Diseases impose a heavy burden, not only on the individual but also on his family, society and nation. Among the various infectious diseases, Human Immunodeficiency Virus (HIV) infection imparts one of the greatest afflictions on the physical, emotional and social levels of the individual. Despite the rapid advances in scientific and medical technology, the disease remains rampant and the number of new cases and deaths persistently increase especially in the African continent. Hence many scientific studies and researches have focused on the cause, treatment and the reason for its persistence over the last 30 years. In terms of its effects, most studies centered on the economic, political and social consequences of the disease and only a few tackles the disease’s ramification on the family structure. Since the disease affects the overall health of the person, it is expected to have numerous repercussions on the sick person’s family. This impact is also predictably higher in countries with a high burden of the disease like those found in Africa and in those where poverty is expected to be prevalent due to recurrent internal strife like Cotê d’Iviore. Hence, after a short discussion on the meaning and significance of HIV infection, this paper aims to determine the impact of AIDS on the family structure especially in a war-conflicted country like Cotê d’Iviore.
Background of AIDS
In the early 1980’s the world was alarmed by the increasing death toll from an unknown disease that initially affected gay men. This disease was defined as Acquired Immunodeficiency syndrome or AIDS. Presently, the disease is recognized as an ongoing pandemic that can affect all people in all walks of life.
Definition: Acquired Immunodeficiency syndrome or AIDS is a disease characterized by the destruction of CD4 or T helper cells, a type of white blood cells that normally protect your body from infection. If an insufficient number of T helper cells prevail, your body cannot mount an appropriate immune response to destroy microorganisms that invade your body and you will easily suffer from rare cancers and opportunistic infections or diseases that a body with a normal immune system can easily fight off.
Causative agent: Despite the controversies that encompass its causative agent, it now widely accepted that AIDS is caused by two types of Human Immunodeficiency Virus, HIV-1 and HIV-2 (Gallo, 1988; Gallo & Montagnier 2003, pp.2284). Since HIV-1 is closely related to the simian immune virus (SIV) frequently isolated in common chimpanzees of the species Pan troglodytes troglodytes while HIV-2 shares close resemblance to the SIV in Old World monkeys prominent in West Africa known as sooty mangabeys of the species Cercocebus atys (Gao, et al. 1999), these viruses are believed to arise from a mutation of the African monkey virus thereby enabling them to infect humans. HIV-1 is more infectious, virulent and lethal than HIV-2 hence HIV-1 is associated with epidemics worldwide and higher mortality rates while HIV-2 infections are often restricted to West Africa and more prolonged survival rates (Gallo, 1988, p. 522; Gilbert, et al. 2003, p. 573; Jaffar 2004 p.467, Holmgren 2007 p. 85).
History of spread: Gallo postulated that humans became infected with the Human Immunodeficiency Virus after contact with infected monkeys more than 30 years prior to the first recognized case (1988, p. 523). Despite evidences pointing to the origin of AIDS in Africa, the first proven HIV infection is reported from an adult Bantu male living in Congo in 1959 (Zhu et al. 1998) and the first outbreak of cases of gay men developing AIDS-like symptoms were initially reported in the United States and Haiti in 1981. It wasn’t until investigations were underway that the first reported cases in Africa were recorded in 1982. It was postulated that the infection sporadically infected a small number of people living in remote tribes in Africa as early as the 1940s or the early 1950s (Zhu et al. 1998). The infection may have been carried by a single person from Africa to Haiti around 1966 as they returned from working along the Congo River (Carter 2007) and from Haiti to the United States as Haitians began migrating to other countries. Since the beginning of the epidemic the disease has spread from the gay population to men, women and children with millions affected worldwide and an estimated 25 million infected people dying from related illnesses (UNAIDS 2008, pp. 15, 31).
Epidemiology: The 2008 Report on the global AIDS epidemic (Joint United Nations Programme on HIV/AIDS (UNAIDS) disclosed that the percentage of people developing new HIV infection has decreased in some countries, stabilized at high levels in some (Lesotho, Namibia, South Africa and Swaziland) and increased in others (including China, Germany, Indonesia, Mozambique, Papua New Guinea, the Russian Federation, Ukraine, the United Kingdom, and Viet Nam) (p.17). This contributed to the continued generalized global stabilization trend in the prevalence of AIDS that was noted after its peak in the 1995. However, the number of people infected and become newly infected are still staggering. In 2007, the number of surviving people infected with AIDS was approximately 33 million (p.18). The good news is that the number of new HIV cases decreased to 2.7 million in 2007 compared to 3 million in 2001 (p.32). Also, the amount of deaths attributed to AIDS has declined from 2.2 million in 2005 to 2 million in 2007 (p.17). However, this number is still significantly higher compared to the estimated 1.7 million HIV-infected people who died in 2001 (p.32).
