AIDS in Africa

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Effects of Decolonization
Lasting Legacy of Imperialism
Factors that Impacted the Economic and Political
Success of Newly Liberated Nations:
• Did the nation fight to become free?
• How enlightened had the colonizing power been? Had it
educated a native elite, leaving behind politicians,
economists, and trained personnel with practical skills?
• Were there serious ethnic, cultural, or religious divisions?
• Did a country have natural resources to exploit? Did the
government exploit them efficiently or were they unable
to diversify its economy?
• Did a newly liberated country take sides in the Cold War,
i.e. the United States or the Soviet Union? Superpowers
often intervened in the affairs of decolonized nations.
• This political
cartoon depicts
a common
theme about
modern Africa.
• What do you
think is the
theme?
• Why?
Overview of Why Modern African Nations
Facing So Many Problems:
• Unity
– inherited borders drawn up by imperial powers, split
ethnic groups and tribes
• Finding Professionals
– before independence Europeans dominated
professions
– few Africans had training as educators, doctors,
scientists, engineers, etc…
• Maintaining Government:
– When independence came, Africans had little
experience running a government
Economic Problems Facing
Modern Africa
Economic Challenges
After achieving independence, many African nations faced economic
challenges that came with their new status.
Struggling
Economies
Farming, Mining
Development
Loans
• After independence
most African
nations’ economies
fragile
• African nations not
industrialized,
depended on
farming, mining raw
materials
• For loans, turned to
international
organizations, like
World Bank; bad
planning, corrupt
leaders left nations
with huge debts, no
infrastructure
• Depended on only
one, two exports for
support
• Example: Ghana
depended on
cocoa; Nigeria, oil
Economic Problems
• Structural Legacies
--Economies based on raw material exports
--Aid/dependency
--Migrant labor/labor compounds
--Tension between “tradition” and “modernity”
Economic Problems
• During imperialism European nations set up
export type economies.
– Economies depended on the export of raw
materials.
Cash Crops
Raw materials
Economic Problems
• Many African nations still relied on these export
goods.
– Problem
• When no demand/prices fall/countries become poor.
Economic Problems
• African nations relied on buying manufactured
goods and had no industrial base.
Economic Problems
• Economic Policies
– Failed socialist economy
– Cash crops instead of food
crops
– Lack of funding for rural
areas.
Economic Problems
• African nations have to import manufactured
goods and incurred a large debt.
Economic Problems
• Economic Dependence
– Need for foreign aid
– Need for imported goods
– High debt
Debt and Structural Adjustment
Origins of African Debt
• For some countries (Ghana, for example),
debt began with ambitious development
projects in the 1960s
• In most cases, however, serious
indebtedness began in the early 1970s
• Oil crisis dramatically increased the price
of imports
• Worldwide recession decreased the
willingness of the US and former colonial
powers to distribute aid in grants
Origins of African Debt
• World prices for exports (especially
agricultural exports) fell
• The public sector grew, especially
with increased bureaucracy (in
Ghana, for example, by 150 percent
between 1957 and 1979)
• Between 1970 and 1976, Africa’s
public debt quadrupled
State Contraction in the 1980s:
Trying to Pay Off Debt
• Debt servicing began to take a
substantial portion of many
countries’ GDPs
• Ambitious development plans were
largely scrapped
• Governments tended to focus on
maintaining power and preserving
order
Structural Adjustment: Trying to
Pay Off Debt
• Implemented by the International
Monetary Fund and the World Bank
beginning in roughly 1981
• Required substantial cuts in state
services
• Tended to promote industrialization as a
path to economic growth
• Often involved the devaluation of
currency
Debt, Structural Adjustment
and Legitimacy
• The demands of debt and structural
adjustment often rendered
governments less able to supply the
needs of their people and less able
