SocialismToday           Socialist Party magazine

HIV/Aids inequality

HIV, the virus that causes Aids, continues to spread. Over the last 30 years, attention has shifted from the gay scene in the US, where the disease first appeared, to the neo-colonial countries. In sub-Saharan Africa, Aids is causing havoc to whole peoples and already fragile economies. It is beginning to break into the general populations of China, India and Russia. MANNY THAIN reports on this global catastrophe.

AIDS CAUSES THE complete breakdown of the immune system. Its symptoms can be treated, although there is as yet no cure. Infection and treatment are class issues. The poorest people in the world are the most likely to contract this life-threatening disease. They are also the least likely to receive treatment for it. This applies in neo-colonial countries, the former Stalinist states, and in the advanced capitalist countries. In short, the spread of the disease is linked to the way the capitalist economy operates, to poverty and inequality, and reactionary attitudes towards women and gay men.

According to the UN Aids organisation, in 2003 there were 39.4 million people living with HIV (4.9 million new infections) and 3.1 million deaths (8,500 a day). The most devastating impact is being felt in sub-Saharan Africa. The proportion of 15-49 year olds infected in the five worst affected countries is staggering: Swaziland 38.8%, Botswana 37.3%, Lesotho 28.9%, Zimbabwe 24.6%, South Africa 21.5%. In Swaziland, life expectancy now averages 34.4 years. Fifteen years ago it was 55. It could fall to 30 by 2010. In sub-Saharan Africa, women make up 57% of those living with HIV. There are five million people with HIV in South Africa, more than in any other country – 600 die each day.

HIV/Aids affects more than 2.5 million children worldwide. In 2003, about 700,000 children under 15 were newly infected, nearly 90% of them in sub-Saharan Africa. Half of all children with HIV/Aids die before they reach two years old. More expensive and more difficult to treat than adults, there are hardly any HIV/Aids treatments tailored for them and available in the neo-colonial countries. Of the few with access to drugs, almost all rely on adult capsules broken or mixed by carers, which results in dangerous under or overdosing, according to the World Health Organisation (WHO).

At the end of the 1970s and beginning of the 1980s, HIV/Aids grabbed the headlines in the US. It was branded by the media as a ‘gay plague’, a kind of ‘divine retribution’ for so-called ‘unnatural behaviour’. In Britain, it was used to whip up homophobic hatred, which helped cover cutbacks in public spending. It led to a marked increase in physical attacks on lesbian, gay, bisexual and transgender people, gay men in particular. Reactionaries seized on the claim of a small minority of scientists (notably, Peter Duesberg) that there was no link between human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (Aids). It was used to blame deaths from Aids on lifestyle factors, reinforcing the idea of a gay plague.

Not only did this attitude expose lesbian, gay, bisexual and transgender people to physical and verbal abuse, it contributed to stigmatising HIV/Aids. It masked inaction. It took Ronald Reagan, US president from 1981-89, six years before he used the word Aids in a speech. By then, 20,000 Americans had died and over half a million were infected.

In the rich capitalist countries, vocal, well-organised groups fought against the reactionary homophobic propaganda pushed by politicians and media. Important concessions were won, for example, the establishment of treatment centres and counselling services.

Pharmaceutical companies saw their chance to cash in. Today, through the development of antiretroviral combination drug therapies, it is possible to control the worst symptoms of the disease. People are now described as ‘living with Aids’, as the drug therapies permit them to continue in work and engage in other areas of social activity, leading relatively normal lives for many years.

They do not, however, provide a simple solution. The treatment is complicated and there is an ever-present danger of the virus developing resistance to the drugs. There can be severe and unpleasant side-effects. Damage to the nerves in feet and lower legs is common and can cause excruciating pain. Some of the drugs raise the levels of blood fats and sugars, increasing the risk of heart disease and diabetes. Others can cause the stripping of fat from limbs and face, or the accumulation of fat around internal organs and the neck. Nonetheless, Aids has been transformed from a death sentence with no chance of reprieve to a chronic – and very profitable – illness.

The African model

HIV/AIDS IS concentrated in urban centres. In Africa, it initially travelled along the thousands of miles of trucking routes, following the transcontinental movement of people and goods. The cities are full of migrant workers living in squalid, densely populated shantytowns. People spend months, even years, away from home earning subsistence wages. Impoverished women with no access to paid work are driven down by abject poverty into prostitution. Unprotected sex is readily available. Rape is common. Women have practically no rights. When male migrant workers return home they infect their wives. Because homosexuality is still illegal in much of the neo-colonial world, the extent of male-to-male infection is more hidden.

Sometimes, even the capitalist press cannot avoid revealing the truth. A Financial Times article summed up the situation in Africa: "Experts blame the continued spread among young people on sexual coercion, peer pressure, unregulated prostitution and low self-esteem, generally linked to poverty, inequality and low education levels". (9 July 2004)

To put it another way: if there was no sexual coercion, poverty or inequality, and if everyone had access to good quality education, HIV could be stopped from spreading.

