The countries most affected by HIV/AIDS are among the poorest in the world. The layers of society affected are also among the most vulnerable, both in the underdeveloped and developed countries. Eradicating poverty is the first and most fundamental step in eradicating this disease, something which is impossible under capitalism. This article provides some convincing statistics and arguments in favour of a fundamental change in society.
Far from being a "gay man's" disease, HIV/AIDS now infects 40 million people around the world, 45% of them women and 6% children. In 2005, roughly 4.1 million people became infected with HIV, the virus which causes AIDS, while 2.8 million people died of the disease. Most alarmingly, infection rates are increasing most rapidly among young women (15-24 years of age). [Unless otherwise noted, statistics from the 2006 Report on the Global AIDS Epidemic produced by UNAIDS.]
An epidemic that affects the poor and disadvantaged
The list of regions and populations most affected by AIDS reads like a list of the poorest and most disadvantaged populations. Sub-Saharan Africa is widely known as the hardest hit by the epidemic, reaching pandemic proportions with 2005 rates as high as 18.6% among adults (age 15 - 49) in South Africa and 24.1% in Botswana. The Caribbean, Southeast Asia, Russia and Ukraine are next on the list of most affected regions. Of course, statistics reflect diagnoses; where there are no tests, there can be no statistics. It is safe to assume that there are hidden epidemics in regions where any discussion of sexual health is taboo. In Pakistan for example, one in five Karachi sex trade workers "could not recognize a condom, and one in three had never heard of AIDS" (UNAIDS, 29).
Even in the United States and Canada, infection rates are highest among disadvantaged populations. African Americans for example, make up just over 12% of the population in the USA, but account for 50% of new HIV diagnoses. Poor women in North America are disproportionately at risk and African American women are reportedly up to twelve times more likely to be infected than their white counterparts. Shockingly, in the richest country on earth, "AIDS is the leading cause of death among African American women aged 25 - 34 years and ranks in the top three causes of death for African American men aged 25 - 54 years" (HIV/AIDS among African Americans, US Centers for Disease Control and Prevention, 2004). Canada's Aboriginal population - by far the poorest and most marginalized - make up 16.4% of all AIDS cases, while they are less than 3% of the population (Circle of Hope, The First Nations & Inuit of Québec HIV & AIDS Strategy, Fall 2006). While Canadian infection rates have decreased 24% overall in the last twenty years, they have increased five-fold among the aboriginal population.
Why this correlation between poverty and HIV infection? The answer is fairly obvious. While not yet curable, HIV is preventable and treatable. But under capitalism, prevention education and treatment don't reach the poor, because there is no immediate profit to be gained. AIDS spreads most rapidly where education and healthcare are lacking and where superstition and fundamentalism dominate, preventing people from accessing the information they need to make healthy sexual choices. Poverty and despair also correspond to increased injection drug use, which is the leading cause of infection in post-Soviet Russia. Tragically, the new thriving Russian drug market has targeted young people; three in four new HIV infections are in youth under the age of thirty.
Once the virus moves outside the circles of gay men and injection drug users, women are the most vulnerable to infection. There is a physiological explanation for this, as HIV is spread through blood or semen and must be able to enter the bloodstream in order to infect. But there are social factors as well. Women may bear the brunt of poverty and despair physically, as victims of physical and sexual violence. They are also doubly burdened by unpaid domestic work and care-giving, and less likely to find time to get tested or take care of themselves. According to YouthCO AIDS Society, "young women are [...] usually the last to get tested and receive treatment" (www.youthco.org). As mentioned above, young women (15 - 24 years) are the fastest growing demographic contracting HIV. This is especially true where there is extreme impoverishment and deep gender inequality. In Trinidad and Tobago for example, 15 to 19 year old girls are six times more likely to be HIV positive than boys the same age.
In sub-Saharan Africa, 59% of adult HIV infections are among women. In Botswana, 38% of pregnant women visiting clinics in 2003-2004 were HIV positive. The corresponding figure for South Africa is 29.5%. These numbers graphically explain why there are twelve million orphans in sub-Saharan Africa. Meanwhile, there are two million HIV positive children in this region, accounting for nine tenths of infected children worldwide. It is capitalism that has deprived them of the right to life. In 2007, there is no sane reason for this number of children to be infected by their mothers. With treatment and proper care (including formula and clean water to mix it with), there is less than 1% chance of mother-to-baby transmission. But it is this treatment and proper care that does not exist for those who cannot pay for it.
