Introduction
Epidemics have always been threatening and disruptive events that jeopardize the health, well-being, and lives of populations across large territories. The outbreak of deadly diseases is particularly dangerous due to its devastating outcomes on the healthcare system, society, economy, and human safety in general. HIV/AIDS is one of the most dangerous viruses that impact an individual’s immune system, exposing them to the fast deterioration of health and susceptibility to comorbidities and complications. The rapid spread of the disease in Africa has been recognized as a global concern due to the uncontrolled transmission of the infection across the continent, with multiple deaths as a result (“AIDs in Africa,” n. d.). Such a rapid development of the epidemic in Africa justifies the need to explore the issue and identify the root causes of HIV/AIDS spread on the continent with particular attention to socioeconomic factors. In particular, socioeconomic factors are the circumstances and processes in society, economy, education, healthcare, family policies, income, and employment that have an influence on the quality of human life.
Thus, this research paper is designed to explain the reasons for the HIV/AIDS epidemic within the context of the antecedents of African colonization. It aims to argue that HIV/AIDS has spread rapidly across Africa due to excessive poverty, the lack of educational and preventative measures, poor healthcare systems development, and cultural particularities of sexual behavior. The socioeconomic factors contributing to the health issue and its outcomes will be addressed in the paper.
HIV/AIDS Disease Overview
Among the many viruses impacting humanity, HIV/AIDS is one of the deadliest and most threatening due to the lack of treatment that would cure the patients with this diagnosis. Overall, HIV stands for Human Immunodeficiency Virus, which ultimately causes Acquired Immune Deficiency Syndrome in the infected individuals (“AIDs in Africa,” n. d.). Sub-Saharan Africa is now the epicenter of the HIV/AIDS epidemic since approximately 70% of people infected with HIV reside in these countries (Velloza et al., 2020). To put this percentage in numbers, one might state that among 36.7 million individuals with HIV, 25.5 million live in Sub-Saharan Africa (“AIDs in Africa,” n. d ). Such a high prevalence of the disease and a disproportionate concentration of the virus in Africa burden the region’s population and its prospects for healthy development.
It is a deadly infection that remains one of the leading mortality causes in Africa. For example, as stated by the SOS Children’s Village organization, “in 2016, there were 730,000 AIDS-related deaths in the region” (“AIDs in Africa,” n. d., para. 3). Although some advancement has been achieved in the promotion of the disease management medication, namely antiretroviral therapy (ART), many people in the region do not know their diagnoses or do not have sufficient access to therapy (Velloza et al., 2020). Thus, a wide range of socioeconomic factors should be considered when identifying the root causes of the infection spread and the difficulty of its management.
Socioeconomic Causes of the Spread of HIV/AIDS in Africa
When determining the specific factors impacting the spread of HIV/AIDS in Africa, one should set the problem into a larger historical context. Indeed, Africa has long been colonized by European countries, which has contributed to the ignition and development of the disease. According to Vance (2019), the period when HIV appeared in Africa on the verge of the 19th and 20th centuries coincides with the active expeditions of the European colonizers into the region. In particular, the relationship between colonization and HIV/AIDS breakout is validated by “unsterile injections of large numbers of Africans that, along with other unsafe therapeutic interventions, may have propelled the evolution of HIV” (Vance, 2019, p. 1). Moreover, the political and population-related policies initiated by colonizers had disruptive health-related influences in the context of HIV spread. Indeed, according to Nugent (2004), “the dislocation of populations and the growth of Magento (the black market) made Uganda an ideal site for the spread of HIV/AIDS” (p. 373). Thus, the inception of the infection was induced by colonization, which had negative socioeconomic influences on the population of Africa, which will be discussed further.
Prevention and Education Issues
With the steady and rapid evolution of the disease and its uncontrolled spread over the continent and beyond, the problematic management of its effects has been associated with the lack of prevention. Indeed, the absence of youth education on HIV/AIDS and the overall population’s awareness about the infection contributes to the rapid spread of the disease. Experts state that HIV is most commonly transmitted during unprotected sexual intercourse with infected individuals (“AIDs in Africa,” n. d.; Vance, 2019). The lack of such knowledge in sexually active youth limits their opportunities for safety and exposes them to particular levels of risk of becoming infected.