to claim grassroots legitimacy
• Debt seen as attached to a country,
not to a particular government—
transferred even when a government
was deemed illegitimate
International Aid to Help African
Debt
• Since the 1970s, the general trend has been a
decrease in aid to Africa—monetary aid fell by
almost half in the 1990s
• A large proportion of what is counted as aid by
donor countries is known “phantom aid”—for
example, some 50% of all technical assistance is
said to be wasted because of inappropriate usage
on expensive consultants, their living expenses,
and training
• Aid frequently carries restrictions with regard to
its use
Aid Donors to Africa
• Most donor countries use aid as part of a broader
foreign policy focused on “national interests”
• The US has directed aid to regions where it has
concerns related to its national security, e.g.
Middle East
• Sweden has targeted aid to “progressive
societies”
• France has sought to promote maintenance or
preserve and spread of French culture, language,
and influence, especially in West Africa, while
disproportionately giving aid to those that have
extensive commercial ties with France
African Trade Imbalance
• Many aid packages require receiving countries to
purchase goods from the donor country, often in a way
that disadvantages the economy of the recipient
• Reports have suggested that aid tied with conditions cut
the value of aid to recipient countries by some 25-40
percent, because it obliges them to purchase imports
from the richer nations at uncompetitive prices
• As of 2000, over two-thirds of United States aid was tied
to requirements to purchase goods and services from the
US
• Aid generally fails to increase the export side of receiving
countries’ economies
Economic Realities of Contemporary Africa
• The Combined Gross Domestic Product for all of Sub-Saharan Africa
in 2000 was US$322.73 Billion—less than the GDP for the
Netherlands (and considerably smaller than the GDP for the state of
California)
• Between 1990 and 2000 GNP per capita declined .7 per cent in SubSaharan Africa
• However, since 2000 a number of African countries have
experienced a annual growth rate of around 5%
• Nearly 40% of Africa’s GNP is from agriculture, less than 15% from
manufacturing: lowest of any region in the world.
• Africa counts for less than 2% of global trade
• In 1960 average service debt of an African country was 2% of
exports; in 2000 239% of exports
Economic Realities of Contemporary Africa: Poverty
(Numbers and Percent of People living on $1 or less a day)
World
Region
1990
1999
#*
%
2015
#
%
#
%
S-S Afr
241
47
315
49
404
46
L. Amer
48
11
57
11
47
7.5
S. Asia
506
45
488
37
264
16
5
2
6
2
8
2
M East & N
Afr
Economic Realities of Contemporary Africa: Poverty
(Numbers and Percent of People living on $2 or less a day)
World
Region
1990
1999
#*
%
2015
#
%
#
%
S-S Afr
386
76
480
75
618
70
L. Amer
121
28
132
26
117
19
S. Asia
1010
90
1128
85
1139
68
50
21
68
23
62
16
M East &
N Afr
Economic Realities: Congo
Congo:
• Mineral Rich: Copper, Cobalt, Coltan, Diamonds,
Tin
• Agriculture: wide variety of food and cash crops
including coffee, tea, rubber and commercial
lumber.
• Industry: very little manufacturing, mineral
processing
• Yet: GDP per Capita is $88 compared to an average
of $541 in Sub-Saharan Africa; Per Capita Income
$110 per capita compared to $600 for Sub-Saharan
Africa
Economic Problems in Africa
• Population and Poverty
– Population explosion
– Widespread hunger
Political Problems
Left Side Activity
• Pairs: Look at the following political cartoon.
• What is the message of the political cartoon?
• How can you tell?
Political Problems in Africa
• Political Problems
– Power hungry and greedy
leaders
– Military takeovers
– Harsh dictators
– Ethnic and regional
conflict.
Military Dictatorships
One–Party System
• End of 1960s, nearly all newly
independent African nations
adopted one-party system
• Single political party controls
government
– Elections rarely competitive
– Opposition parties outlawed in
many countries
• Dictators ruled many nations,
maintained power through
patronage, giving loyal
followers well-paid positions in
government
Bribery and Corruption
• Some corrupt officials required
bribes for government
