AIDS now kills more people worldwide than any other infectious disease and is mankind’s fourth leading cause of death, after heart disease, strokes and respiratory infections. And more people died of AIDS in 1999 than in any previous year.  In many affected countries the improvement in the quality of life that has taken place over the past fifty years is being reversed. In Zimbabwe over 25% of adults are HIV positive - the world’s highest infection rate - and some estimates there show life expectancy falling to 38 years, 17 years shorter that it would have been. “Healthy life expectancy in some African countries is dropping back to levels we haven’t seen in advanced countries since medieval times” says one UN Health Agency director. This is a far worse disaster than anything foreseen when worst-case HIV scenarios were first discussed. US Government analysts now say that a quarter of southern Africa’s population is likely to die of Aids, and the epidemic could follow a similar course in South Asia and the former Soviet Union.

As well as causing massive human suffering, AIDS has a pernicious economic impact. For unlike most health disasters, AIDS affects the strong and the productive - the people on whom functioning societies rely. By weakening and killing adults in the prime of their working lives, it lowers productivity and erodes countries’ skill bases. And as the disease spreads, spending on health care can rise massively.  AIDS’ widespread nature can easily overwhelm a government and start to undo the careful progress made in other areas. It is becoming more and more a part of the fabric that constitutes a country’s security.

In the West the vast majority of HIV transmission was between gay men.

But worldwide about 70% of HIV positive men have acquired the virus through vaginal sex. Interestingly circumcised men are up to 8 times less likely to acquire HIV from heterosexual sex than uncircumcised men. It is easier for a man to pass the infection to a woman than vice versa and so more women are infected than men. The women are usually younger than the men and therefore likely to survive longer, although infected.

In many places, ignorance, complacency and the stigma attached to the disease are potent killers. In a study of home-based care schemes in southern Africa, fewer than one in ten people who were caring for HIV-infected relatives acknowledged that they were suffering from the disease. A doctor noted “One might think that in a country with a quarter or third of the population infected, people would become more open about the epidemic. But experience teaches us that this does not happen automatically. The silence needs to be broken, publicly and courageously, by leaders who encourage their people to face the truth about Aids. The epidemic has to be given public recognition, without stigma, before it can be seriously tackled.”

In Jamaica about 1.6% of the general population is infected with the HIV virus. According to Dr. Yitades Gebre, Director of the National STD/AIDS Control Programme, our present condition is far better than most countries in the Caribbean region and 10 to 15 times better than most African or South East Asia nations, including India. By responding to the epidemic in a timely and organized manner as early as 1986, Jamaica has avoided the tremendous macro and micro economic impact of AIDS being experienced in other countries. Our prevention effort and good public awareness has slowed the rate of increase over the years. There was only a 7% rate of increase last year, compared with a 20% rate a decade ago.

Yet Dr. Gebre says Jamaica cannot afford to get complacent, for we remain a highly promiscuous country. Almost 14% of boys and 10% of girls have been initiated to sex before age 10. Sixty percent of boys and 15% of girls aged 15-19 have multiple sex partners, and reported levels of ‘transactional sex’ among schoolgirls are worryingly high. Any society with such high levels of sexual activity and infidelity will always have the potential for an AIDS explosion. 

But all in all Jamaican authorities seem to have done a good job in combating the spread of AIDS. Now our health care system is often criticized, sometimes justifiably so. Yet it should be recognized that very few countries have managed to provide such good primary health care with such limited financial resources. A recent WHO study calculating the number of years that a person can be expected to live in full health ranked Jamaica 36^th out of 191 countries. The only ‘poor’ countries ahead of us were Dominica and Cuba, and we ranked above both our richer West Indian cousins Barbados and Trinidad. Sometimes we Jamaicans should step back and look around at what we may be doing right and not simply concentrate on the negatives.

The AIDS education campaign also seems to be permanently changing Jamaican sexual behaviour. Condom use is now over 65% for both women and men, while most men have reduced their number of sexual partners. And more young people are remaining virgins and abstaining from sex until a later age.

Many people feel that one of the main sources of Jamaica’s social problems is our extremely high out of wedlock birth rate, which at 85% is perhaps the highest in the world. Many official attempts in the past have been made to change the mating patterns of Jamaican men and women, but none have been very effective. It seems ironic that AIDS may succeed where governments have failed. On one level fear of the disease is making young people wait longer to have sex and reducing the ‘Nuff Gal’ syndrome, both large factors in our high teenage pregnancy rate. On a more Darwinian level, AIDS is simply more likely to kill people who sleep around. The bottom line result will be a less promiscuous population overall and less children born to the unmarried. As the old hymn goes, God moves in mysterious ways his wonders to perform.

Indeed it may well be that AIDS on a world wide basis, and especially in Africa, will act in the 21^st century as the ‘Black Death’ plague did in the 14^th century when it killed one third of Europe’s population. That is it will ‘purge’ society of those whose behaviour is not suitable to the needs of the time and actually leave survivors economically better off in the long run. This may seem a cruel view of the numberless tragedies the disease has inflicted. But then history is always heartless. “A single death is a tragedy,” sneered Stalin “but a million deaths is a statistic. Unfortunately he was right. changkob@hotmail.com