Moreover, the lack of educational and preventative measures initiated by governments limits the population’s knowledge about the HI virus and its threatening implications for health and longevity. Indeed, as research shows, African countries have long neglected the identification of HIV as a public health threat relevant to policy implementation (“AIDS in Africa,” n. d.). The majority of the populations residing in Sub-Saharan Africa do not know about the disease, even in modern times. Moreover, “enlightenment is made difficult not least by the fact that the majority of people have no access to education” (“AIDS in Africa,” n. d., para. 10). Thus, since local governments fail to implement adequate preventative policies capable of improving education quality and raise public awareness about HIV/AIDS epidemics, the infection continues to disrupt the continent, remaining a leading cause of death.
Healthcare System’s Inadequacy
Another cause of HIV/AIDS epidemics in Africa is the underdevelopment of healthcare systems. This problem involves the lack of timely and accurate diagnosis, adequate treatment, and proper management of the disease to minimize its spread and deadly consequences. Indeed, with the high rate of cases of HIV infections in the population, an effectively functioning healthcare system is expected to allocate maximum efforts and resources to locate, treat, and manage the disease. However, in African countries that are still recovering from colonialization, the medical industries are poorly developed (Arnold, 2005). The lack of proper resources at a higher level of the healthcare sector minimizes the opportunities for providing adequate care to individuals with the virus. Moreover, the high costs of medications and inaccessibility of clinic treatment for the population, which is recognized as a “system-level barrier,” obstruct patients’ recovery and the obtainment of timely professional help (Velloza et al., 2020, p. 1728). The insufficient development of the healthcare system in the region does not allow for the advancement of HIV/AIDS treatment and consecutively contributes to the fast spread of the disease. The issue stems from larger post-colonial economic problems in the development of Sub-Saharan countries.
Poverty
One of the most influential causes of the HIV/AIDS epidemic in Africa is the insufficient economic development of the region, which has contributed to the elevated levels of poverty, both urban and rural, after Africa’s independence. With the struggle for liberation from the colonizing nations, the countries of Africa have faced economic challenges of advancing their income-generating industries and facilitating proper economic functioning to ensure smooth national development. Indeed, “the leaders carried over into the new dimension of freedom their passionate anti-colonialism, not least because though they had achieved their political freedom, they found themselves prisoners of their countries’ weakness and poverty” (Arnold, 2005, p. 129). With the lack of resources on a country level, the populations face health risks both within governmental systems and in their individual behaviors and lifestyle choices.
More specifically, poverty is related to unemployment, and dysfunctional economic processes limit the population’s opportunities for food, housing, access to services, and, most importantly, health promotion and protection. For example, according to statistics, within the past decades, approximately 30% of the total population of Ghana has lived below the poverty line (Nugent, 2004, p. 352). Approximately 390 million people live in extreme poverty in Africa, which obstructs their opportunities for obtaining contraceptives for safe sex, undergoing HIV tests, and receiving adequate therapeutic treatment to manage the disease (“AIDS in Africa,” n. d.). The countries of Sub-Saharan Africa lack policies to “alleviate poverty, improve economic and financial opportunities for people with HIV/AIDS, and improve infrastructures to empower individuals with HIV/AIDS to continue with productive economic activity” (Gona et al., 2020, p. 12). Furthermore, the burden of the disease on the economy is observed due to the limitations in population longevity and consecutive shortage of workforce to lead the national economies. Thus, the economic causes and outcomes of HIV/AIDS come in unity and have far-reaching long-term implications.
Substance Use
In addition to the abovementioned social and economic factors, one more social concern has its impact on the spread of HIV/AIDS. Indeed, substance use, including alcohol consumption and drug use, are a risk factor for HIV infection. The relationship between substance use and the disease is indirect and implies unsafe behaviors as the outcome of being drugged. In particular, Peltzer and Phaswana-Mafuya (2018) state that “certain health risks behaviors such as common mental disorders, alcohol use disorders, HIV risk behaviors, and criminal victimization have been found to be associated with drug use” (p. 1). The exposure of African populations to substance use is associated with unsafe behaviors and elevated risks for HIV/AIDS spread.
