I was reading an article today that presented a really intriguing result of the economic mayhem that rules in Zimbabwe. It stopped me enough to make me wonder, what effect, if any the economic slowdown worldwide has impacted on the spread of STi’s. The article i read was posted by a South African reporter after a presentation by Dr Michael Silverman at a major international AIDS conference in South Africa this week. Dr Silverman said the prevalence of the virus that causes AIDS fell from 23 percent in 2001 to 11 percent at the end of 2008. His study was based on tests of 18,746 women at a prenatal clinic in rural Zimbabwe over that period. Dr Silverman, a Canadian infectious disease expert, works at Howard Hospital in Zimbabwe, where the women were tested. Dr Silverman said he concluded that “a lot of the effect (of the decline in HIV infections) is from the collapsing economy.” AIDS experts have long noted that the richest countries in Africa are also those with the highest infection rates. “You can’t pay the sex worker if you have no currency,” he said. “It’s hard to have a concurrent relationship if you’re always in earshot of your spouse, because you can’t afford to travel. Because of the economic collapse, people are forced to stay home, like being in quarantine.
Now it’s almost impossible to compare the UK and Zimbabwe. I mean inflation in the UK even in one of the deepest recessions of the last 50 years makes the UK seem like paradise compared with the hyper inflation that Zimbabwe experiences. However, we all know that the recession has had a major impact on both the economy and family unit here in the UK over the last twelve months. So is it just possible that economic hard times could affect the spread of STi’s throughout the world?
Dr Silverman’s study appears to have only covered the spread of HIV and AIDS in Southern Africa, but what an ideal place to study the impact of economic conditions on the effects on health. It is a well known fact for any person living in Africa that extra marital sexual relationships are common practice. It is common place for men to have two or three wives and several mistresses tucked away in normal circumstances. The battered economy means that sugar daddies are not able to afford to keep their mistresses tucked away, and certainly cannot afford to visit sex workers.
Granted, no matter what the state of the economy, the sex trade will always survive. Even while the majority of the population live below the bread line, there are people who it would seem have a licence to print money. The criminal underworld especially have money to burn and it is common place for those caught up in criminal activities to be associated or linked to the sex trade in one way or another. But with the bulk of the population spending greater lengths of time at home or with their families, could it mean that a new trend could emerge later down the line as hidden benefit of the recession? Will the slowdown in sexual relationships outside of the marital circle, and the lesser use of women of pleasure give the health services a breather in terms of the diagnosis and treatment of STi’s? It is certainly an interesting question and would be an amazing result if it did indeed prove that the fact that the economy has a hic up means that we are spared the effects of the uncontrollable spread of serious illnesses we see currently.
Interestingly the research coming out of Zimbabwe would seem to indicate that this could be the case. Getting accurate AIDS numbers in Africa, however, has been notoriously difficult since researchers are often forced to guess from imperfect indicators like HIV incidence in pregnant women, instead of counting actual numbers of HIV patients. Researchers long have speculated how much they could drive down incidence of AIDS if people were constricted to having sex with partners in their age group. Now, in Zimbabwe, said David Katzenstein, a professor of infectious diseases at California’s Stanford University who has worked in Zimbabwe for 25 years, “everybody’s hungry, there aren’t as many sugar daddies (older men who attract young girlfriends with gifts and money) and those that are around don’t have as much sugar.” “The good news from Zimbabwe is that, apparently without any intervention whatsoever, there does seem to be a declining incidence in young women and maybe young men,” said Katzenstein, who was not involved with Silverman’s study. “Lack of transport, lack of money, lack of food, all decrease the amount of sex that you can have and the number of partners,” Katzenstein said.
Katzenstein noted there is no evidence of a decline in infection rates in other places which had incidences as high as Zimbabwe – Swaziland, Botswana and South Africa’s KwaZulu-Natal province. AIDS infections in many African countries are tending toward a plateau. But Mike Chirenje, an AIDS researcher in charge of obstetrics and gynecology at the University of Zimbabwe, said: “You’re also talking about a period of time when a lot of people were not accessing ARV (anti-retroviral) therapy. So you cannot rule out cases of people dying for lack of access to ARVs” and therefore not being around to be studied. Another consideration: Women infected with the virus are less likely to fall pregnant.
Yes it is possible that we have jumped to a conclusion, and what a wonderful conclusion it would be if we were able to link the slowdown of the spread of AIDS to the slowdown of the economy. Another consideration lurking in the back of my mind is that does the economy have to be impacted to the scale such as in Zimbabwe before this effect kicks in, or would the type of dent we are currently experiencing in the UK have any effect what-so-ever? Another factor that springs to mind here in the UK is the matter of STi’s among the youth. It is a stark statistic that STi’s are far more common between the ages of 16-26 here in Europe than in African countries. Differences in the way of life and children’s up bringing means that the European youth are far more promiscuous than those of the same age group in Africa.
Many ask how anyone can really know what is going on in Zimbabwe, where President Robert Mugabe’s years-long fight to remain in political power triggered economic and social crises that caused as much as a third of the population to flee, collapsed government health and education and left more than 80 percent jobless. The collapse of piped water services brought on a cholera epidemic that killed 2,000 people. But Howard Hospital, run by the Canadian branch of the Salvation Army, remained open throughout the crises. The decline registered by Dr Silverman at Howard is “in keeping with national data that shows from research 10 years ago a decrease from 30 percent (prevalence) to 15 percent today,” said Chirenje, whose work is funded in part by the U.S. National Institutes for Health and who has done clinical trials, especially in HIV prevention through microbicides and risk reduction through condom use.
Simon Gregson, a professor at Imperial College London and a demographer and epidemiologist who has worked half time in Zimbabwe since 1998, said he also sees a sharp decline in Zimbabwe. He was not involved with Dr Silverman’s study. Through studies following the same 10,000 to 12,000 people every couple of years, Gregson said: “We have found that it is not just that more people are dying than are becoming newly infected; it’s not just because the death rate is very high; but the rate of new infections have been coming down and that is because people have been changing their behaviour and adopting safe practices.” The studies show people, particularly men, are having fewer partners, and condom use is quite high, Gregson said in an interview from his office in Zimbabwe. “What’s not so clear is what caused them to change their behaviour and why there is more of a change in Zimbabwe than in other neighbouring countries.”
As I sat reading their facts and figures I can’t help but wonder if they have taken into consideration that the Zimbabwean people have been seeing the effects of AIDS first hand every day for the last ten years. At its peak, 400 people a day were dying as a result of AIDS related illnesses. Over 2,3 million orphans live alone in Zimbabwe, whole families having been wiped out through AIDS. It has become a hard task to get grave space in some of the more populated centres, and there was a time that hospital mortuaries could not store the corpses of the multitude of bodies. Yes there have been very successful education campaigns, and Zimbabwean people while maybe cautious to accept western logic at first are sharp enough to realise when something is in their best interests and adopt the lessons that they are being taught. But just maybe it is the stark lessons of having to bury so many of your own family and friends that has lead to an awakening within the community to change its ways.
But whatever the reason, I can only take comfort that what was once a worry that AIDS would be the end of a nation, has proved that people can change and whether it be as a result of education through the hard examples or a result of the hardships of economic ruin, I am grateful that there is a decline in the prevalence of AIDS cases in Zimbabwe. It is about time some good news came out of the ashes of a once truly proud and wonderful country. Maybe through its ruin Zimbabwe can teach the world something. There is a blessing around every corner if you look hard enough you’ll find it.