"Rwanda will never leave me: it's in the pores of my body. We saw lots of them dying, and lots of those eyes still haunt me -- angry eyes, innocent eyes. They're looking at me with my blue beret, and they're saying, 'What in the hell happened?' ... And they're absolutely right: How come I failed? How come my mission failed?" (General Romeo Dallaire)
Today, an important Rwandan genocide suspect was arrested so I thought I'd post a very interesting documentary about the genocide. Idelphonse Nizeyimana was head of intelligence and military operations at Rwanda's elite military training school. He is charged with adhering to and executing a plan to wipe out the Tutsis. "Ghosts of Rwanda" is a PBS Frontline documentary about the genocide and particularly the response (or lack thereof) of America and the West.Even though Rwanda is a very small and unknown country at the time America, Europe and the UN had been warned about what was happening. Instead of intervening, the West resisted intervention from the beginning.Americans, French, Belgians and Italians citizens on the ground were all evacuated and the entire U.N. Security Council voted to withdraw 90% of the peacekeepers in Rwanda.General Romeo Dallaire was left with 450 ill-prepared troops from developing countries.Leaders refused to call it genocide and the world failed to intervene.
The documentary can be watched online.It is gruesome but very well done.This is the first part of the documentary but the rest can be watched online as well (on youtube or here: http://www.pbs.org/wgbh/pages/frontline/shows/ghosts/video/ )
Here's the website on "Ghosts of Rwanda" where you can find a timeline and several interviews.
HIV/AIDS is predominantly a sexually transmitted disease. It causes illness and death among mature and sexually active adults, usually between 15 and 50 years of age, therefore the most productive people.
Why is Africa so affected by HIV?
Susceptibility varies from continent to continent, from society to society. Over three-quarters of those killed by HIV/AIDS live in Sub-Saharan Africa. The region remains the worst affected area and yet there is no straight-forward answer as to why Africa is more affected by AIDS than any other continent. It is influenced by various factors. None of these problems are particularly unique to Africa but nowhere else do they exist in such abundance. In Somalia, the HIV prevalence is under 1% of the adult population, but in Namibia, South Africa, and Zimbabwe around 15-20% of adults are infected. In Botswana and Swaziland (Southern Africa) the national adult HIV prevalence rate now exceeds 20%. West Africa has been less affected by HIV and AIDS, but some countries are experiencing rising HIV prevalence rates.
It must also be added that anti-retroviral therapies are too expensive and need fairly sophisticated delivery infrastructure. Access in therefore very difficult, contrary to countries such as the US.
Some factors:
- Patterns of sexual behavior: In African countries, the majority of infections are transmitted through heterosexual sex. One of major causes of HIV infections is unsafe sex.
Many individuals have multiple sexual partner but do not necessarily use protection. A married man may have several partners at the same time, including young girls. Such behaviors are normative in Africa and differ from serial monogamy. As a result, the virus spreads through generations as these overlapping "concurrent" relationships link individuals and generations, a little bit like a giant spider web.
Some groups are more at risk than others: Truck drivers, female sex workers are less likely to use contraceptives.
- History: Migration, slave trade, mismanagement, violence, inequalities, corruption etc…
- Poverty: AIDS is not caused by poverty (although poor people are more likely to get infected) but has indirect effect on HIV incidence. Poor people are more likely to be infected.
- Gender inequalities
Many women find it difficult to ask their husband to use condoms. Sexual violence, such as forced sex, is also widespread in many regions.
- Migration and a mobile work force, especially truckers. The virus travels.
- War: Refugees spread HIV as they flee.
- Lack of access to health care: There is no vaccine but Anti-retroviral therapy reduces the morbidity of the virus as it prolongs the time between HIV infection and AIDS.
- Talking about sex is often taboo, leading many people to remain silent
- Rapid urbanization. Cities are breeding grounds.
Why are women particularly affected?
Infection rates in young African women are higher than young men. It is difficult for women to protect themselves as result of several factors
- Gender inequalities
- Prostitution to gain economic power (female sex-workers are a high-risk group).
Women are often economically and socially disadvantaged, leading to a lack of access to treatment and financial support. In some cases they are also perceived as the cause of the HIV/AIDS and as the prime transmitters. These believes lead to stigmatization, often leading to differential treatment in terms of care and support.
Discrimination has spread rapidly, leading to anxiety to come forward. For example, HIV and AIDS are believed to bring shame upon the family. People living with the disease are often seen as being responsible for contracting HIV, especially as it is associated with death and behaviors that are already stigmatized.
>> There is a need to pay more attention to women as they are already disadvantaged and find it harder to seek care, which is why the project and research I will do on the ground will primarily focus on women
Effects on African societies
The impact of HIV/AIDS on African countries is enormous but hard for to imagine. A lot of the continents problems are directly and indirectly linked to the AIDS crisis. The HIV virus causes AIDS and destroys the ability of the body to fight off opportunistic infections by destroying the immune system cells. The body therefore becomes vulnerable to all kinds of diseases
The social and economic consequences of HIV/AIDS are enormous and tragic. It kills more people than wars and AIDS is making Africans poorer, especially because the epidemic is hitting the middle generation of society.
