Anyone following the issue of AIDS and South Africa will know that Mbeki, the President of South Africa, has taken the position that AIDS is not a threat to South Africa, that the issues concerning AIDS have been overblown, that basically AIDS ain't a problem for South Africa and it is just racist for us to say it is. A recent report about mortality rates in South Africa renders this position much less tenable than it could have ever been. In other words, you have to now absolutely believe in the Tooth Fairy now to buy in to Mbeki's positions while before you could just sort of suspect that the Easter Bunny and the Tooth Fairy were lovers in some alternate universe.

Here are some extracts:

South Africa's government reported Friday that annual deaths increased 57 percent from 1997 to 2003, with common AIDS-related diseases like tuberculosis and pneumonia fueling much of the rise.

The increase in mortality spanned all age groups, but was most pronounced among those between ages 15 and 49, where deaths more than doubled. Working-age adults are more sexually active than the rest of the population, and the opportunity for transmitting H.I.V. is greatest among members of this group.

The report states that 499,000 of South Africa's roughly 44 million people died in 2002, up sharply from 318,000 in 1997. Much of that increase appears to result from H.I.V., the virus that causes AIDS. Experts agree that there are at least five million H.I.V.-positive citizens here, the most of any country. Diagnosing AIDS as a cause of death can require advanced medical knowledge and equipment. Moreover, an unknown number of AIDS deaths go unreported because South African life insurance policies frequently do not cover AIDS-related deaths.

Nevertheless, the agency reported that the new figures "provide indirect evidence that H.I.V. may be contributing to the increase in the level of mortality for prime-aged adults, given the increasing number of deaths due to associated diseases."

Dr. Steve Andrews, an H.I.V. clinician and consultant in Cape Town, said the sobering figures in the report suggested that it had not been politically varnished. Given the improvement in medical care and living standards in South Africa, he said, "we should not be seeing this aggressive move in death rates - not at all."

The report concluded that the average number of deaths in South Africa rose to 1,370 per day in 2002 from 870 in 1997, an increase that could not be explained by the 10 percent increase in population during the same period.

The reported causes of death point to AIDS as the factor underlying much of the increase in mortality. Deaths from tuberculosis, influenza and pneumonia - all primary causes of AIDS-related deaths - more than doubled in the five years encompassing 1997 to 2001, while deaths from other AIDS-related diseases like gastrointestinal infections rose about 25 percent.

Deaths from some ailments unrelated to AIDS, like hypertension and cerebrovascular problems, also rose, but at lower rate. General heart disease, once by far the biggest killer of South Africans, fell during the period and was well behind tuberculosis and influenza in 2001.

Two aspects of the report were especially notable.

The death-certificate figures indicate the proportion of deaths among sexually active women is rising significantly compared with deaths among men - a ratio that strongly indicates a country's AIDS-related mortality rate. In 1997, 149 men ages 25 to 29 died for every 100 deaths among women; the comparable figure in 2003 was 77 male deaths for every 100 female deaths.

The report also suggested that AIDS was increasingly exacting a toll among the very youngest South Africans. In 1999, the report stated, disorders of the immune system emerged for the first time as one of the 10 leading causes of deaths of children under 15.

Let's do a little math together, to put some of this in perspective, ok? Just a little math, cause math is not my strong suit. But let's try. The numbers are: 499,000 of South Africa's roughly 44 million people died in 2002. 499,000 is roughly 1% of the total population of South Africa. Slightly more, but close enough for my purposes. Let's compare, then. The population of the United States, according to the Census Bureau is: 295,523,454. Let's just say 296 million. One percent of that would be just about 3 million people. Can you imagine now the scope of this disaster? If an equivalent percentage of Americans were dying of AIDS we would be loosing some three million people a year. Mind boggling, isn't it?

How can Mbeki assert AIDS is not a problem when it is killing 1% of his country a year, and rising?

And consider, briefly, those who are dying and maybe some of the implications associated with those deaths: More woman; more children under the age of 15; and more of working age.

What can we assume results from that?

More women: this would mean that more children will be born with HIV. Fewer women will be around to take care of children. Fewer women will be around to give birth to children. What does that imply about replacement rate? Beats me but I doubt it is anything good.