According to the UNAIDS (2008), despite the low number of citizens residing in Sub-Saharan Africa (about 10%) relative to the world’s population, it still carries the largest burden of the infection worldwide, accommodating 67% of all infected people and harboring 75% of all AIDS-related mortality in 2007 (p.30). 2% of these cases are adults living in Cotê d’Iviore (UNAIDS 2008, p. 215).
Burden of the disease in Cotê d’Iviore
Cotê d’Iviore or Ivory Coast is dubbed as the most progressive state in West Africa. However, for over a decade, it has been rocked by internal sociopolitical conflict. From the first-ever military coup in December 1999, the country has witnessed a series of civil conflicts until the most recent rebel insurrection that claimed its northern half. This plunged the nation into poverty and its citizens into masses of confusion and despair. Concomitant with the conflict is a reported rise in the prevalence of HIV infection from 6% of the population in 2001 (UNAIDS, 2008, p.215) to 7% at the height of the conflict at the end of 2003 (WHO et al. 2004). Increased poverty, inability to access health and other public services and facilities, lack of doctors, poor education and increased number of female prostitutes are among the factors associated with the increase in the incidence of HIV infection (Knight & Manson 2005).
Presently Cotê d’Iviore is still acclaimed as the country with the highest prevalence rate of 3.9% in West Africa (UNAIDS, 2008, p.215). According to UNAIDS (2008), about 480,000 people in Cotê d’Iviore are infected with HIV in 2007 (pp.214). This represents a 19% decline in the incidence of infected patients which amounts to 580,000 from 2001. Although the percentage of people living with HIV compared to the total populations has significantly decreased to 3.9% in 2008 (UNAIDS, 2008, p.215), such number is more than double the average prevalence rate of 1.8% for all nations in West Africa.
Similar to findings in other countries, the number of women with AIDS greatly outnumbers men. Out of 480,000 cases, 250,000 are women in 2007. Fewer women suffer from AIDS in 2007 compared to 2001 (320,000). The number of children with AIDS is increasing from 47,000 in 2001 to 52,000 in 2007. (p.216). 38,000 died in 2007 compared to 43,000 in 2001 (p.217). There were 270,000 orphan children due to AIDS in 2007 compared to 220,000 in 2001 (p.218).
In Ivory Coast, there is a statistically significant decrease in HIV prevalence among pregnant women attending antenatal clinics of more than 25% from 2000-2004 in urban areas but has insufficient data for rural areas (table 2, UNAIDS, 2008, p.34). The Percent of young people between 15 and 19 years having had sex before age 15 significantly decreased among females but increased among males. (p.34). The Proportion of males and females having sex with more than one partner in the last 12 months has significantly decreased (p.34). Condom use during last sex among those with more than one partner in the last 12 months decreased among females but No evidence of change among males (p.34).
Mode of transmission: The HIV virus is acquired by direct contact with an infected person’s body fluids like breast milk, blood, semen and vaginal secretions. Sexual contact, either homosexual or heterosexual, is the most common mode of transmission. It could also be transmitted from mother to child during childbirth and breastfeeding.
Impact of AIDS on Family Structure: The Family is considered as the glue that bonds individuals together and the unconditional support that serve as the individual’s pillar of strength. However, problems with one family member will also affect its other members. This relationship is more prominent in cases of long debilitating illnesses like AIDS. The effects of AIDS on the family can be summarized into 3 main consequences: (1) decrease in the family size; (2) increase in the number of orphaned children; and (3) reversal in the roles of family members.
Ratio of school attendants between orphaned and non-orphaned children in Ivory Coast increased from 0.82 to 1.21 (UNAIDS 2008 p. 165).
People infected with HIV suffering from severe infections will need constant support. The support system will now shift to the any able-bodied members of the family - % to older family members, 2/3 women (p. 168).
Discrimination: Shame and discrimination connected to HIV and AIDS refers to intolerance, negative attitudes, abuse, biasness, unfairness and maltreatment shown towards people living with HIV and AIDS. These kinds of stigmatizations can sometimes result into being spurned by family, friends and even whole community at large. It can also go as far as getting poor treatment in healthcare, learning institutions, government offices and even at work places. Consequently, it leads to wearing away of rights, psychological damage and in most cases negatively influences the success of testing and treatment. AIDS stigma and discrimination is found everywhere in the world, even though they manifest themselves in a different ways across countries, communities, religious groups, age brackets and individuals. Some times stigma and discrimination take place together with other types of stigma and discrimination, such as tribalism within countries, racial discrimination, homophobia or misogyny. Stigma and discrimination is always directed towards those who people think are or were engaged in what are generally regarded as socially objectionable behaviors for instance commercial sex work, drug abuse or practicing same sex (Zhu et al. 1998).