Similarly, alcohol consumption contributes to the HIV/AIDS epidemic in Africa due to the implications of unprotected sex behaviors and the disruption of treatment in HIV-positive patients. As stated by Velloza et al. (2020), “Sub-Saharan Africa has the highest global prevalence of heavy episodic drinking, and alcohol uses likely remains an important contributor to ART non-adherence in this setting” (p. 1728). Consequently, even if a person is diagnosed with HIV/AIDS and undergoes ART treatment, their recovery and disease management might not be effective and sustainable under the disruptive influence of heavy drinking. Alcohol dependency and excessive use lead to mere forgetfulness or deliberate neglect of precautions and therapy regimens, which puts others at risk of infection. Thus, substance use contributes to the advancement of the HIV/AIDS epidemic in Africa.
Sexual Behavior Patterns
Given that HIV/AIDS is a sexually transmitted disease, it is relevant to consider the patterns of sexual behavior in the researched population. Indeed, HIV is predominantly transmitted through the exchange of bodily fluids during sexual contact, which implies that unprotected sex leads to an increase in the risk of being contaminated (Vance, 2019). Overall, statistics show that in many African countries, “the polygamy and promiscuity practiced in different regions of Africa favors the spread of HIV/AIDS” (“AIDS in Africa,” n. d., para. 12). In other words, the presence of multiple sex partners and unprotected intercourses with them put the individuals at risk of transmitting HIV at a high rate.
Moreover, another essential contributing factor in terms of HIV/AIDS epidemic advancement is prostitution. This issue is related to the low economic development of the countries and high poverty levels. Consequently, individuals practice prostitution to obtain income, which implies uncontrolled and commonly unprotected sex of prostitutes with multiple partners. Some policies and governmental actions have been implemented to prevent AIDS spread via prostitution by imposing mandatory HIV tests and monitoring (Nugent, 2004). However, the effectiveness of such measures on a large scale should be pursued by all the countries in the region to obtain the desired results of reducing the epidemic rate.
Furthermore, HIV/AIDS spread is associated with rape and sexual assaults against women. For example, according to experts’ data, “South Africa, one of the countries most affected by the epidemic, has one of the highest rates of rape in the world” (“AIDS in Africa,” n. d., para. 13). The virus is transmitted from an HIV-positive rapist to his victims, as well as from infected women to the children of rape. Therefore, violence against women, which is a justice system concern, contributes to the HIV/AIDS crisis in Africa.
Stigmatization of the Disease
Large-scale system-related health problems commonly derive from small-scale individual behaviors that are shaped by society. In particular, the context of HIV/AIDS implies unprotected sex, which is often considered a taboo topic in many African countries (“AIDS in Africa,” n. d.). People with the symptoms of the virus might be intimidated to report them and seek help due to the pressure of society and the stigmatization of the disease. According to the results of the study conducted by Velloza et al. (2020), “fear of disclosure of HIV status and resulting stigma” have been found to be substantial factors in the diminished treatment and diagnosis of the disease (p. 1728). Consequently, HIV-positive people might fear social exclusion based on their status and fail to address their health issues in a timely manner, concealing their conditions and continuing the spread of the infection.
Moreover, coupled with the limited education and awareness of the population about the disease, the intercourses with different partners might not be protected even if an infected person suspects or knows about their condition. In other words, preventative and educational measures might not be effective in a society where stigmatization is as powerful as in Africa. According to Gona et al. (2020), stigma-free societies and healthcare settings are the cornerstones of increased HIV testing and the effectiveness of preventative and therapeutic procedures. Unfortunately, cultural and religious beliefs in Sub-Saharan Africa limit the opportunities for minimizing the stigma associated with HIV/AIDS (Velloza et al., 2020). Thus, this socio-cultural factor significantly influences the speed at which the virus spreads across African countries and on a global scale.