contracts, licenses
• Also ran government
enterprises for personal profit
• New generation of dictators
robbed countries of wealth
– Mobutu Sese Seko, dictator
of Congo, amassed personal
fortune of about $5 billion,
while his people fell into
poverty
Democracy for Some
• Despite conflicts, war throughout late 1900s, many African countries
still dictatorships
• Cold War: U.S., Soviets gave large amounts of money to dictators
friendly to their side
• Cold War ended, money dried up; weakened some dictators’
governments
Elections
• Many Africans saw weakness as
opportunity to create democratic
governments, demanded elections
• By 2005, more than 30 African
countries had abandoned one-party
systems, held elections
Results
• Election results mixed
• Some former dictators resorted to
fraud, intimidation to win elections
• Others elected because people
preferred them to alternatives
Political “Realities” of Contemporary Africa:
Regime Types Today: Africa’s Second
Revolution/Independence
Democratic (17)
Partially Democratic (15)
Undemocratic (16)
Benin
Botswana
Cape Verde
Gambia
Ghana
Kenya
Malawi
Mauritius
Mozambique
Namibia
Nigeria
Sao Tome
Senegal
Seychelles
South Africa
Tunisia
Zambia
Chad
Camoros
Congo (Brazzaville)
Gabon
Egypt
Eritrea
Ethiopia
Lesotho
Madagascar
Morocco
Rwanda
Sierra Leone
Swaziland
Tanzania
Uganda
Algeria
Angola
Burundi
Cameroon
Congo (Democratic Republic) ?
Cote D’Ivoire
Djibouti
Equatorial Guinea
Guinea
Libya
Mauritania
Niger
Somalia
Sudan
Togo
Zimbabwe
Impact of Cold War Funding on
Africa
Results for Africa of aid from U.S. and the West
during the Cold War
• US gave at least $1.5 bill weapons to Africa
during Cold War (1950-89)
– - incl $400 mill to dictator Mobutu in Congo
– $250 mill to Jonas Savimbi’s UNITA movement
Angola
– Half the US aid went to governments with known
human rights abuses including Congo, Rwanda,
Uganda atrocities (perhaps 3 million)
Militarization Across Africa
Portuguese
soldiers
planting and
unearthing
land mines in
Angola, 1970s
•
•
•
•
•
•
Militarization Across Africa: Curse of landmines
Angola: more than 70,000 amputees and more than 16,000 killed.
– Estimates of total number of land mines = 10-20 million
– Angola is the one most heavily impacted by 1-2 land mines per person
– Whatever you want to do, whether it's plant a field or rehabilitate a school or open a
road, you've first got to clear away the mines. The threat of mines has paralyzed the
country
More than 70 types of mines - manufactured in at least 22 countries - have been planted
in Angola during recent decades.
– Mines were installed by the government military, the South Africans, the Cubans, the
Russians, UNITA, the police, by neighboring governments, and several other Angolan
armed groups.
The numbers of mine layers makes demining - which includes understanding the strategy
and patterns of mine laying - even more complicated.
– Mine clearance experts say only the Cubans made accurate maps of their mine fields.
Tens of thousands of one-legged Angolans hobbling around their country on crutches
provide graphic evidence that most of the mines laid here are small anti-personnel mines
designed to maim rather than kill.
Yet the explosives are often targeted at civilians, most often women and children, rather
than soldiers.
Planted near water sources and under shade trees in the savannah, they are designed to
terrorize, often with the goal of depopulating the countryside.
Militarization in Africa—The Cost
• An average of $22 billion is being spent each
year by the nations of Africa, Asia, Middle
East, and Latin America on arms.
• If this were redirected, it would be enough to
reach the UN targets of Universal Primary
Education
• And reducing infant and maternal mortality.
• And Meeting all of the Millennium
Development Goals
Militarization of Africa –Arms Sales
Out of Control
• The U.S., France, Russia, China and the UK together
account for 88% of all the world’s conventional arms
exports.
• There are 639 MILLION small arms and light weapons in
the world
• Today, eight million more are produced every year.
• From 1996-2001, the USA, UK, and France earned more
income from arms sales to developing countries than
they gave in all kinds of emergency, disaster, and
