Module two IMPACT Social Context of HIV/AIDS in Africa – February17,09

1. Module two IMPACT Social Context of HIV/AIDS in Africa – February17,09 • AIDS and Impact • MDG-Anita Alban et al 2007 intro to impact presented 10/2/09 • Population – life-expectancy • Johnson Samuel Adari et. al. “Life expectancy of people living with HIV/AIDS and associated socioeconomic factors in Kenya- Journ. Of Int. Dev. (2007) 19,357-366., • Dependency-ratio, Orphans growth rate litt see later.

2. Estimated number of people living with HIV and adult HIV prevalence Global HIV epidemic, 1990–2007; and, HIV epidemic in Sub-Saharan Africa, 1990–2007 Global HIV epidemic, 1990–2007 HIV epidemic in Sub-Saharan Africa, 1990–2007 Number of people living with HIV (millions) % HIV prevalence, adult (15–49) Number of people living with HIV (millions) % HIV prevalence, adult (15–49) 40 4.0 30 15.0 25 12.0 30 3.0 20 9.0 20 2.0 15 6.0 10 10 1.0 3.0 5 0 0 0 0 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 1990 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 2000 ‘01 ‘02 ‘03 ‘04 ‘05 ‘06 2007 NOTE: Even though the HIV prevalence stabilized in Sub-Saharan Africa, the actual number of people infected continues to grow because of ongoing new infections and increasing access to antiretroviral therapy. Number of people living with HIV % HIV prevalence, adult (15–49) These bars indicate the range around the estimate 2.3

3. Selected events in tracking the epidemic Millennium Development Goals Guidelines on second generation HIV surveillance As of 2007, 31 countries have conducted population-based surveys with HIV prevalence measurement Global Programme on AIDS launched by WHO First Demographic and Health Surveys with HIV prevalence measurement in Mali and Zambia Universal Access Targets First Reference Group on Estimates, Modelling and Projections meeting The first HIV antibody test becomes available First global series of regional training workshops on estimation methods for national epidemics 2001 2008 2015 1985 1987 1998 2000 2003 2007 2010 Midway to Millennium Development Goals UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment 2.1

4. HIV prevalence (%) among 15–24 years old, by sex, selected countries, 2005–2007 Swaziland South Africa Zimbabwe Central African Republic Uganda Female Chad Côte d'Ivoire Male Sierra Leone Rwanda Haiti Guinea Ethiopia Benin Mali DR Congo Niger Dominican Republic Senegal Cambodia India 0 5 10 15 20 25 % HIV prevalence Source: Demographic and Health Surveys and other national population-based surveys with HIV testing. 2.10

5. 90 80 Western Europe Asia 70 Southern Africa Western Africa Years 60 Eastern Africa 50 Central Africa 40 30 1950– 1955 1955– 1960 1960– 1965 1965– 1970 1970– 1975 1975– 1980 1980– 1985 1985– 1990 1990– 1995 1995– 2000 2000– 2005 2005– 2010 Life expectancy at birth, selected regions, 1950–1955 to 2005–2010 Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp 2.11

6. Dependants-number of peopledependingonothersworkingability in countriesw/no pension scheme Intergenerationalbargain • Young adults stand straight • New shoots (children) climb up • Old ones (people) maketheirwaydown to the earth • Core and most importantbagains made and maintainedbetweenpeople. Is the basis onwhich social order is constructed.

7. Ghana 1950 2007 100+ Male Female Male Female 80 60 Age 40 20 0 10 5 0 5 10 10 5 0 5 10 Percentage Percentage Lesotho 1950 2007 100+ Male Female Male Female 80 60 Age 40 20 0 10 5 0 5 10 10 5 0 5 10 Percentage Percentage Changes in population structure: Ghana and Lesotho Source: Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat, World Population Prospects: The 2006 Revision, http://esa.un.org/unpp 2.12

8. Population Chimney

9. Selected events related to mitigating the impact of AIDS Millennium Development Goals UNICEF first International Conference on AIDS orphans Anglo American introduces policy to make antiretroviral therapy available for HIV positive employees “Unite for Children, Unite Against AIDS” campaign launched by UNICEF and partners Universal Access Targets Children on the Brink: Strategies to Support HIV/AIDS," published by USAID includes the most comprehensive global estimates of the effects of HIV/AIDS on the world's children In Mexico, the Universal Antiretroviral Therapy access was guaranteed by the newly implemented “Seguro Popular” for the informal sector along with the social insurance schemes for the formal sector 2001 2008 2015 1991 1997 2002 2003 2005 2010 Midway to Millennium Development Goals UN General Assembly Special Session on HIV/AIDS June 2001/ 189 Member States signed the Declaration of Commitment 6.1

10. OVCOrphans and Vulnerable Children Candace Marie Miller et al. Emerging health disparities in Botswana: Examining the situation of orphans during the AIDS epidemic. Soc. Scie. & Med. 64, pp. 2476 – 2486, 2007.  Tatek Abebe et al. Children, AIDS and the politics of orphan care in Ethiopia: The extended family revisited. Soc. Scie. & Med. 64, pp. 2058 – 2069, 2007. T. Barnett and Whiteside: AIDS in the 21stCentury (2007) Chapt. 8

