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Center for Disease Control Histories Mysteries Division Internal Department Use Only- Not To Be Distributed Subject: AIDS Epidemic in the Republic of South Africa Summary: Researchers estimate that sometime in the 1930s a form of simian immunodeficiency virus, SIV, jumped to humans in central Africa. The mutated virus became the first human immunodeficiency virus The first known case of HIV in a human occurs in a person who died in the Congo, later confirmed as having HIV infection from his preserved blood samples The earliest case of AIDS in the United States involved a female baby born in New Jersey in 1973 or 1974 to a sixteen-year-old girl, who was identified as a drug-injector who had had multiple male sex partners. The infant died in 1979 after having shown the symptoms of AIDS for 5 years; her stored tissues later tested positive for HIV-1 As of 2012, there are estimated to be upwards of 34 million persons living with HIV/AIDS worldwide. With 5,600,000 is the leading country among persons living with HIV/AIDS. Problems: Our analysts estimate that the HIV/AIDS epidemic has taken an enormous toll on developing nations, especially those on the African continent. More than two-thirds (69 percent) of all people living with HIV, 23.5 million, live in sub-Saharan Africa—including 91 percent of the world’s HIVpositive children. Determination: Historians tell us of the economic and social impacts that the Black Plague had on Europe in the 1300s. We must use this knowledge to develop a plan to help the Republic of South Africa effectively deal with this modern pandemic. Exhibit A Stigma of Being an AIDS Victim Exhibit B Exhibit C AIDS Map of Africa Exhibit D Getting Access to AIDS Treatments is a HIV/AIDS Vital Statistics Struggle Exhibit E African Superstitions on AIDS Exhibit F Health Care compared US vs. S. Africa Exhibit G Black Death Eyewitness Exhibit H Black Plague Suggested Medical Cures Table of Contents Exhibit A Stigma of Being an AIDS Victim “Last week, in announcing that his eldest son had died of complications of AIDS, Nelson Mandela urged South Africans to stop treating the disease as a sickness for which "people will go to hell and not to heaven." The announcement by Mandela, the former president and a national icon, was a highly public attempt to fight the stigma that has accompanied AIDS across South Africa, hampering both testing and timely treatment of the disease, even as it has become the country's top killer, with 1,000 people a day dying from its ravages, according to the United Nations. The message, like appeals made by other regional leaders in the past few years, was greeted with relief by people suffering from the affliction. Yet many interviewed in recent days said they were still treated as contaminated sinners by neighbors, friends and their own families. Some are ordered to use separate toilets or to wash outside. Others are banished. A study of 144 HIV patients at two Johannesburg hospitals found that 38 percent had not told a single family member that they had HIV, and 21 percent had not told their sexual partners. One in 10 said diagnosis of the disease was followed by suicidal thoughts. A small number of women reported that their partners beat them after learning of the presence of the infection. Such violent reactions remain rare, although an AIDS activist was killed outside Cape Town in 2003 after she told a group of men who had gang-raped her that she had HIV. Another woman with AIDS was stoned to death in a township near Durban in 1998. Simple shunning is far more common and deeply hurtful, say those with the virus. The reaction compounds feelings of terror and self-loathing that can accompany the diagnosis of a disease that many here believe, incorrectly, to be fatal in all cases and contracted exclusively through promiscuous sex.” Source: http://www.washingtonpost.com/wp-dyn/articles/A7822-2005Jan13.html Exhibit B HIV/AIDS in Africa Vital Statistics •In Mozambique 73% of young people aged 17-23 said they did not know how to protect themselves from getting HIV/AIDS •5,500 people die from HIV/AIDS EVERYDAY in Africa alone. •Affects people regardless of age, ethnic groups, income, or social standing. •11% of infected are African children •Hospitals often do not have money for clean needles, gloves, and methods of testing •Rates of HIV/AIDS infection up to 30% in Sub-Saharan Africa in the past 10 years •17 million have already died in sub-Saharan Africa •Out of 34 Million people world-wide who have HIV/AIDS 24 million live in Sub-Saharan Africa •The top 10 countries with the highest incidence of HIV/AIDS are all in southern Africa •Out of the top 10 countries with HIV/AIDS, 8 of them also rank among the world’s poorest •Poverty and lack of education helps to keep African HIV/AIDS rates among the highest in the world. •Many people are ashamed to admit they have AIDS for fear of being shunned or beaten by their family and neighbors. •Governments are trying to educate the population in hopes of slowing the spread of the disease. AIDS victims are not able to access modern medications such as Anti-Retroviral (ARV’s) which can help because most cannot afford such expensive medicines. Exhibit C Exhibit D Getting Access to AIDS