More children under 15: first, how are they getting this disease? Are they still being used by HIV infected men who think that sexual relations with a virgin will cure them? That belief exists and is acted upon, you know. If children are not surviving, who is going to lead their country into the future? Where will the next great innovators come from? Who will provide for parents as they age? Who will inherit family farms and property?

Working age: If these people get AIDS, who will provide the labor needed to fill government coffers with tax receipts as the economy slows because no one is alive to do the work? Does the country collapse entirely? Is this too far fetched in terms of speculation?

Go away from this post, assuming you got this far, and leave a comment if you disagree. The enormity of this problem and the implications are almost too great for me to wrap my mind around. I'd appreciate your thoughtful comments.

Posted by: Random Penseur at 12:45 PM | Comments (3) | Add Comment
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You really can't understand any problem in its totality. You can't grasp the complexities and the shifting sands which hold up reality. All you can hope for is sometimes to get a glimpse of various aspects of a problem. AIDS in Africa is like that. For other writings I've done about it, go and click on the AIDS category on the sidebar.

Anyway, here's a wrinkle. Here's a new concern. After all the thought and writing about how AIDS is devastating sub-Saharan Africa, it never occurred to me that people would regard the widows and orphans as targets for theft. I extract from the article I read below:

Actually, the answer is simple: custom. Throughout sub-Saharan Africa the death of a father automatically entitles his side of the family to claim most, if not all, of the property he leaves behind, even if it leaves his survivors destitute.

In an era when AIDS is claiming about 2.3 million lives a year in sub-Saharan Africa - roughly 80,000 people last year in Malawi alone - disease and stubborn tradition have combined in a terrible synergy, robbing countless mothers and children not only of their loved ones but of everything they own.

The degree to which men control household property varies from country to country and tribe to tribe.

In matrilineal tribes, children are considered descendants of the mother, and the family typically lives in the mother's village. Should the husband die, the widow typically keeps the house and land, plus items judged to be women's essentials like pots, pans, kitchen utensils and buckets, according to studies by Women and Law in Southern Africa. Her in-laws collect the more valuable belongings, like bicycles, sewing machines, vehicles and furniture.

Many tribes are patrilineal, meaning children are considered the father's descendants and men are seen as the sole property owners in the family. If her husband dies, the wife may be allowed to stay in the couple's house - but, sometimes, only on condition that she marry one of her husband's relatives. If she wants to move, perhaps back to her own family, she typically leaves with nothing but the clothes on her back.

Or she may simply be driven out altogether. Increasingly, in-laws cite the possibility that a widow is infected with the AIDS virus as reason to confiscate her home.

There are laws on the books to protect widows from rapacious relatives, but they are rarely enforced, assuming even that the widow is aware of the legal protections:

Under Malawi law Mrs. Wyson was entitled to half or two-fifths of what her husband left behind. Her in-laws might even have been convicted of property grabbing under a 1998 amendment to the inheritance law that provides for a fine of up to $200 or five years in prison.

Legal centers and human rights advocates say such cases are ubiquitous in sub-Saharan Africa. In one 2001 study in Uganda financed by the United States Agency for International Development, 29 percent of widows said they had been victims of property grabbing. One in five teenage orphans said outsiders had seized their belonging after their parents had died.

Laws to protect the inheritance rights of widows and children are not enforced or are simply no match for the power of tradition, legal advocates say. Few widows know their rights, and fewer still are able to seek legal help, especially in countries like Malawi, where about 500 lawyers serve a population of 11 million.

"Even in families that are better off economically there is normally some sort of coercion or family pressure that forces women to give up their inheritance," said Ms. Scholz, of the housing rights center. Some in-laws threaten to invoke witchcraft if widows persist with their claims. Others simply make life unbearable.

When one widow in Zambia refused to marry her brother-in-law in order to keep her home, her in-laws turned her homestead into a cemetery, Ms. Scholz said in a telephone interview from Geneva. Sixteen graves now lace her property. A local judge recently ruled that the court had no jurisdiction to settle the dispute.

