Poverty and HIV Infection
The characteristics of the poor are well known as also are some of the causal factors at work which contribute to a "culture of poverty" - the fact that the children of the poor often become the poor of succeeding generations.
Poverty is associated with weak endowments of human and financial resources, such as low levels of education with associated low levels of literacy and few marketable skills, generally poor health status and low labour productivity as a result. An aspect of the poor health status of the poor is the existence amongst many Africans of undiagnosed and untreated STDs which is now recognised as a very significant co-factor in the transmission of HIV.
Poor households typically have few if any financial or other assets and are often politically and socially marginalised. These conditions of social exclusion increase the problems of reaching these populations through programmes aimed at changing sexual and other behaviours.
It is not at all surprising in these circumstances that the poor adopt behaviours which expose them to HIV infection. It is not simply that IEC activities are unlikely to reach the poor (which is too often the case) but that such messages are often irrelevant and inoperable given the reality of their lives.
Even if the poor understood what they are being urged to do it is rarely the case that they have either the incentive or the resources to adopt the recommended behaviours. Indeed to take the long-view in sexual or other behaviours is antithetical to the condition of being poor.
For the poor it is the here and now that matters, and policies and programmes that recommend deferral of gratification will, and do, fall on deaf ears.
Even more fundamental to the condition of poverty is social and political exclusion. So HIV-specific programmes are neglectful of the interests of the poor and are rarely if ever related to their needs, and also unfortunately are other non-HIV related programme activities - such as those relating to agriculture and credit. More generally it is the absence of effective programmes aimed at sustainable livelihoods which limit the possibilities of changing the socio-economic conditions of the poor.
But unless the reality of the lives of the poor are changed they will persist with behaviours which expose them to HIV infection (and all the consequences of this for themselves and their families).
Poor families have a reduced capacity to deal with the effects of morbidity and mortality than do richer ones for very obvious reasons. These include the absence of savings and other assets which can cushion the impact of illness and death.
The poor are already on the margins of survival and thus are also unable to deal with the consequent health and other costs. These include the costs of drugs when available to treat opportunistic infections, transport costs to health centres, reduced household productivity through illness and diversion of labour to caring roles, losses of employment through illness and job discrimination, funeral and related costs, and so on.
In the longer term such poor households never recover even their initial level of living as their capacity is reduced through the losses of productive family members through death and through migration, and through the sales of any productive assets they once possessed. A true process of immiseration is now observable in many parts of Africa.
The HIV epidemic has its origins in African poverty and unless and until poverty is reduced there will be little progress either with reducing transmission of the virus or an enhanced capacity to cope with its socio-economic consequences.
It follows that sustained human development is essential for any effective response to the epidemic in Africa. A conclusion that has yet to permeate approaches to the epidemic not only in Africa but more or less everywhere. While the HIV epidemic makes sustained human development more and more unattainable, and actually adds to poverty, it also destroys the human resource capacities essential for an effective response.
Herein lies the problem: how to achieve the sustainable development essential for an effective response to the epidemic under conditions where the epidemic is destructive of the capacities essential for the response. Simple answers to this problem do not exist, but at least recognition of its existence is a step towards its solution. The next step has to be the development of policies and programmes that address the inter-relationships between poverty and development and to actually put in place those activities that can make a difference for development outcomes.
Central to these activities are programmes that address poverty today so as to facilitate future socio-economic development tomorrow. For unless the intergenerational effects of HIV are addressed now then it is optimistic in the extreme to assume that Africa will become a pole of development in succeeding decades.
