiscuous sexual relations, the prevention goal is to reduce the probability of transmission in promiscuous sexual relations. In this context male and female condoms provide a proven prevention option. Microbicides, vaccines, antiretroviral prophylaxis, control and prevention of herpes simplex virus-2 infection and male circumcision are unproven prevention options, which may have great potential in the future (Karim, 290-292).
Africans should be encouraged to use condoms. There are convincing data from several studies collated in a Cochran review that consistent condom use reduces HIV incidence by almost 80%, within the context of the varying levels of effectiveness described in different studies. To highlight just one study in discordant couples, there were no new infections in those who used condoms consistently, while the HIV incidence was 4.8% in those who used condoms inconsistently. Condoms are 86% to 97% effective for protection against unintended pregnancy. Hence, there is compelling evidence that condoms are effective if used consistently. In the past decade female condoms have become available as an additional barrier method. In vitro data support their impermeability to HIV. Several studies demonstrate that they are as effective as male condoms use such that female condoms will merely displace male condoms and not really increase overall condom use. Data from the female condom program in Brazil, however, which used community-based and health care settings, consistently showed that there was a substantial increase in the number of protected coital acts with the introduction of the female condom, regardless of the way in which they are introduced. In other words, the overall number of sex acts protected by a condom rose substantially, showing the beneficial effect of introducing the female condom (Karim, 290-292).
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Detecting infection early for minimal impact and intervening within risk contexts. Prior to the availability of ARV therapies, there were a few good reasons for a person to want to know his or her HIV status. At that time it seemed reasonable that a person could just assume that everyone had HIV and practice safer sex to avoid becoming infected and infecting others. It was a common phenomenon for people with HIV to learn so only when they became ill. The double jeopardy of being diagnosed simultaneously with HIV and AIDS has significant psychological ramifications. Today, late diagnosis of HIV infection represents lost opportunities for life-extending medications and also for positive prevention. HIV transmission occurs during the entire course of HIV infection, not just in the early acute phases. The earlier people know that they are infected, the greater their chances of forestalling AIDS by engaging in proactive health practices as well as their stemming HIV transmission through positive prevention.
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The personal, interpersonal and social contextual factors that influence behavior and facilitate a person becoming HIV infected do not disappear when a person becomes HIV infected. Several factors are reliable predictors of HIV transmission including gender-power imbalances, non-injection substance use, alcohol use, depression and emotional distress, maladaptive coping, non-HIV sexually transmitted infections, high levels of stigma, homelessness, and food insufficiency. These same factors continue to influence behavior after a person has contracted HIV. For example, Luriel et al. found that urban residence and history of alcohol consumption were independent predictors of sexual activity in people living with HIV receiving services from South Africa wellness clinics. In a household survey conducted in Acape Town Township, Smit et al. found a significant association between experiencing forced sex and transactional sex with depression, post-traumatic stress, and substance use. Contextual factors such as emotional distress and substance use are therefore likely to be more concentrated among people living with HIV/AIDS as they are in risk populations. The high prevalence of co-occurring contextual factors may tax health systems unless they are specifically designed to deliver multiple services for multiple diagnoses. Positive prevention interventions will be effective only to the degree to which they address of transmission risk behaviors (Rohleder, 278-279).
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A Better Solution
As compared to other solutions, the use of condoms will be more effective in reducing the HIV problem in Africa. For instance, the theoretical efficacy of latex condoms for preventing HIV transmission is 100%. Tests have confirmed that latex condoms do not leak HIV in the laboratory setting. In contrast, natural membrane condoms should not be used to prevent HIV infection because they may allow HIV transmission through small pores. Latex condoms may also prevent HIV infection by decreasing the incidence of other sexually transmitted diseases that may facilitate HIV transmission
Proper and consistent condom use has a proven record of effectiveness in the prevention of sexual transmission of HIV. In both Europe and Africa studies have demonstrated up to a 90% reduction in HIV transmission among serodiscordant couples who reported consistent condom use. In a meta-analysis of 12 studies among serodiscordant couples, consistent condoms use was 87% protective against HIV transmission compared with lack of condom use. Over reporting of condoms use may account for some of the transmission reported in these studies. In a study conducted by the European Study Group on Heterosexual Transmission of AIDS, no HIV transmission occurred during 15,000 acts of intercourse among 124 serodiscordant couples who reported 100% use of latex condoms. Male latex condoms have remained central to HIV prevention campaigns due to their proven bio-efficacy in protecting sexual partners from HIV (Essex, 498).
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The impact of HIV on Africa has been devastating and the number of people already infected with HIV means that its impact will inevitably worsen in the coming decades. However, the lessons learned from the successful responses to the problem, which have resulted in sustained reductions in HIV prevalence in some areas, demonstrate that the spread of the epidemic and its impact can be reduced and mitigated respectively. To do so requires comprehensive responses that take account not only of heterogeneity of the epidemic but the complex social, population and biologic dynamics that determine the course of the epidemic.
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