economic assistance aid.
Tribalism and Nationalism
Causing Civil Wars and Genocide
Tribalism and Nationalism
• African boundaries had been set by imperialistic
nations not African nations
– Berlin Conference 1885.
Tribalism and Nationalism
• Many tribes and nations were split by these
European boundaries.
• Because of these splits there is more loyalty to
one’s tribe then the country they live in.
Ethnic Conflicts and Civil War
When the European powers divided Africa into colonies, preexisting political
units were not maintained.
Ethnic Conflicts
• After independence, rival ethnic
groups competed for control,
some by destructive civil wars
• 1967, Igbo-speaking group of
eastern Nigeria proclaimed
independent state of Biafra
• Bloody civil war erupted; 2
million died from fighting,
another 2 million from starvation
Civil Wars
• 1992, civil war, drought led to
suffering in Somalia
• Hundreds of thousands of
Somalis died when warring
militias stole food sent from
international relief agencies
• 1990s, tensions between Hutu,
Tutsi erupted in violence
• 1994, 1 million Tutsi, moderate
Hutus massacred in Hutu-led
government genocide
Example: Nigeria
• In Nigeria this tribalism
lead to a civil war.
• More than 200 ethnic
groups live within Nigeria.
• During independence
many of these tribes
fought for control of the
country.
Example: Nigeria
• The two main groups fighting for control were the
– Muslim Hausa and Fulani people of the north
• Vs.
– Christian Ibo and Yoruba of the south
– In 1966 20,000 Ibo were massacred by the Hausa controlled
government.
– In a several year period about 1 million people had been
killed or starved to death.
– Military leaders took control in the 70’s and 80’s
– In 1999 Nigeria elected a civilian government.
The costs of the new wars to Africa’s
children
Up to 20,000 children are fighting in Africa’s conflicts
today…..
Health Issues
Disease
• African nations also challenged by management of deadly diseases
• Malaria continues to be one of most common causes of death today
• 1980s, new disease, acquired immune deficiency syndrome (AIDS) spread
rapidly throughout Africa
AIDS
• HIV virus that causes AIDS weakens body’s immune system, results in death
• Social costs in sub-Saharan Africa staggering; millions of orphaned children
because parents died from AIDS
• Only small percentage of infected Africans receiving AIDS treatment
AIDS
70% of the world’s estimated
40 million people living with
HIV/AIDS are located in
Sub-Saharan Africa.
Sub-Saharan Africa is home to
90% of the world’s
HIV infected children.
Of 30 children born in
sub-Saharan Africa10 will acquire the virus
simply by being born4 will be infected from breast
feeding .
Most of these children will not
th
live to see their 5 birthdays.
Health Realities of Contemporary Africa
The Scourge of HIV-AIDS
• HIV-AIDS: Out of approximately 40 million HIV-AIDS victims in the
world 29.4 victims reside in Sub-Saharan African countries.
• Nearly three million children under the age of 15 are HIV positive
• Four countries in southern Africa have HIV infection rates of 25% or
higher of adult population
• In the last decade 12 million people died of AIDS in Africa
• Life expectancy in southern Africa increased throughout the region
to nearly 60 years of age in 1990 (from 44 years in 1950); life
expectancy expected to drop to 40-45 years of age by 2005.
• Rays of hope: decline in infection rate in a number of countries,
stabilization in South Africa; reduction in the price of antiretrovirals.
AIDS in Africa
• Data suggests AIDS began in Africa in the late
1970s, spreading south from equatorial areas
over the 1980s
• Southern Africa has been hit particularly hard
by the AIDS epidemic—Botswana has approx.
38% of the adult population infected
• Uganda is often cited as a model for the
control of AIDS—percentage of the population
infected has dropped to 5% from a high of
14%
History of AIDS in Africa
• Between 1999 and 2000 more people died
of AIDS in Africa than in all the wars on the
continent.
• The year 2000 began with 24 million
Africans infected with the virus.
• Each day, 6,000 Africans die from AIDS.
• Each day, an additional 11,000 are
infected.
History of AIDS in Afirca
In 2007…