- Direct effect: increase in mortality
Someone who has been infected by HIV can expect to live 9 years on average before falling seriously ill. Mortality will affect both adult and infants (mother-to-child transmission). Ex: life expectancy at birth in Swaziland is 31 years (approximately 78-80 in Europe and North America).
- Economy and development
Lack of producers and consumers is setting back economic activity and social progress on several levels depending on where she/he fits in the community. HIV/AIDS acts as a significant brake on economic growth and development as the virus reduces the productivity of workers and skilled workers become scarcer. In return, lack of development has affected African country’s ability to cope with the disease.
- Household
The impact of AIDS is immediate and catastrophic. AIDS has devastated entire Africans families as individuals are hit in their productive prime and no longer can act as a caregiver and income earner. At the same time, the medical bill rises. Families therefore lack basic necessities
- Food production
Fields can no longer be tended for. Food shortages, malnutrition, exacerbation of poverty, starvation at household and community level.
- Children
Orphans and child-headed households
- Health sector
The large number of patients puts strains on an already fragile health system. It affects the availability of treatment for non-AIDS illnesses n the health system and put additional pressure on health staff.
- Education
Some schools lack teachers because of AIDS. Children also drop out of school to help nurse their parents. Families can also no longer pay school fees since the money is spent on medical care. Fewer children therefore receive basic education.
Response
The response varies from country to country. While other first evaded the subject, many governments have been very effective in their response and place great emphasis on prevention.
- Education and prevention (including schools, ad campaigns, "Miss HIV" contests,...)
- Voluntary counseling and testing
- Access to condoms
- Strategies to prevent mother-to child transmission of HIV
- Anti-AIDS Drugs, anti-retroviral treatment programs (availability difficult)
- Protection from stigma and discrimination
- Care for people living with HIV, AIDS orphans etc
Ghana
Facts and statistics
- First case reported: 1986
- Total Population: 22,9 million. 320,000 estimated to be living with HIV (2005). The cumulative AIDS cases is difficult to estimate as the vast majority of those infected do not know they are
- HIV/AIDS Adult prevalence rate: 2.6 % compared to 7.5% in Sub-Saharan Africa and 1.1 % globally (UNAIDS report on the Global Aids epidemic, July 2004). Currently the epidemic is stable. In comparison to other African countries, Ghana’s prevalence rate is relatively low.
- Prevalence of women (56%). The initial cases were predominantly female but ratio started to narrow 10 years ago.
- People between 25-34 are the hardest hit, especially young women
- Estimated number of Aids orphans:
- Percentage of HIV-Infected people receiving Anti-retroviral Therapy: 16% (end 2006)
- Number of people estimated to be in need of ART:
- Most at risk populations: sex-workers and their clients (transactional sex), particularly women. Economic migrants, female itinerant traders. Refugee flows from neighboring countries, such as Côte-d’Ivoire can also lead to an elevation of Ghana’s HIV prevalence rate.
- Many factors have led to the spread of HIV/AIDS, including compromised political and economic situations, unbalanced gender relations, labor migration (national and international), high-risk sexual behaviors.
Knowledge and Concern
There is widespread knowledge about HIV and the modes of transmission. The problem, however, is to turn this knowledge into behavioral change. Also, stigma and discrimination are still great, leading many infected people to hide their HIV-positive status.
National Response
- The Ghanaian Government responded actively to the HIV epidemic by creating a Ghana AIDS Commission. The government spearheaded several programs and has increasingly partnered with NGOs. The role of the commission is to coordinate and oversee all the HIV related activities and programs as well as implement a National Strategic Framework on HIV-AIDS.
- The National Strategic Framework is based on several intervention areas: promoting HIV/AIDS policy, coordinating a decentralized response, organizing prevention and behavioral change programs, providing treatment and care to HIV patients and affected individuals, HIV research and monitoring, mobilizing resources and funding.
- Most Ministries play a role in preventing the spread of HIV, particularly the Ministry of Education and the Ministry of Employment and Social Welfare.
- Nationwide HIV/AIDS campaigns have also been organized with the aim of disseminating information, empowering adolescent girls, helping people to move away from judgemental attitudes about safe sex and HIV/AIDS. Some initiatives also target specific groups, such as commercial drivers.
Remaining challenges in Ghana
- HIV is spread by certain types oh human behavior and so it could be controlled by changing these behaviors. There needs to be involvement from all sectors of society to promote prevention and intervention to reduce high-risk sexual behaviors, mitigate the problems of those already infected by the virus or otherwise affected by the epidemic. - Indifference and denial. The epidemic in Western Africa is not as visual in the East.
- Many people are never tested for HIV and only become aware of the infection once they have developed an AIDS-related illness.
- Discrimination and stigma
- Funding
- Continuing feminization of the epidemic. Because women were particularly affected initially, HIV/AIDS is still perceived as a women’s epidemic. The myth the AIDS is caused by women still exists. There are also gender differences in access to economic opportunities.
