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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