• 32.8 million living with HIV
• 2.5 million new infections of HIV
• 2 million deaths from AIDS
• Over two-thirds of HIV cases, and some 80%
of deaths, were in Sub-Saharan Africa.
AIDS and Government Stability
Describe the impact of government stability on the distribution
of resources to combat AIDS and famine across Africa.
• In highly affected regions, HIV/AIDS also places huge strains on
state institutions and the economy.
• AIDS most frequently strikes at the most productive members of
society, those 15-45 years old.
– Their deaths have left Africa with over 11 million orphans
• Number of deaths and infection rate to increase over the next 10
years
• Therefore, the acute impact of the AIDS pandemic may result in
the widespread economic and political destabilization of societies,
states, and entire regions.
Impact of AIDS
• Poor health care systems, poverty, and lack of
government organization
• Lack of knowledge about the disease and its
prevention
• Antiretroviral drugs that are able to slow
down the progress of the disease are
expensive
12 million African children
have been orphaned due to the
AIDS virus.
17 million Africans have
already died since the
epidemic began in
the late 1970’s.
Within 10 years the average
life expectancy in 11 countries
in Africa will drop below 40
as HIV/AIDS continues to
shorten life spans.
The Paradox of Botswana: Stable
Government and Economy, but AIDS
Rampant
• Botswana has maintained a stable, democratic government
since 1965
• The country’s diamond resources and strong beef industry
have produced a middle-class standard of living for many
residents
• Even as Botswana thrives, however, it has the second
highest rate of HIV infection in Africa (after Swaziland)—
over 1/3 of people between the ages of 15 and 49 are
infected
AIDS and Famine
Describe the impact of government stability on the distribution
of resources to combat AIDS and famine across Africa.
• If people are sick, what happens?
• Aids kills young adults, especially women - the people whose labor is
most needed. When the rains come, people must work 16 hours a day
planting and weeding the crop. If that critical period is missed, the family
will go hungry. In a community depleted by Aids, each working adult
must produce more to feed the same number of dependents - not just
children but sick adults, too.
• Just as HIV destroys the body's immune system, the epidemic of HIV and
Aids has disabled African countries.
• As a result of HIV, the worst-hit African countries have undergone a
social breakdown that is now reaching a new level: African societies'
capacity to resist famine is fast eroding.
• Hunger and disease have begun reinforcing each other.
Health Realities of Contemporary Africa
Diseases of Poverty:
• Malaria kills over 1 million people in Africa each
year with an estimated cost to African
economies of over $2 billion
• Sleeping Sickness (trypanosomasis) threat to 60
million, infects 300,000 each year
• River Blindness (onchocerciasis) 17.5 million in
Africa (99%) of world total
• Biharziasis impacts estimated 80 million in
Africa
Malaria has not received adequate
attention and is a major cause of
death of children
60
50
40
30
20
10
0
Angola
Benin
Burkina
Faso
Eritrea
Gambia,
The
Ghana
GuineaBissau
Kenya
Nigeria
Tanzania
Uganda
Percentage of children under five sleeping under insecticide-treated bednets 2000-2004
Percentage of children under five with fever accessing effective antimalarial drugs 1997-2004
Zambia
Ebola
The Deadly African Virus
X
Ebola Virus Introduction
• First appeared in Africa 1976
• “African Hemorrhagic Fever”
–
–
–
–
acute,mostly fatal disease
causes blood vessel “bursting”
systemic (all organs/tissues)
humans and nonhuman primates
• Excluding ‘2000 outbreak
– 1,500 cases
– over 1,000 deaths
Figure. Ebola virus disease (EVD)
cumulative incidence* — West
Africa, October 18, 2014
* Cumulative number of reported EVD cases per 100,000 persons since December 22, 2013.
MMWR 2014;63(43):978-981
94
Ebola Outbreaks 1976-2014
2014 Ebola Outbreak, West Africa
WHO Ebola Response Team. N Engl J Med 2014. DOI: 10.1056/NEJMoa1411100
http://www.nejm.org/doi/full/10.1056/NEJMoa1411100?query=featured_ebola#t=articleResu
lts
96
EVD Cases (United States)