A similar pattern has emerged in India, the second most populous country in the world. Complacency had set in because HIV/Aids has been present in India since the mid-1980s without the explosion of infection seen in Africa. Some commentators have lulled themselves with the official infection rate of under 1%, as this figure is taken as meaning that the virus is contained within the main high-risk groups, all marginalised to one degree or another – prostitutes, intravenous drug users and gay men. Even this figure would mean 5.1 million people with the disease.

That is, however, a false picture. A number of densely populated city districts are recording infection rates over 4%, indicating that HIV has moved into the general population. In South Africa it took five years for prevalence rates to move from 0.5% to 1%, then only seven more to jump from 1% to 20%. The sub-Saharan Africa model is being repeated: a highly mobile workforce, concentrations of migrant workers packed into filthy, overcrowded shantytowns, prostitution and the low-level status of women in society.

Worryingly, India has another factor which has not been significant in Africa, infection through the use of illegal, intravenous drugs. Mumbai, for example, is a major export centre for Southeast Asian heroin with a large domestic market for the drug. Fear of persecution and prosecution means that the full extent of HIV infection is hidden. The fact that homosexuality is against the law drives underground what is thought to be another important factor. Because it is illegal there are no reliable statistics available.

The catastrophe in the neo-colonial countries is exacerbated by the economic policies dictated by the International Monetary Fund (IMF), World Bank, multi-national corporations and imperialist powers. Their neo-liberal policies have led to the impoverishment of masses of people. Government subsidies to poor farmers throughout Africa, commonplace in the 1970s and 1980s, have been axed as part of this agenda. The direct results of ending state guarantees to buy small farmers’ surpluses are that less food is grown, no surpluses are stored for times of hardship, and farmers’ incomes collapse. This leads to a general increase in malnutrition – disaster during famines – lowering the capacity of people’s immune systems to cope with diseases such as malaria, tuberculosis, polio and HIV/Aids.

In Mozambique, the World Bank demanded the privatisation of the cashew industry in return for ‘debt’ rescheduling. Ninety percent of the workforce in this major export industry lost their jobs in the early 1990s. Nearly 80% of Mozambique’s population live on less than £1 a day. Life expectancy is 41 years. The privatisation of copper mines in Zambia resulted in thousands of workers losing their jobs.

There is a vicious circle. The World Food Programme has warned that Aids-related deaths of farm workers mean that hundreds of thousands of people in Mozambique and Zambia face hunger, despite above-average harvests, because distribution networks have been severely disrupted.

Bush’s deadly morals

GOVERNMENTAL ‘STRATEGIES’ TO deal with the crisis are little more than public posturing while world ‘leaders’ protect the obscene profits of multi-national pharmaceutical corporations, agribusiness and military spheres of influence.

In January 2003, a couple of months before US and British armed forces invaded Iraq, George W Bush promised to create a $15 billion Millennium Challenge Account, an emergency package to combat HIV/Aids: "I carry this commitment in my soul", he said. It was part of a charm offensive as the US regime tried but failed to build a ‘coalition of the willing’ in its war to subjugate the Iraqi people. "Officials at the Millennium Challenge Account are quick to list the countries that, through good governance, have qualified for the programme. They are not as quick to list the countries that have received a dime: there aren’t any". (Editorial, New York Times, 28 January 2005)

What cash is available comes with strict conditions. The right-wing Christian fundamentalists who exert a decisive influence on the White House are driving its international ‘aid’ programmes. These are implemented in the neo-colonial world through Christian, faith-based groups.

A report by the Center for Health and Equity, Maryland, which monitors US international health policy, said that between 60-80% of all money is going to abstinence-only programmes. Relatively little money goes to prevent HIV transmission through heterosexual intercourse, especially promoting condom use, even though this accounts for about 80% of infections in Africa. The UN Population Fund estimates that if the condoms currently available in sub-Saharan Africa were distributed evenly, every man would receive three a year.

Abstinence is not the answer. It is meaningless unless women have the power to exercise it. HIV infection rates are higher among married females between the ages of 15 and 19 than among sexually active singles of the same age. Most of these young brides are ‘faithful’, but they cannot abstain or negotiate condoms. Most of them want or are expected to have children. Ninety percent of the women in India with HIV contract the disease from their husbands. It has been said that for women worldwide, being young and married are the most significant risk factors for acquiring HIV infection.

The most significant measures required to halt the spread of HIV/Aids would be those which raise women out of poverty and hunger, and into education, productive employment and decent living conditions.