Still, more and more widows are putting up a fight. In Zambia, the police say they investigated 458 cases of property grabbing in 2003. In Malawi, the nonprofit Center for Advice, Education and Research counseled some 120 people on issues of inheritance, death benefits or property grabbing from last July to September, a 60 percent increase from the preceding three months.

I never suspected that even after death, the survivors would be cast out by their blood relatives. I reject the notion that mulitculturalism should prevent me from being judgmental about this. This is barbaric. It is corrupt. It is preying on the weak and the infirm and the children.

And I have to ask, why should we give any money to help people when their own families won't? In effect, we subsidize this practice if we pay for all new things for the survivors after their families denude them of everything, including the iron roof.

This has left me feeling very disheartened. And angry.

Posted by: Random Penseur at 09:34 AM | Comments (3) | Add Comment
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Watching, from afar, as the AIDS plague has ravaged Africa, I have felt completely helpless, as I am sure many of you do. The plight of the adults who suffer from this syndrome has moved me less than the plight of the orphans who are left behind. The children, some of whom are forced to turn to prostitution in order to survive, are the most heart rending of all the victims. I have tried to imagine, and my mind shies away, from what it must feel like for a child to suddenly be left with no parent at all, entirely dependent on his or her native intelligence and skills to survive, to eat, to find shelter, sometimes at a very tender age when we, in the United States, probably would not let a child walk to school alone, much less live alone. I have discovered a charity that seems to be making a difference, though, and I want to call it to your attention: Hope and Homes. H&H helps children orphaned by HIV and AIDS. H&H helps by providing shelter, food, education, and training so that these children can grow and join society. H&H helps keep families together. They are doing the Lord's work, if you will.

H&H also helps place children left in institutions in Eastern Europe and those orphaned by conflict.

You can donate here, if you should wish to do so.

Posted by: Random Penseur at 12:02 PM | Comments (1) | Add Comment
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I have written on AIDS and Africa, before, and discussed the horrifying impact of this syndrome on that continent. But, there were a couple of articles this weekend in the NY Times that brought it all back again. A team of reporters spent 5 weeks in Lavumisa, Swaziland, a small town in South Africa. They interviewed scores of residents. The reporters also recorded their observations. The story is hard to put down. But, primarily, it is a newspaper article. This means it has heart rending human suffering details with hard facts about the impact on the society. I am interested in the facts, here, although I read the human suffering details in the article and found them quite moving. No, my interest is primarily in the huge dislocative effects on society writ large. The disease is destroying society and in Africa and turning the clock back on decades of social and economic progress. As the article asks:

Epidemics typically single out the aged and young - the weak, not those at society's core. So what happens to a society when its fulcrum - its mothers and fathers, teachers, nurses, farm workers, bookkeepers, cooks, clerks - die in their prime?

No one will be able to forecast with any great degree of certainty how this will play out, but we can extract some nuggets from the article just the same, which I do in the extended entry: more...

Posted by: Random Penseur at 08:40 AM | Comments (3) | Add Comment
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Regular visitors will have noticed that I am fascinated by Zimbabwe. It is sort of like watching a train wreck in slow motion. You just can't look away. That same elusive creature, the regular reader, might also have noticed that I am also very concerned about the impact of AIDS in the developing nations of the world. Well, today, the NY Times brought both of these topics together in an article about AIDS in Zimbabwe. As is my habit, I extract for you here those bits from the article which caught my attention. But first, a quick review of the thrust of the article.

The article is a snap shot of the effects of bad governance on AIDS. Briefly, people in Zimbabwe are suffering from AIDS at an enormously high rate but international organizations are reluctant to assist Zimbabwe because one, the present government will likely divert or steal the aid money and two, manipulate the aid for political ends. No one trusts the government, no one wants to throw money into that pit of despair.

Here are some of the statistics that stood out:

*In Zimbabwe, where 1.8 million people are H.I.V. positive and 360,000 need life prolonging antiretroviral drugs, virtually the only ones who get them are the 5,000 who can afford them. Relief workers here estimate that fewer than 1,000 Zimbabweans receive antiretroviral drugs free through government or charitable programs, with little hope of expanding that number.

*Zimbabwe, where roughly one in four adults is infected with H.I.V. and more than 2,500 people a week die of AIDS.