Reasons for HIV/AIDS’ Devastating Effects
While the causes of the fast spread of HIV/AIDS have been discussed and explained in detail, it is relevant to review the reasons why this disease has had such a wide range of negative implications globally. According to statistics, unprecedently high numbers of individuals are impacted directly or indirectly by the HIV/AIDS epidemic. Indeed, in Sub-Saharan Africa, “730,000 AIDS-related deaths in the region” happen annually, as well as “11.7 million people still do not receive antiretroviral therapy” despite the overall advancement in the treatment of the disease (“AIDS in AFRICA,” n. d., para. 3-4). From a large-scale perspective, the persistence and significant deteriorating outcomes of the epidemic are associated with the history of European colonization of African countries, which minimized the opportunities for the nations’ independent political and economic development (Arnold, 2005). As the causes of the epidemic demonstrate, the socioeconomic, cultural, and political contexts have a decisive impact on the quality of preventative and awareness-raising interventions, education, level of income, and health promotion.
Even highly-developed states might face challenges in allocating means for an adequate response to epidemics. With insufficient resources for national development due to European states’ colonization of the territories for a long time, multiple African states remain excessively poor and unable to handle large-scale public health crises (Nugent, 2004). Moreover, the population growth in the region, coupled with insufficient healthcare and poverty, hinders the effectiveness of the solutions that are being implemented (“AIDS in Africa,” n. d.). With numerous such populations, it is difficult to manage the epidemic without systematic decisions and evidence-based approaches, which are lacking in African nations due to the post-colonial political and economic burden. Therefore, the uncontrolled spread of the disease has caused devastating growth in mortality and morbidity, putting the global community at continuous risk of HIV/AIDS.
Conclusion
In summation, the exploration of the causes of the HIV/AIDs epidemic in Africa has revealed a variety of socioeconomic factors contributing to the problem. Firstly, Sub-Saharan African countries lack adequate preventative and educational measures implemented at a state level to raise awareness about the disease and encourage safety measures. Secondly, the underdevelopment of local healthcare systems diminishes the opportunities for timely diagnosis, prevention, treatment, and health promotion. Thirdly, a high level of poverty limits the access of the population to protection and adequate services or consultation. Fourthly, substance use disrupts treatment regimens and contributes to unhealthy and risky behaviors yielding HIV spread.
Fifthly, sexual behaviors, such as infidelity, polygamy, violence against women, prostitution, and others, increase disease transmission. Sixthly, the stigmatization of HIV-positive individuals obstructs their likelihood of reporting the condition and encourages their concealing of the diagnosis with the consecutive spread of the infection. Overall, the devastating outcomes of the epidemic might be explained by a broader historical context that exposes Africa to post-colonial developmental challenges that obstruct adequate management of the disease spread. It is important to implement systematic changes across the governmental systems to ensure the development of African countries so that they have enough resources to overcome the crisis.
References
AIDs in Africa: facts, figures, and background information on the epidemic (no date) Web.
Arnold, G. (2005) Africa: a modern history. London: Atlantic Books.
Gona, P. N., et al. (2020) ‘Burden and changes in HIV/AIDS morbidity and mortality in Southern Africa development community countries, 1990–2017’, BMC Public Health, 20(1), pp. 1-14.
Nugent, P. (2004) Africa since independence. 2nd edn. Houndmills: Palgrave Macmillan.
Peltzer, K. and Phaswana-Mafuya, N. (2018) ‘Drug use among youth and adults in a population-based survey in South Africa’, South African Journal of Psychiatry, 24(1), pp. 1-6.
Vance, M. A. (2019) ‘Conflicting views in narratives on HIV transmission via medical care’, Journal of the International Association of Providers of AIDS Care, 19, pp. 1-9.
Velloza, J. et al. (2020) ‘Alcohol use and antiretroviral therapy non-adherence among adults living with HIV/AIDS in sub-Saharan Africa: a systematic review and meta-analysis’, AIDS and Behavior, 24(6), pp. 1727-1742.