Capitalism and AIDS
A disease mortality specialist will tell you that most diseases target and kill the young and the old. HIV however, is most prominent in the 20-49 age group and in the worst affected parts of the world, the result has been the virtual demise of an entire generation - the majority of the working and child-rearing population. The effects that this has had on the economies and already sickeningly inadequate infrastructures of these countries can be well imagined. In parts of sub-Saharan Africa, the workforce in both industry and agriculture has been all but obliterated. In many communities, there are no nurses and no teachers; those adults who are well have had to turn their attention to caring for those who are unwell.
The relationship between poverty and the pandemic spread of AIDS in some parts of the world is no longer denied by anybody. The important question is, what conclusions can be drawn from this connection? In the world of wealth and diplomacy, where worldly intellectuals gather to ponder new ways of absolving the guilt that comes with defending an undefendable economic system, a simple conclusion has been drawn. It is nicely summed up in the following introduction to Chapter 4 of UNAIDS' 2006 Report on the Global AIDS Epidemic - Impact of AIDS on People and Societies:
"In some countries, AIDS is undermining progress towards the Millennium Development Goals, particularly those related to poverty reduction, achieving universal primary education, promoting gender equality, reducing child mortality and improving the health of mothers (80)."
Most people, upon hearing about the Millennium Development Goals, were torn as to whether they should laugh or cry. There is something tragicomic about the UN, which has in the face of George W. Bush proven itself to be completely useless, committing to reduce poverty, improve healthcare and education, promote gender equality, develop a global partnership, etc, by 2015. Those who believe these gains might actually be possible are either revolutionary socialists (who know it will not be the UN to carry it through but the working class by taking power worldwide) or simply naïve believers in the wonders of the market economy. Even the drafters of the document admit, as is made clear by the paragraph above, that the 2015 target may be difficult to meet. Why? Now here's the clincher - they claim, because of AIDS.
This is no simple case of Which came first, the chicken or the egg? These folk are claiming that somehow the AIDS epidemic is responsible for their inability to proceed with the reduction of poverty in these so-called "developing" countries. It fits in nicely with the "development" myth as a whole. The story goes that these "developmentally challenged" countries are on some gradual steady incline of progress, with the aid of the superior brawn and intellect of "the West". Although anybody who even glances at world economic statistics will know that the poor world has been doing anything but developing or progressing and has in fact been regressing, while the disparity between wealthy and poor nations increases steadily. While these fools sigh with relief at the opportune timing of the appearance of HIV to cover up the complete inability of their economic system to improve conditions for the world's population, we know that actually it is poverty that has allowed AIDS to reach pandemic proportions. And poverty is simply the product of an economic system which not only allows but depends upon gross inequality.
A graphic illustration of capitalism's responsibility for AIDS reaching epidemic and pandemic proportions comes from a Caribbean country that our readers will no doubt be fairly familiar with. The Caribbean is the second most AIDS affected region, after sub-Saharan Africa. AIDS is the leading cause of death among adults (15 - 44 years) and 51% of those infected are women. Yet even the folk at UNAIDS are forced to admit that "Cuba [...] remains an anomaly in the region. The country's mother-to-child transmission programme is among the most effective in the world, and has kept the total number of HIV-infected babies to date below 100, while universal, free access to antiretroviral therapy has limited both AIDS cases and deaths" (UNAIDS, 39).
While Harvard academics like the late Jonathan Mann[1] blather about "combining the synergistic forces of public health, ethics and human rights" (whatever that means...), it is the simple and concrete gains of the nationalized planned economy that have led to Cuba having one of the lowest infection rates in the world. And not surprisingly, these glowing gains are at very real risk of being reversed where capitalism is encroaching. Since the collapse of the Soviet Union, the only hope of a decent income for many Cubans is in the tourist industry, and for many women this means prostitution.
