Module Nineteen, Activity Four

HIV/AIDS and Social Change in East Africa

The Facts

Everyone has heard about HIV and AIDS by now. AIDS is a disease that was first identified in 1981 in the United States. Soon after, AIDS cases were found throughout the world. It is a disease that can infect any person, regardless of gender, age, sexual orientation, or race if that person is exposed to it. But what exactly is AIDS? How is it different from HIV? And how does a person contract the disease from someone else?

This information may be a review for many of you, but we think it is still important to lay out the facts about HIV and AIDS before discussing how they are affecting life in East Africa.

Put simply, AIDS (Acquired Immune Deficiency Syndrome) is a disease and HIV (Human Immunodeficiency Virus) is the virus that causes it. A person can be infected with HIV, yet live a healthy life for many years before becoming ill with the disease AIDS. HIV can be transmitted from a person with HIV to a person without it through sex (either heterosexual or homosexual intercourse), sharing a needle, unscreened blood transfusions, pregnancy, childbirth, or breastfeeding. It is through the exchange of body fluids in these acts that HIV is passed. The most common way that HIV/AIDS is transmitted from person to person is through heterosexual intercourse. Someone cannot get AIDS from such things as touching, hugging, or sneezing. Once someone has AIDS, his/her body loses the ability to fight off diseases with the body’s immune system. While there are some drugs that can prolong the life of someone with HIV/AIDS, there is no known cure.


Worldwide, 40 million people were estimated to be living with HIV/AIDS by the end of 2001. That is about 0.6% of the total world population. In other words, out of 1000 people, 6 of them are infected. That is no small number! Indeed, about 70% of those people infected live in Sub-Saharan Africa. The African countries with the largest concentrations of HIV/AIDS infection are in East and southern Africa. You know what an epidemic is. So wide-spread and devastating is HIV/AIDS in southern and eastern Africa that medical experts refer to the spread of these diseases as a pandemic!

HIV/AIDS in East Africa

East Africa has been one of the hardest hit regions of the world with the HIV/AIDS panepidemic. The chart below shows the percentage of adults in most East African countries who are living with HIV/AIDS. Remember that this chart shows only adults, but there are also children with HIV/AIDS. Unfortunately these numbers are not available for many of these countries.

After reading through the chart, answer the questions that follow.

Estimated Percentage of Adults Living with HIV/AIDS At the End of 1999 in East African Countries:

adults with aids table

Information from AIDS in Africa, Country by Country, African Development Forum 2000.

  1. Which East African country has the highest percentage of HIV/AIDS infected adults?
  2. Which East African countries have over 10% of their adult population infected with HIV/AIDS?
  3. Which countries have less than 1% of their adult population infected with HIV/AIDS?

As you can imagine, life has changed drastically in East Africa with so many people infected with HIV/AIDS. First of all many people have died, often leaving behind orphans that need to be cared for. Families have had to struggle to provide care for the sick and buy medicines if they are available. Drugs that can help prolong the lives of HIV/AIDS patients are usually not available, but even if they are, they are rarely affordable to most people in East Africa. In addition, people with HIV/AIDS often suffer from social stigmas (much the same as in the United States)—people looking down on them for contracting a fatal disease that is associated with sexual promiscuity.

While the HIV/AIDS situation looks grim for many countries in Sub-Saharan Africa, some countries have done well to drastically reduce their number of people with HIV/AIDS. One such example is in East Africa—the country of Uganda.

The Story of Uganda: Learning How to Succeed Against HIV/AIDS

Uganda Map

Reversing the Trend

Uganda has been noted as a country who has made great steps towards being able to get the spread of HIV/AIDS under control. Over 940,000 Ugandans have already died from AIDS since the start of the epidemic. In the early 1990’s, the percentage of the population estimated to be infected with HIV/AIDS was 18%. Since that time, Uganda has been able to reduce that percentage to 6.5% by the end of 2001. How did this percentage decline so much in just a decade? What was Uganda’s strategy?

Anybody Want to Talk About Sex?

Uganda’s president Yoweri Museveni is given much credit for Uganda’s reduction in HIV/AIDS. From the beginning of his presidency in the mid-1980’s, Museveni made dealing with the HIV/AIDS epidemic one of his national priorities. He has strongly supported education on HIV/AIDS and sex. Ugandans have been quick to recognize early on in the HIV/AIDS epidemic what AIDS is and how someone gets it. They have been open to discussing sexual behavior, HIV testing, distribution of condoms, and stories of national celebrities who admit publicly to being HIV positive. As a result, young people are starting to be more careful about sex by limiting the number of partners, using condoms, or abstaining from casual sex. And people in general have become more comfortable discussing with each other healthy ways to have sexual relationships. These students in the photo below are having a lesson on HIV/AIDS in school.