Treatments is a Struggle AIDS is a catastrophe of unprecedented historical proportions. Since the epidemic began, 22 million people have died, 17 million in Africa. There are 13 million AIDS orphans in Africa and it is estimated that the number will grow to 40 million by the end of this decade without massive intervention. In rich countries, drug cocktails have been remarkably successful in making AIDS a chronic disease like diabetes or hypertension. AIDS mortality dropped by over half within a few years of making such treatment available. In poor countries, less than 1/10 of 1% of the people with AIDS are being treated. Without access to medicine, almost all of the 36 million people living with AIDS will die. In the past several months, the principal objections to enhancing access to AIDS treatment have been overcome; now is the time to advocate for universal treatment. Treatment cost over $15,000 per person per year until activists and developing country pharmaceutical companies forced the big companies to reduce prices to as low as $350 per person per year. The medical infrastructure required to manage AIDS has now been simplified; after the first several weeks, only 2-4 blood tests per year are required for monitoring. Adherence to medications (two pills, one each in the morning and evening) has been shown to be as good in poor countries as rich ones. Prevention efforts, which have lagged in much of Africa, have been given a huge boost by availability of treatment in Brazil and Botswana. Experience has shown that people are much more likely to be tested and stigma easier to reduce when treatment is available. How much money is really needed for AIDS treatment? Estimates vary, depending how broad the interventions might be. A Harvard Faculty Consensus Statement has estimated that the cost of treatment for the 1-3 million HIV-infected Africans would be $1,100 per patient per year for a total of $1.1 - $3.3 Billion/year; this quantity includes drugs, testing, directly observed therapy, clinical support and research. Extending this program to the rest of the world, the total tab would be $4.2 Billion. Additional money would be needed to sustain prevention efforts. All in all, it is a small price to pay. The figure is about one cent per $100 in the GNP of rich countries and significantly less than the worldwide development assistance target of 1% of GNP. The United States has proposed a contribution of $200 million to the Global Fund, although they have suggested more money will be made available next year, if the fund performs acceptably. In this way the Bush Administration is setting the bar so low that the fund will be starved of resources before it starts. Given the shortage of money, policy makers will argue against providing treatment at all choosing instead to focus solely on prevention. If history is our guide, HIV prevention efforts will have limited success without availability of treatment. Exhibit E African Superstitions on AIDS Nurse Mugobi, a clinical nurse from a private clinic in northern Botswana, explained Botswana's extensive efforts in battling the superstitions. "Africans are very superstitious people," said Mugobi. "When someone gets sick they do not think it is a virus or bug, they think someone has put a hex on them. People think their neighbor or someone they upset wished bad things upon them," she said. This thinking deters people from going to see the doctors. She explained that it is customary to see a traditional healer if a medical conditions becomes serious. "They will go to see the traditional healer to get well and he will give them a cure." While the methods of traditional healers for some practices using herbs or animal products may alleviate some of the problems with some illnesses, the methods for HIV/AIDS treatment are worthless. "I will give you an example. If you get sick and go to the healer," Nurse Mugobi said, "he will take some water and bless it and say, 'Drink this water and you will get better.'" According to Mugobi, teaching and convincing traditional healers about HIV/AIDS including its transmission and side effects, was very challenging. "People would be very confused. They were taught one thing at school. Then, they go see a healer and they tell them something completely different," she said. "Then, they go to a clinic and a doctor tells them something completely different." Exhibit F United States South Africa South Africa United States Average Income $8,048 $48,000 Doctors per 1000 people .77 2.3 Health Care spending per person $843 $7900 Black Death Eyewitness Account: # 1 "One man shunned another... kinsfolk held aloof, brother was forsaken by brother, oftentimes husband by wife; nay, what is more, and scarcely to be believed, fathers and mothers were found to abandon their own children to fate, untended, unvisited as if they had been strangers." Exhibit G Black Plague Suggested Medical Cures The swellings should be softened with figs and cooked onions. The onions should be mixed with yeast and butter. Then open the swellings with a knife. Take a live frog and put its belly on the plague sore. The frog will swell up and burst. Keep doing this with further frogs until they stop bursting. Some people say that a dried toad will do the job better. Exhibit H