11. The Orphans curve 1 200 000 Number of orphans 1 000 000 800 000 600 000 400 000 200 000 0 projection 1980 1990 2000 1985 1995 2005 2010

12. Nutritional health and orphans

13. OVC-Orphans and Vulnerable children • In 2005 it was estimated that we had 15 million orphans ww. And it is estimated to be 20 mill in 2010 • In predictions show that Africa south of Sahara may have 8 million orphans

14. Estimated number of children under 18 orphaned by AIDS in sub-Saharan Africa (1990–2007) 12 Millions 10 8 6 4 2 0 2007 1990 1995 2000 2002 2003 2004 2005 2006 Source: UNAIDS/WHO, 2008 6.2

15. Orphans due to AIDS in Sub-Saharan Africa, from 2006 projected to 2015 16 14 Millions 12 10 8 6 AIDS orphans_base 4 AIDS orphans scaled phase-up AIDS orphans UA2010 2 0 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 Source: UNICEF, UNAIDS, WHO, 2008. 6.4

16. Orphans: A Lost Generation • Numbers are large and growing • Social support systems are overwhelmed • Risk of a lost generation • little or no education • poor socialization • social upheaval • economic underclass

17. Ratio of school attendance among orphans to non-orphans in countries with HIV prevalence greater than 5% Côte d'Ivoire UR Tanzania UNGASS 2007 Zambia UNGASS 2005 Namibia UNGASS 2003 Central African Republic Swaziland Malawi Uganda Zimbabwe Lesotho Kenya Cameroon Gabon South Africa Mozambique 0.0 0.2 0.4 0.6 0.8 1.0 1.2 1.4 Proportion of school attendance, orphans/non-orphans Source: UNGASS Country Progress Reports 2008. 6.3

18. Household Impact: Caring for Orphans • A study from Uganda shows that 25% of households are providing for an orphan Source: Lyons, M. 1997 • A study from Tanzania shows that 21% of the families in Bukoba district were fostering an orphan Source: Rugalema, 1999

20. Definitions of core concepts • To be vulnerable means • to be in a social situation where one does not receive appropriate care, ressources or recognition •  To be an orphan is according to UNICEF • Maternal-mothers have died • Paternal – fathers have died • Double orphans – both parents have died • To be a child is according to UN’s convention on the rights of the child a person younger than 18 years.

21. Social Context of HIV/AIDS in Africa – 3rd Tuesday February 24-09 Stigma Gillian Paterson. (G.P.) Ecumenical Advocacacy Alliance and World Council of Churches. AIDS related stigma. Thinking outside the box: The theological challenge. 16 pages. Leickness C. Simbayi et al. (L&S.) Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, SA. Soc. Scie. & Med. 64, pp. 1823-1831, 2007. Lawrence Hsin Yang et al. (H.Y) HIV/AIDS Culture and Stigma: Adding moral experiences to stigma theory. Soc. Scie. & Med. 64, pp. 1524-1535, 2007.

22. STIGMA-What is it ? Gillian Paterson on STIGMA • It is contextual and social in its background guiding the stigmatised and the stigmatisers (responses from others) • Stigma is diff from descrimination and it has to do with fear • Religion may act as a reinforcement and ritualising of symbolic stigma • Self-stigma is part of stigmatisation • Stigmatising may be part of reinforcement of moral and cultural norms • Scapegoats are stigmatised – 4Hs homoesex. Haemophili, heroin-addicts and Haitians - to distance moral majority from a sense of danger – or self be at risk • Moral –conservative right -and political-liberal left- chasm • Stigma the ideology of othering-power relations • Do we listen to those w/positions and power or do we also listen to PLWHA

23. L.H. Yang et al – Stigma • Historically the concept of stigma is largely grounded in the individual space but now it is also rooted in the social space • It is embedded in a ”Language of relationships” Goffmann(63) • Different models has beendeveloped, oftenneglecting the stigmatisedownviewpoints • Stigma is devaluing social identity • Not onlywithin the stigmatised person but within a social contextthatdefines an attribute as devaluing • Moral experiencerefers to that register of everydaylife and practical engagement thatdefineswhatmatters most for ordinary men and women. (Kleinman 06)

24. Stigma in Yang cont. • Umbrella which links interrelated stigma components • It is a situational threat; stigma tizing individuals or groups is a response to perceived threats, real dangers and fear of the unknown • Resulting in a concept that stigma predisposes individuals to poor outcomes by threatening self-esteem, academic achievement and mental or physical health • An individual’s stigmatised social identity is constructed through cognitive affective and behavioral processes

25. L.H. Yang et al – Stigma cont • Stigma is dangerous, durable and difficult to curb because • For the stigmatised stigma compounds suffering-shame humiliation and despair – loosing face, depression • For the stigmatiser stigma seems to be an effective and natural response emergent not only as an act of self-preservation or psychological defense, but also in the existential and moral experience that one is being threatened