Public Information Campaign
Serious and frank public information campaigns spread needed knowledge, particularly among the youth.
Photo: UNICEF / Jorgen Schytte; Photo taken from Africa Recovery, United Nations

A United Nations report from 1999 gives the following information on changes in sexual behavior in Uganda:

  • 98 percent of Ugandans now know that HIV is transmitted mainly through sex.
  • The proportion of young women and young men aged 15 to 19 who have not had sex rose from 20 percent in 1990 to 50 percent in 1995.
  • Among adolescents, 36 percent of boys and 25 percent of girls reported using condoms, compared to 15 percent and 7 percent respectively in 1989. For the 25 to 39 age group, 31 percent of men and 19 percent of women use condoms, compared to 11 per cent and 3 per cent in 1989.
  • Smaller numbers say they have sex with non-regular partners. Among those involved in non-regular sex, 60 percent have only one sexual partner. In 1989, the majority reported multiple sexual partners.
  • HIV prevalence among pregnant women has dropped from 30 percent some years ago to around 10 percent. At clinics for sexually transmitted diseases in Kampala, Uganda, AIDS infection rates have declined from 44 percent in 1989 to 30 percent in 1997.

The Debate Over Treatment

Uganda has made tremendous progress in reducing both the rate of HIV infection and the social stigma and suffering of individual victims of HIV/AIDS. There remains, however, the very important issue of reducing the suffering and very high death-rates of individuals who develop AIDS in Uganda and other African countries. Medical evidence from Africa and other areas of the world suggest that reduced stress and access to a healthy adequate diet can reduce suffering and prolong the lives of individuals infected by HIV/AIDS. However, until a cure is found for HIV/AIDS the best chance that victims have for living a long and normal life is by taking a combination of drugs known as antiretovirals (ARTs).

In the U.S. and Europe many individuals infected by the HIV virus have lived normal lives without developing full-blown AIDS. However, the combination of three ARTs which have been most effective in suppressing the virus are very expensive costing more than $10,000 a year per patient. How can Uganda with a per capita income of less than $1,200 a medical budget of less than $200 per person afford $10,000 treatments for the estimated 600,000 Ugandans infected with HIV? Given these statistics it is clear that Ugandans, unlike Americans and Europeans infected with HIV, cannot afford treatment that would prolong and increase the quality of their lives.

But the story cannot end here. Many medical experts and HIV/AIDS activists argue that the high cost of ART drugs can be dramatically reduced if major drug companies would be willing to reduce their profits. Drug companies, for their part, have responded that the price of the ARTs reflect the true cost of producing the drugs and for funding research for improved treatments. Protected by international trade agreements drug companies have until very recently refused to sell the ARTs to poorer countries at reduced prices.

The governments of India, Brazil, and South Africa, all of which have relatively highly developed drug industries, have decided that they have the moral obligation to those infected by HIV to provide ARTs at prices that are more affordable to victims in Africa, Asia and Latin America. Their remedy? They decided to ignore the patents (special licenses that protect the developer of new products) that U.S. and European drug companies hold on their ARTs. They decided to copy and produce these drugs locally with no payments to the drug companies that originally developed the drugs. ARTs produced in India, Brazil and South Africa cost about $300 a year, instead of the $10,000 charged by the original drug manufacturers. This action clearly is in violation of international trade and property protection agreements, but the countries involved justify their actions using ethical and moral based arguments. They assert that more important than the property rights of large drug companies are the lives of millions of HIV victims in Africa, Asia and Latin America who cannot afford to pay $10,000 a year to live!

What do you think? Are these countries justified in breaking the patents of international drug companies? Do the 600,000 HIV victims in Uganda have a right to drugs that would prolong and increase the quality of their lives? At $300 many Ugandan victims would be able to afford the drugs that evidence suggest would prolong and increase the quality of their lives.

In his State of the Union address in January 2003, President Bush announced a $15 billion fund to fight HIV/AIDs in Africa and other regions of the world. For the first time, the US will expend money for treatment (through the distribution of ARTs) as well as for prevention of HIV/AIDS.

Living with the Consequences of AIDS: Orphans Left Behind

In Uganda—a nation of currently about 24 million—nearly a million people have died from AIDS over the past two decades. AIDS has been so common in Uganda that everyone there knows someone who has died from the disease. The young death of this many people in such a short period of time has put tremendous stress on Ugandans. One of the primary stresses is finding someone to care for the children of people who have died from AIDS. About 51% of all Ugandan orphans under 14 years old are AIDS orphans. The total number of AIDS orphans in Uganda has been estimated at 1.7 million. These children are put in a hard situation for many reasons. First, they have the emotional trauma of losing one or more parent to deal with. Secondly, they will either be supported by a single parent, taken in by other relatives, or go to an orphanage. This will mean they most likely are sharing resources with many more people in their household, perhaps not leaving enough to pay for their school fees, medical problems, or other needs.

Your Turn

  1. Uganda is considered a model nation for tackling the HIV/AIDS epidemic. Think for a minute about how people in your own society have dealt with HIV/AIDS. (The percentage of adults in the United States living with HIV/AIDS in 1999 has been estimated at 0.61%). Have Americans been open to talking about how to prevent HIV/AIDS and changing sexual behavior so as to be safer? Have they tried to teach people to be understanding towards AIDS patients rather than judging them or being afraid of them? Write a paragraph comparing the way that Uganda has dealt with the HIV/AIDS epidemic to how the United States has. What are some of the similarities and differences that you can see?
  2. Write a letter to a major drug company that produces antiretovirals (ARTs). In this letter either support or challenge the position of major drug companies in “protecting” their product in Africa, Asia and Latin America. In addition to addressing the ethical issues, be sure to detail what you consider to be the major financial and logistical issues involved providing ARTs to patients in countries like Uganda.

This is the final activity of this module. Return to the curriculum, go on to Module Twenty, or select from one of the other activities in this module.