|
|
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.
|