THE LINK BETWEEN AIDS AND POVERTY

AIDS is now second only to the Black Death as the largest epidemic in history and kills a little less than 2 million people a year (*1). While the link between HIV&AIDS and Poverty is complex, figures suggest that aggregate socioeconomic development does have a protective effect.

This view is supported by fact as 95% of PLWHA (People living with HIV&AIDS) live in developing or transition countries. More specifically, 72% of people living with HIV&AIDS come from Africa home to only 13% of the world population. To add none of the developed countries have population prevalence rates above 0.5%.

During the early years of the pandemic, the chances of poorer individuals being exposed to HIV in the first place was not necessarily greater than wealthier individuals or households. In many countries, relatively rich and better educated men and women have higher rates of partner change because of greater personal autonomy and spatial mobility. At a later stage, however, it has been argued that individuals with higher socioeconomic status tend to adopt safer sexual practices, once the effects of AIDS-related morbidity and mortality become more apparent, adding greater credibility to HIV prevention messages (*2).

Today, the poor are less able to protect themselves as they have more limited access to information about health risks and, even where information on HIV is present, poorer and often more rural communities may still practice unsafe sex if they do not understand the messages or if they do not perceive the risk to be more significant than the other problems they face daily (*3). As Alex de Waal has said of the long term effects of the disease:

“If AIDS is the only disaster that threatens, it is likely that individuals and communities will take action against it. But when AIDS is only one disaster among many, it is not the highest priority.” (*4)

In countries where poverty is prevalent there are often struggling health facilities, which interprets to a lack of prevention and care facilities and services. Individuals in rural areas particularly struggle with access to adequate health service. Consequently, even where health services can be accessed, the poor may be reluctant to use them, and may prefer to turn to alternative less effective traditional forms of medicine not effective for chronic disease management. The big issue here is that if people do not visit clinics to get tested, or to be treated for STIs or TB, the virus will go untreated. Further, the opportunity to access delivery and prevention messages and avail oneself to condoms will also be missed. Consequently those that are HIV positive will be unaware as they continue to spread the disease. (*5)

Unique to the link between poverty and AIDS, and not shared with other infectious diseases is that poor woman are more likely to turn to sex work than richer woman and that poor sex workers cannot always negotiate safe sexual practice. Additionally the female that relies on transactional sex for basic survival, shelter and food for herself and her family, is not in a position to negotiate safe sexual practice.

The effect of caring for someone with AIDS is also on average far more detrimental to lower income families than wealthier families. In such households it may be the sole income earner that has taken ill. The cost of managing the illness, together with funeral and medical payments may require that children drop out of school to seek income to support the familily, thereby perpetuating the cycle of poverty.

People with HIV are extremely vulnerable to TB infection, which causes the death of a third of people with AIDS worldwide. UNAIDS has attributed one third of the increase in TB cases over the last five years to HIV. However, with HIV pushing the spread of TB, TB infection rates are increasing even among HIV-negative people in poor communities (*6). The World Bank has estimated that “about one out of four TB deaths among HIV-negative people would not have occurred in the absence of the HIV epidemic.”

TB affects the poor to a much greater extent than the rich (and, like AIDS, it is a long-term, costly disease), so AIDS, by pushing up TB rates, has an adverse equity impact on the health status of the poor—an impact that has the potential to increase over time. Other opportunistic infections may show a similar pattern. (*7)

In less developed countries school attendance and literacy rates are often lower than in developed countries. The lack of access to good education or any education reduces the chances of the poor having good knowledge of HIV prevention. In South Africa, while the school system remains challenged, the government does spend about 5.3% of gross domestic product (GDP) and 20% of total state expenditure on education, one of the highest rates of public investment in education in the world. The impact being that in 2007, statistics show that South Africa had 14 167 086 pupils enrolled in all sectors of the education system, attending 35 231 educational institutions and served by 452 971 teachers and lecturers. Hence South Africa must ensure that awareness, prevention and management of HIV&AIDS and health care is taught to our youth in our schools, as this is a powerful and captured market place.

*1 Joint United Nations Program on HIV/AIDS (UNAIDS), World Health Organization (WHO).

*2 Is poverty or wealth driving HIV transmission? Gillespie, Stuarta; Kadiyala, Suneethab; Greener, Robertc

*3 M. van Landingham, et. al., (1997)

*4 Alex de Waal, “AIDS: Africa’s Greatest Leadership Challenge,”

*5 http://tilz.tearfund.org/

*6 Centers for Disease Prevention and Control, 2001. “The deadly interaction between TB and HIV,” http://www.cdc.gov

*7 World Bank, “Confronting AIDS: Public Priorities in a Global Epidemic,” World Bank Policy Research Report (New York: Oxford University Press, 1997) Chapter 4, 173–233.