*The plight of this nation of more than 11 million people is evident at Harare Central Hospital, where workers say just 23 patients are receiving antiretroviral treatment and no more can be started until next year because of lack on money. It is obvious at the Parirenyatwa city hospital, where, local news reports say, the morgue reeks of bodies of AIDS victims whose relatives cannot afford to bury them. And it can be seen at one seven-year-old cemetery south of Harare, where more than 14,000 people have already been buried just 18 inches apart, and workers say they dig about 25 graves each day.

It is a hell of a situation. The only question left to ask is: when do you think that entire society will disintegrate?

Posted by: Random Penseur at 09:02 AM | Comments (3) | Add Comment
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I think about AIDS a lot. I have no personal connection to this disease. I know no one who has it or has died from it, to the best of my knowledge. So, that's not why I care. No, generally, I am concerned about the impact AIDS has on developing societies. I am fascinated by how this modern day plague is devastating the African Continent, how social norms appear to be in the process of being rewritten as a result, how prevention and treatment are advanced and thwarted, how Asia is responding in general and China in particular, and how this might effect the world beyond the borders of those countries and continents most particularly affected. Whole generations are being more than decimated and the impact of such a reordering of population norms may not be felt for years.

However, I never really thought much about the impact on US society in the same way, since it seems like the US has AIDS under much better control. I guess I was wrong, at least with respect to the black community here. And, if it concerns such an important segment of our society as a whole, it ought to concern everyone.

The NY Times today had an article on the spread of AIDS in the black community in small, Southern cities: Links Between Prison and AIDS Affecting Blacks Inside and Out. Again, as is my wont, I'll extract some of the statistics that caused my mouth to drop open on the train today:

*Blacks now account for more than half of all new H.I.V. infections, according to the Centers for Disease Control and Prevention. Black women account for 72 percent of all new cases among women. During the decades that the AIDS epidemic has spread, the number of people incarcerated has also soared, to nearly 2.1 million, according to the Bureau of Justice Statistics. Of that total, more than 40 percent are black.

*In North Carolina, African-Americans make up more than 70 percent of all existing H.I.V. and AIDS cases, and about 60 percent of the state's roughly 35,000 prisoners.

*The prevalence of confirmed AIDS cases in prisons is three times as high as it is in the general population, according to the Bureau of Justice Statistics. H.I.V. cases are harder to count, because only 19 states conduct mandatory H.I.V. testing of inmates. But many researchers believe the number of prisoners with H.I.V. to be far higher than the 1.9 percent most recently documented by the justice agency.

I'll put the rest of my observations below in the extended entry section. more...

Posted by: Random Penseur at 09:36 AM | Comments (6) | Add Comment
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I've posted before about the impact of the AIDS virus in Africa. About how 2-3 people have to be hired to perform the same job in middle management in South African companies because chances are statistically very good that only one of them will be around to get the job done. Or maybe I haven't posted about this. I have certainly harangued my wife about it. (By the way, the poor dear deserves your sympathy entirely because before I discovered blogging, she was the sole "beneficiary" of my rants.)

There was an article in the NY Times this morning about AIDS in South Africa. Its lead in was about how graves have to be recycled in Durban because of the high number of deaths and the small amount of cemetery space. It included some shocking statistics and I want to bring them out here so that all my readers, all eleven of you (and you know who you are), can share my concern:

*51 of the 53 municipal cemeteries are officially filled to capacity

*"Five years ago, we used to have about 120 funerals a weekend, but this number has now jumped to 600," Thembinkosi Ngcobo, who heads the municipal department of parks and cemeteries, said in an interview this week. "In order to cope with the current rate of mortality - we hope it is not going to increase - we will need to have 12.1 hectares every year of new gravesites." That is nearly 30 acres.

*Roughly one in eight South Africans is H.I.V.-positive

*in Durban, South Africa's third-largest city with about 3.5 million people, a survey two years ago of women at pregnancy clinics found about 35 percent were infected with H.I.V.

This is tragic. I just never contemplated the effects of the deaths vis a vis funerals and cemetery use. I'm glad that the NY Times brought these facts out.

Posted by: Random Penseur at 08:58 AM | Comments (5) | Add Comment
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