Stigma and discrimination not only complicates and makes it even more challenging for people struggling to come to terms with HIV and deal with their conditions on a personal level, but it also obstructs the attempts being made in fighting the HIV and AIDS pandemic all together. On a national level, the shame that is normally correlated with HIV can prevent governments from taking speedy and effectual actions against the pandemic. At the same time, on a personal level it can sometimes result into individuals becoming unwilling to seek an access HIV testing, management and care. In Ivory Coast, dread of infectivity together with negative, value-based suppositions about people living with HIV and AIDS has led to high levels of stigma surrounding HIV and AIDS. The major factors that have highly contributed to the stigma and discrimination related HIV and AIDS in Ivory Coast are several. HIV and AIDS are generally considered a life-threatening condition and as such people react to it in numerous strong ways.
The infection is also frequently connected to unacceptable social practices such as homosexuality, drug abuse and addiction, commercial sex work and promiscuity. These are practices that were already unacceptable in their traditions and as such, highly stigmatised even in other societies. Given that the majority of people normally become infected with HIV through sex which regularly bears ethical luggage and at times cannot even be discussed in public. There is also very many erroneous information concerning the origin and transmission of the HIV is virus thereby creating unreasonable behaviour and misperceptions of individual risk. In most part of Ivory Coast, HIV infection is commonly believed to be ultimate consequence of an individual irresponsibility. Moreover, religious or moral beliefs have made some people to believe that being infected with HIV is the direct consequence of moral blemish that most do agree that whoever is involved actually deserves to be punished.
Another significant factor is that HIV/AIDS is a somewhat new disease in this part of the world and thus highly adds to the strong stigma and discrimination attached to the condition. There is also the trepidation surrounding the emerging pandemics in the early eighties which is still fresh in a lot of people’s mentalities. To add onto that, at around that time insufficient information was available about the risks associated with its transmission which therefore so made people scared of those infected due to fear of infection. In most parts of Ivory Coast, women who are living with HIV or AIDS are most of the times treated in a different way from their male counterparts especially in rural areas where many people are economically, culturally and socially disadvantaged. Women are most of the times erroneously taken to be the main transmitters the diseases that are sexually transmitted. Men, on the other hand are more likely than their female counterparts to be excused for the behavior that resulted in their own infection, putting the blame squarely on their women (UNAIDS 2008, pp.46).
The stigma and discrimination due to HIV and AIDS have grave effects on the fight against the scourge. For instance, it is a common Knowledge that the fear of stigma and discrimination is normally the main reason why many are unwilling to be tested, to reveal their HIV status or to enrol for the antiretroviral prescriptions. Some researches have found out that those who reported high intensities of stigma were over four times more likely to report reduced access to proper care. All these factors lead to the spread and complication of the HIV and AIDS pandemic. This is a direct result of the unwillingness to establish one’s HIV status or to talk about or exercise safe sex. This therefore indicates that people are more likely to pass on the disease to others and thus a higher number of deaths related to HIV and AIDS. This is because people are tested when it is already too late and the virus has already advanced to AIDS, making the management of the condition less effective and causing unnecessary early death. It also this extensive fear of stigma that is held responsible for the comparatively low uptake of avoidance of mother-to-child transmission during child birth campaigns in the country.
Some studies, for instance, point out that regardless of the fact that the service is offered at every antenatal centre in the country, only about twenty six percent of pregnant women availed themselves of the chance to protect their unborn children. About half of them did not take the test and almost half of those who were found positive refused go on and enrol in the treatment programmes. Stigma and discrimination of people living with HIV and AIDS have been found to be insidious and disparaging and therefore must be recognized as important impediments to any valuable education sector answer to HIV and AIDS. Stigma as already established, is a methodical progression that strengthens existing separations in our society.
Discrimination on the other hand can carry off a person’s rights. They are, nevertheless, not easy to deal with owing to their forceful nature. This is because they tend to change both when a person advances from HIV to AIDS and as the pandemic progresses in a learning community. Learning and acknowledging the foundations and end results of stigma, as well as the diverse varieties of stigma, can thus provide opportunities to confront and decrease stigma and discrimination. However, there are several realistic exploits that an education segment or establishment can undertake to produce a compassionate, enabling, accommodating and stigma-free environment, the advantages of which will quickly be realized (Knight & Manson 2005).
HIV/AIDs started off as a small epidemic that could was not a major threat to the livelihood on earth. Since its inception the virus has taken many lives. It has destroyed many dreams and interfered with the peaceful coexistence that was previously cherished by the societies around the globe. In Cotê d’Iviore, political instability has played a significant role in the spread of the HIV.
There is no definite medication for HIV has been approved by the medics around the world, thus HIV remains a challenge to many societies. This challenge might not find a permanent solution in the near future. The society bears the responsibility of reducing HIV preferences by altering their promiscuous behaviors to save the future generations.