Bush’s ‘moral code’ is also being used to withdraw funding from organisations which, even verbally, back abortion rights. In Bangladesh, the Family Planning Association has lost $378,000 a year and has closed seven clinics serving 230,000 people. Planned Parenthood of Ghana, which distributed condoms and HIV/Aids information, lost $200,000, affecting 2.2 million people. The list is long. What the US regime cannot control, it destroys.

Supplying the drugs

THE US SUPPLIES drugs to the neo-colonial countries which it buys from US multinationals – which donate large sums of money to the Republican and Democratic parties. Until very recently, the US refused to sanction the use of much cheaper generic drugs. This was justified on spurious grounds of safety, even though a range of generics has been passed by bodies such as WHO. It is a mainline cash injection into the US pharmaceutical industry.

In January this year, for the first time, the US Food and Drug Administration approved a package of generic drugs produced in South Africa. The fact that this has only just been agreed – it is not yet happening – is testament to the power, influence and determination of multi-national pharmaceutical corporations and their White House backers, which fight tooth and nail to defend their massive profits.

In 2000, Nelson Mandela received a standing ovation at the international HIV/Aids conference in Durban, South Africa. Outside there were angry demonstrations organised by the Congress of South African Trade Unions, Aids groups, and thousands of HIV-positive people with no access to treatment. Under this pressure and in the glare of the world’s media, multi-national pharmaceutical companies pledged that they would lower the cost of their treatments. Promises were made that generic versions could be bought and used by economically poor countries without breaking trade agreements or intellectual property rights and patents.

The anger is another manifestation of the worldwide anti-globalisation, anti-capitalist mood. However, progress is painfully slow. As soon as the media circus leaves town, governments and bosses revert to type. Mass pressure has to be applied constantly.

In 2002, with little headway made, mass demonstrations vented their fury mainly at US pharmaceutical corporations at the subsequent international conference in Barcelona, Spain. And in mid-July 2004, the 15th international HIV/Aids conference took place, this time in Bangkok, Singapore. A scheduled conference of world leaders was cancelled because too few bothered to turn up. The London-based Independent on Sunday newspaper called it a "carnival and medical trade fair", estimating the value of the ‘Aids industry’ at £2.4 billion a year (11 July 2004).

On 14 July 2004, the Financial Times reported that Abbott Laboratories had actually implemented a fivefold price increase for Norvir, one of its protease inhibitors used in combination therapies, in the US! Miles White, Abbott CEO, explained the cynical calculation: pharmaceutical companies lower prices only when they are forced to. "Why spend money on corporate citizenship? Frankly, because it is required. If I don’t provide our product in Africa, governments will licence our intellectual property to others who can". The article continues: "In Abbott’s case every $20 million spent on corporate citizenship knocks 1% from earnings per share… corporate citizenship is a cost of doing business, an overhead to be managed like any other".

This points to the need to nationalise the pharmaceutical industry, with control and management in the hands of technical and production workers. On that basis, nationalised companies could share data and cooperate in research and development. That would end the duplication of R&D which, at present, wastes valuable resources as rival companies do the same work in order to be the first ‘on the market’ with a particular drug. Resources wasted on advertising for similar products could be eliminated and used productively. R&D could be focused on developing cures, rather than being concentrated on the more lucrative treatment of symptoms.

If the whole economy was based on the same lines, a democratically organised socialist plan of production could be developed, ultimately internationally, which took into account people’s needs, environmental sustainability, and so on. Areas in most need could be quickly identified and provided for. Long-term global strategies could be worked out and implemented.

US class, gender & race

HIV/AIDS REVEALS all the class, gender and race divisions in the richest, most powerful country, the US. As the poorest people are from ethnic minorities, these communities are the most severely affected. African Americans make up 13% of the US population but account for 50% of new HIV infections.

In the US in 2003, according to the Centers for Disease Control and Prevention, black women were more than 20 times as likely to contract Aids as white women and five times Latina women. Black and Latina women accounted for 77% of all new cases among women in 1994, 85% in 2003. They also made up 83% of reported Aids diagnoses among women, although they represent only 25% of all women. (Washington Post, 7 February 2005)

There is a direct link between prison and the spread of HIV/Aids, especially in African American working-class communities. The Bureau of Justice Statistics puts the US prison population at nearly 2.1 million. Over 40% are black people. The bureau estimates an infection rate of 1.9%, which is widely considered a gross underestimate. Even so, 1.9% of 2.1 million means there are nearly 40,000 US prisoners with HIV.

A common misapprehension is that most sex in prison involves men who were already active homosexuals. A study in The Prison Journal suggested that about 70% of prisoners experienced their first same-sex encounters in prison. Condoms are unavailable or banned in the vast majority of US prisons. Intravenous drug use behind bars greatly increases the dangers. When prisoners are released, so is the virus, into their predominantly poor communities.