An uphill battle under capitalism
There are many areas in which sincere AIDS activists can place their hopes. There is the quest for a cure, a long line of anti-retroviral drugs for combination therapy, as well as research into new preventative measures. The latest holder of hope is the topical microbicide which is still in the clinical trial stage and would be the first preventative method that can be controlled by a woman without the knowledge of her partner. This is an exciting prospect that may help reduce infection rates in the developed world and would certainly be made available to all under socialism. But under capitalism, it is no more likely to be available where it's most needed than are the plethora of other drugs, supplements and preventatives kept under lock and key by patent-holders.
Most readers will already be well aware of the questionable activities of the world's big pharmaceutical companies (see "Dying for drugs"- Health warning: capitalism kills! by Jordi Martorell). To the present author, the handful of people at the top in these corporations, who profit from illness and hinder treatment, personify the only real evil in the present world - that is, the capitalist system. The pharmaceutical giants have leeched off publicly funded research, put innocent disease sufferers at risk in their rushed clinical trials, charged exorbitant prices for medications that cost pennies to produce, and threatened governments that have attempted to produce cheaper generic versions of their patented drugs.
Human Immunodeficiency Virus (HIV) attacks the body's immune system, infecting vital defense cells (primarily CD4+ T cells). On the one hand, the virus directly kills the cells that it infects, but it also causes other defense cells in the body (CD8 cells) to attack and kill the infected CD4+ cells. When the number of CD4+ cells in an individual's body falls below a critical level, the body loses its cellular defense ability and becomes vulnerable to various opportunistic infections that the body would otherwise be able to fight. The presence of opportunistic infections heralds the onset of Acquired Immune Deficiency Syndrome (AIDS) and it is in fact one of the opportunistic infections that in the end kills the HIV infected person.
It is possible, with access to nutritious immune-boosting food and expensive antiretroviral combination therapies, to live a fairly full life with HIV. The problem is that the majority of the world's population does not have access to nutritious food or antiretroviral treatment. In sub-Saharan Africa, only one in six people in immediate need of antiretroviral therapy have access to it. The numbers in Southeast Asia are similar and in Russia and Ukraine they are even lower.
Even in the developed world, those most vulnerable to infection - injection drug users, sex-trade workers, and disadvantaged populations including poor women - do not have access to nutritious food. In 2006, for the fourth year in a row, London's Economist magazine ranked Vancouver the world's most liveable city. It is also home to Canada's poorest neighbourhood, the Downtown Eastside, which boasts the highest rate of HIV infection in the Western world. Here, where extreme poverty, open-air drug use, prostitution and homelessness dominate, 40% of injection drug users are HIV positive. This population does not have access to the nutritious diet required by a compromised immune system and they are dying from illnesses like pneumonia and tuberculosis - long thought to be killers of the past in this part of the world.
Meanwhile, countless non-profit AIDS service and prevention organizations are fighting an uphill battle to meet the basic needs of HIV positive people around the world. Essential counselling, education, and support services that ought to be available globally through public healthcare, are instead left to charities to provide. These organizations are forced to beg and grovel at the feet of the big pharmaceuticals for funding, and to compete with other causes to catch the eye of the likes of Bill and Melinda Gates, who I assure you, require lots of glitz and glamour to impress.
In a recent contest held by a regional Canadian bank for example, four incredibly worthy community non-profits competed against each other, to win a million dollars toward their infrastructure and programming. The ensuing campaign frenzy engulfed the population in a battle that pitted hungry against homeless against battered against HIV-positive. The public were left wondering if perhaps the million dollars would be better spent reimbursing the four organizations their publicity costs during the competition. Like any other industry, competition in the non-profit sector means a race to the bottom. Funders are rarely interested in paying an organization to treat their employees well. They are happy to sponsor glamorous conferences and the production of pretty packages, but rarely the people who put these things together. The result is an unregulated sector, made up mainly of contractors without any reliable income, security or benefits.
Under capitalism, charity means guilt relief and tax credits for big corporations. It allows the exorbitantly rich to appear kind and generous. In the end, it subsidizes a decaying economic system that is no longer able to meet even the most basic needs of its population.