As of October 31, 2014, four U.S. health workers and one
journalist who were infected with Ebola virus in West Africa
were transported to hospitals in the United States for care
 All the patients have recovered and have been released from the
hospital after laboratory testing confirmed that they no longer have
Ebola virus in their blood
98
Ebola Virus Transmission

Virus present in high quantity in blood, body fluids, and excreta
of symptomatic EVD-infected patients

Opportunities for human-to-human transmission
 Direct contact (through broken skin or unprotected mucous
membranes) with an EVD-infected patient’s blood or body fluids
 Sharps injury (with EVD-contaminated needle or other sharp)
 Direct contact with the corpse of a person who died of EVD
 Indirect contact with an EVD-infected patient’s blood or body fluids via
a contaminated object (soiled linens or used utensils)

Ebola can also be transmitted via contact with blood, fluids, or
meat of an infected animal
 Limited evidence that dogs become infected with Ebola virus
 No reports of dogs or cats becoming sick with or transmitting Ebola
99
Modes of Transmission
There are 3 modes of
infection:
1. Unsterilized needles
2. Suboptimal Hospital
conditions
3. Personal contact
http://www.ecplanet.com/pic/2003/12/1071257871/ebola.jpg
Human-to-Human Transmission

Infected persons are not contagious until onset of symptoms

Infectiousness of body fluids (e.g., viral load) increases as patient
becomes more ill
 Remains from deceased infected persons are highly infectious

Human-to-human transmission of Ebola virus via inhalation
(aerosols) has not been demonstrated
101
Early Clinical Presentation

Acute onset; typically 8–10 days after exposure
(range 2–21 days)

Signs and symptoms
 Initial: Fever, chills, myalgias, malaise, anorexia
 After 5 days: GI symptoms, such as nausea, vomiting, watery diarrhea,
abdominal pain
 Other: Headache, conjunctivitis, hiccups, rash, chest pain, shortness of
breath, confusion, seizures
 Hemorrhagic symptoms in 18% of cases

Other possible infectious causes of symptoms
 Malaria, typhoid fever, meningococcemia, Lassa fever and other
bacterial infections (e.g., pneumonia) – all very common in Africa
102
Symptoms
• Early symptoms
– muscle aches, fever, vomiting
– red eyes, skin rash, diarrhea, stomach pain
• Acute symptoms
– bleeding/hemorrhaging from skin, orifices, internal organs
• Early Diagnosis
• very difficult
• signs & symptoms very similar to other infections
Prevention
• No vaccines!
• Patients are isolated
• Medical Staff Training
– western sanitation practices
• intake
• care during stay
• after patient dies
• Infection-control Measures
– complete equipment and area sterilization
Prevention
After Death
Virus contagious in fluids for days
• Burial use extreme caution
– handling and transport
– cultural practices/ religious belief
– incinerate all waste !!!!
Patient Recovery

Case-fatality rate 71% in the 2014 Ebola outbreak
 Case-fatality rate is likely much lower with access to intensive care

Patients who survive often have signs of clinical improvement by
the second week of illness
 Associated with the development of virus-specific antibodies
 Antibody with neutralizing activity against Ebola persists greater than
12 years after infection

Prolonged convalescence
 Includes arthralgia, myalgia, abdominal pain, extreme fatigue, and
anorexia; many symptoms resolve by 21 months
 Significant arthralgia and myalgia may persist for >21 months
 Skin sloughing and hair loss has also been reported
References: 1WHO Ebola Response Team. NEJM 2014; 2Feldman H & Geisbert TW. Lancet 2011; 3Ksiazek TG et al. JID 1999; 4Sanchez A
et al. J Virol 2004; 5Sobarzo A et al. NEJM 2013; and 6Rowe AK et al. JID 1999.
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