Little wonder then that a study of 500 African Americans by the Rand Corp and Oregon State University showed that nearly half believed that HIV is man-made and more than a quarter that it was produced in a government laboratory. Fifteen percent said that Aids is a form of genocide against black people. (Washington Post, 25 January 2005) This fear and suspicion is linked to hundreds of years of racism and exploitation by US capitalism, and represents total alienation from the political establishment. It is connected to the federal government’s ‘Tuskagee experiment’ (1932-72) when scientists told black men they were being treated for syphilis. In reality, their treatment was withheld so that the course of the disease could be studied.

Russia & China

EASTERN EUROPE, INCLUDING Russia, has the fastest rate of growth in HIV/Aids in the world, triggered by the catastrophic economic collapse following the fall of the Stalinist regimes. Millions of people were thrown into poverty, public and social services were destroyed. UN Aids figures put the number with HIV in the region at 360,000, but it could be as many as 1.9 million. There will be anything between five million and 15 million people with HIV by 2020.

Officially, 292,000 Russian people have HIV – Aids workers say between 750,000 and a million. The wide discrepancies in the figures are due to the collapse of social infrastructure throughout the region. In Russia, people can get treatment only in cities where they are registered as residents. Millions live illegally in places where they cannot register. They are not treated. Of the 70,000 people in Russia who UN Aids says need immediate treatment, only 1,500 actually receive the drugs. Almost all of them in Moscow.

In 2003, the official number of HIV infections actually fell. But this was because central government stopped supplying HIV test kits to Russian regions, and 2.5 million fewer people were tested than in 2002.

An explosion in intravenous drug use in Russia and Ukraine and growing prostitution were the initial centres of the outbreak. More than 80% of the people infected are under 30 years old, compared to 30% in Western Europe and North America. Evidence that Aids is spreading to the wider population is overwhelming. In 2000, 96% of new registered cases were attributed to intravenous drug use, in 2002 it was 76% and in 2003, 64%. In 2002, 5,000 army draftees tested positive for HIV. (Independent on Sunday, 4 July 2004) President Vladimir Putin uses Aids to enforce a conservative social order, to rail against drug addiction, and to push conservative views on family values.

China, too, is on the brink. The main modes of transmission are intravenous drug use, and sexual transmission through prostitution but also gay sex. These are still taboo. Early Aids-control policies identified these groups as social deviants. In 1993, the director of China’s National Institute of Health Education was sacked for ‘promoting gay civil rights’ when he set up a HIV/Aids programme for gay men. Homosexuality was only decriminalised in 1997. In 2001, the Chinese Psychiatric Association finally declassified homosexuality as a pathological condition. China is thought to have 840,000 people with HIV and a prevalence rate of 0.1%. It is, however, spreading at an annual rate of 40%, meaning there could be around 15 million people with HIV/Aids by 2010.

Devastating damage

A SECTION OF the capitalist ruling class is becoming increasingly worried about the economic and social impacts of HIV/Aids. Workers, who produce the bosses’ profits, are falling off company accounts. The World Bank has warned Russia that it will lose 0.5% of economic growth every year until 2020 as a direct cause of the disease. After 2020, that will increase to 1% a year.

Some sub-Saharan economies – already reeling because of the super-exploitation at the hands of the imperialist powers – are collapsing because of HIV/Aids. The mining conglomerate, Anglo American, employs 140,000 workers in South Africa. An estimated 34,000 are infected with HIV. Even from a cold capitalist calculation, that is devastating. The economic and social damage is deep and long term.

The deaths of people in their 20s, especially young women, have removed them when they are at their prime working and parental age. Children receiving any kind of education are forced to try to find work to sustain extended families and care for loved ones. A generation is losing the skills and education that society relies on. There is the spiral of increased poverty as the ratio of people dependent on those who are economically active increases. Massive gaps have appeared in key institutions: education, healthcare and administration.

The abject poverty of the neo-colonial world has been created and is perpetuated by the capitalist ruling classes of the rich countries. Mass action by the working class can wrest temporary and partial concessions from local bosses and their paymasters in the imperialist powers. The rich traditions of struggle against colonial rulers and their neo-colonial successors prove this point. But the logic of the capitalist system – the drive for short-term profit – means that it cannot provide any long-term solutions for humanity. It is a parasitical system, feeding off the human and natural resources of the world.

The rampant spread of HIV/Aids throughout the world is a by-product of this economic system. Increasing inequality and increasing human misery are the fertile ground on which HIV/Aids and other killers thrive. And it is inextricably linked with the second-class status of women, of gender and sexuality discrimination.

The workers of the world represent the only force with the potential of wresting economic control out of the hands of the capitalists. Their role in the production and distribution of goods and services, their collective organisation and instinctive international solidarity, mean that they could play the leading role in the organisation of a socialist society based on human solidarity. It is true that a socialist world is possible. The Aids pandemic shows that it is an absolute, desperate necessity.


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