Still Dying: HIV and the role of unions in Southern Africa

“In the old South Africa we killed people. Now we’re just letting them die.” Pieter-Dirk Uys, South African satirist HIV will cause the death of half the population of some African countries. It has increased the mortality levels of adults in their prime (15-49 years) to pre-modern levels. In countries such as Zimbabwe, life expectancy for women has dropped to the mid 30s.

According to the Global Fund to fight AIDS, Tuberculosis and Malaria, there are around 40 million people with HIV, 95 percent of them in whom live in developing countries. More than 13 million children under the age of 15 have been orphaned by HIV/AIDS, and this number is projected to double over the next few years.

Young people in the prime of their economic and reproductive lives will die from HIV-related diseases before they have brought up their children, cared for their elderly parents or made their contribution to society.

Add to these staggering figures a series of factors that exist in many African countries and it becomes apparent why a pandemic that has been limited in most high-income countries remains such a holocaust in Africa. Barriers include poverty, and lack of access to education and to primary health care. Only a small percentage of people in Africa with HIV can access anti-retro viral drugs (ARVs). Infectious diseases such as tuberculosis are the biggest killer of people living with HIV in Africa yet antibiotics that can cure it are not consistently accessible.

African governments have been reluctant to acknowledge and act against the pandemic. This is compounded by the underwhelming response by the West. 'Trade not aid' has been the mantra of international bodies such as the World Bank and IMF. Foreign investors, however, have been reluctant to invest in countries where HIV affects a high proportion of the workforce. The results are inadequate aid allocations, limited debt cancellation and restricted trade opportunities. The approach of some aid agencies and the role of pharmaceutical companies that hold the patents to antiretroviral drugs have only caused further damage and highly politicised HIV treatment and prevention programs in Africa.

The US response to the global AIDS pandemic, the biggest international health intervention ever attempted - the President's Emergency Plan for AIDS Relief (PEPFAR), a $15 billion dollar program to fund AIDS prevention and treatment in the developing world with a focus on Africa - has been mired in controversy since its inception in 2003.

While PEPFAR has succeeded in saving thousands of lives through treatment, its abstinence-focused prevention programs have put many more lives in jeopardy. A major component of PEPFAR has been the ABC strategy: Abstain, Be faithful and Condoms -- for "high-risk groups". Abstinence only has been the preferred method of the Bush administration. One third of funding is allocated to abstinence only education and one-quarter of grants go to religious organisations.

Men who have sex with men, injection drug users and sex workers are badly served by national AIDS policy decision makers. PEPFAR specifically requires the groups it funds to sign a pledge condemning sex work.

Many funded projects with sex workers aim to get them out of the industry, instead of an approach that promotes preventive measures and facilitates them organising around their rights as workers. But for every woman who leaves there is one to take her place, just perpetuating the high-risk exposure of previously uninfected women.

Some programs teach communities to place greater social value on virginity, some programs going so far as encouraging women to conduct 'virginity testing' on girls. This can increase the incidence of anal sex, increasing the risk of infection.

Stephen Lewis, UN Special Envoy on AIDS has criticised the PEPFAR approach, saying, "You do not provide money on the condition that they reflect your ideological priorities," adding Washington was practising "incipient neo-colonialism" by telling African nations how to fight AIDS.

AIDS funding has become highly politicised under the PEPFAR program - drastically limiting the money and flexibility for broader, proven strategies to combat the spread of HIV and elevating ideology over both science and local needs to prevent the disease.

Unlike PEPFAR's damaging approach, African unions have been leading the fight that calls for real solutions against a disease that is diminishing their membership and affecting the whole of society.

Even if there was a vaccine tomorrow, the epidemic will have adverse impacts for generations to come. African unions recognised this early, and like Western unions fighting the AIDS epidemic in the 1980s, they have focused on maintaining solidarity and combating the stigma and discrimination against people living with HIV & AIDS. More so than governments or employers, unions and workplaces can play a unique role in promoting credible behavior change peer education to workers and their families.

Fighting the virus with an 'abstinence only' approach almost inevitably means condemning sexuality rather than intensifying efforts for education about safe sex and prevention, and universal access to testing, treatments and care.

While HIV/AIDS no longer poses a threat of the same magnitude or urgency in Australia, unionists understand these concerns do not stop at national borders. Through Union Aid Abroad, Australian unions have supported unions and communities responding to HIV in Southern Africa, Vietnam, Kanaky/New Caledonia, Philippines, Thai-Burma border, Cambodia, Laos and Papua-New Guinea.

As long as HIV remains a global pandemic, it requires a global effort and real solutions that do not victimise those infected by HIV and instead empower communities to respond.

© Union Aid Abroad - APHEDA 2003.
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Last Modified: Wednesday, 23-Jan-2008 16:51:11 EST
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