The death of AIDS
How will we do away with HIV and AIDS? This is not an easy question, and there are no easy answers. Perhaps a cure will be found shortly. There is always a chance. But these days, the pharmaceuticals are far more interested in treating sexual dysfunction, acne, male pattern baldness, and other such profitable "diseases". We know how the pharmaceutical companies approach drugs - if they can't make a profit, it's not worth investing. If a cure was found tomorrow, (unless there were massive public pressure and political upheavals,) it would be sold, like the existing antiretroviral drugs, at prices too exorbitant for most of the world to afford.
At the time of writing, the simple chemical dichloroacetate (DCA) has been found to reactivate the mitochondria in cancer cells, allowing them to die normally - potentially a cure for cancer. A major fear now is that the drug will not find its way to cancer patients, "because of economic reasons", reports Top Cancer News (www.topcancernews.com) :
"There is no longer a patent on DCA so it is not owned by any one company. With little chance of one group making a large profit, there may be no incentive for pharmaceutical companies to invest in research. Sadly, this drug - that appears to work remarkably well - may never benefit cancer patients. All because no one stands to make billions of dollars from it."
Contrary to the teachings of capitalist economists, supply does not reflect demand in terms of human need, or even want. Under capitalism, demand refers rather to "demand with benefits". If there is no profit to be made, goods will not be made available. It's as simple as that. So, we have overproduction of food products in some parts of the world accompanied by famine in others. For the vast majority of the 40 million humans infected with HIV, this means that they will not have access to treatment, nutritious foods or other services. Just as seriously, the rest of the population will not have access to prevention information and resources.
We cannot end the AIDS pandemic tomorrow, but we can honestly lay out what resources and structures would need to be in place for it to happen at all. The provision of free antiretroviral drugs around the world is a panacea for those who either do not understand the realities of the disease, or do not understand the realities of capitalism. This of course, will be essential in preventing the spread of HIV from mother to infant, as well as improving the lives of those who are infected. Under bourgeois law however, it is completely illegal, and the people that have power to change the law are the people who do not want it changed.
In a Socialist society, on the other hand, where the wealth produced by the population is put back into the population to be used according to the needs and priorities of the population, this would be a very simple step. In fact, as mentioned above, the nationalized and planned economy in Cuba has made the free distribution of antiretroviral drugs possible. An economic system that similarly prioritizes decent public healthcare, including sexual and reproductive healthcare would rapidly decrease the spread of HIV, allowing diagnoses to be made more quickly and prevention information shared more easily.
A population empowered to make decisions about the distribution of wealth would also no doubt prioritize free public education. This would free up the thousands (if not millions) of brilliant young minds currently flipping burgers or piecing together Nike shoes, to focus instead on finding a cure for HIV and other diseases. In many parts of the world, including sub-Saharan Africa, universal education would free the population for the first time from superstition and ignorance around issues of sexual health. A society not stifled by the profit motive, but driven by real human need and aspiration would certainly prioritize these things.
Most crucially, and completely impossible under capitalism, a real end to AIDS requires that there be no humans who are so impoverished, neglected and unsatisfied that they will inject poison into their veins using dirty needles, just to gain momentary respite from their hellish existence. It requires that no woman be in a position where her only hope of survival or making a decent living is by selling her body through prostitution. These dark realities of capitalist society have no place in a socialist society, where each gives according to his ability to each according to his need.
This socialist society that we speak of is not some impossible imaginary world. It is a world freed from the inequality and inefficiency of the profit motive. It is a world where supply meets REAL human demand. It is a world in which things are prioritized because they will improve life for ordinary people, making way for the real innovation and advancement that is only possible when all people are empowered to participate in decision-making. And it is a simple matter of taking back the means of production - the huge banks and corporations which daily reap the benefits of our labour.
The AIDS pandemic, and the inability of capitalism to do anything about it, is just one symptom of an economic system in decay. When the system is no longer able to meet the needs of the population, and no longer able to advance development and improve production and life, then it is time for the system to be replaced. The future not only of millions of people infected and affected by AIDS, but of all of humanity depends on it.
[1] Head of the World Health Organization (WHO) AIDS Program and founder of the WHO Global Program on AIDS, killed in 1998 in the crash of Swissair Flight 111, en route to Geneva for a UN AIDS vaccine conference.