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1. INTRODUCTION
The description of Nigeria as a paradox by the World Bank (1996) has continued
to be confirmed by events and official statistics in the country. The paradox is
that the poverty level in Nigeria contradicts the country’s immense wealth.
Among other things, the country is enormously endowed with human,
agricultural, petroleum, gas, and large untapped solid mineral resources.
Particularly worrisome is that the country earned over US$300 billion from one
resource – petroleum – during the last three decades of the twentieth century. But
rather than record remarkable progress in national socio -economic development,
Nigeria retrogressed to become one of the 25 poorest countries at the threshold of
twenty-first century whereas she was among the richest 50 in the early-1970s.
Official statistics show that in 1980 the national (average) poverty
incidence was 28.1 per of the population. The distribution of the incidence across
the states of the federation showed a maximum of 49.5 per cent recorded for
Plateau (and Nassarawa which was excised from Plateau). This meant that every
state had a poverty incidence below 50 per cent. By 1985, the national (average)
poverty incidence had risen to 46.3 per cent, with the maximum of 68.9 per cent
recorded in Bauchi (and Gombe which was carved out of Bauchi). As at 1996,
the national average stood at 65.6 per cent with Sokoto, Kebbi and Zamfara (all
Prof. Mike I. Obadan is the Director General, National Centre for Economic
Management and Administration (NCEMA), Ibadan.
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
old Sokoto State) recording the highest incidence of 83.6 per cent; followed by
Bauchi and Gombe with 83.5 per cent. As at 2000, the incidence of poverty was
believed to have risen to 70 per cent at the national level.
The increasing incidence of poverty, both within and among locations,
was in spite of various resources and efforts exerted on poverty-related
programmes and schemes in the country, thus suggesting that the programmes and
schemes were ineffective and ineffectual. In the light of the present government’s
deep concern for the widespread and scourging poverty, this paper reviews
previous and current initiatives at poverty alleviation/reduction in Nigeria, and
examines some pertinent issues on the way forward. Accordingly, Section 2
overviews some poverty alleviation policies and programmes prior to the advent
of the present administration while Section 3 presents highlights of current
poverty reduction efforts. Section 4 addresses some pertinent issues on the way
forward. Section 5 concludes the paper.

II. OVERVIEW OF PREVIOUS POVERTY ALLEVIATION
PROGRAMMES AND POLICIES
II.1 Poverty Alleviation and National Development Plans
Unit.l The inauguration of a Poverty Alleviation Programme Development
Committee (PAPDC) by the Nigerian government in 1994, all efforts at poverty
alleviation were essentially ad-hoc. It was generally the case that poverty
alleviation programmes and strategies were not crystallised and consolidated
within the nation’s overall development objectives. This view is borne out of a CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4 perusal of the various National Development Plans over 1962-85 period, and National Rolling Plans from 1990. The particular significance of the National
Development/Rolling Plans hinges on the fact that they provided/provide much of the framework for the pursuit of development objectives since the attainment of
political independence in 1960. It can be observed from the Plan documents that “the primary goal of economic planning in Nigeria is the attainment of rapid increase in the nation’s productive capacity with a view to improving the living standards of the people”. This statement suggests some concern with poverty reduction which entails
improved standard of living. However, poverty alleviation objectives were tangential and not explicit objectives of all the plans. The poverty-related objectives during 1962-85 included:

(a) increase in per capita income;
(b) more even distribution of income;
(c) reduction in the level of unemployment; and
(d) increase in the supply of high level manpower.

In a related vein, the First National Rolling Plan had, among other things, the objectives of:

* Creating ample employment opportunities as a means of
containing the unemployment problem; and

* enhancing the level of socio-political awareness of the people and further strengthening the base for a market-oriented economy and mitigating the adverse impact of the economic down-turn on the most affected groups. CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4 Although not direct statements of concern with poverty alleviation, the foregoing have implications for poverty. For example, if there is an increase in per-capita income, simultaneously with more even distribution of income, such would
lead to poverty reduction. Reduction in the level of unemployment is conceivably a necessary condition for realization of increased income per-capita. The closest
direct statement of concern with poverty is contained in the Third Plan (FRN, 1975:29):
…development is not just a matter of growth in per capita income. It is possible
to record a high growth rate in per capita income while the masses of the people
continue to be in abject poverty and lacking in the basic necessities of life,
particularly in a situation as in Nigeria today, where the momentum of growth
derives from a sector whose direct impact on the bulk of the population is small.
An important objective of the plan, therefore, is to spread the benefits of
economic development so the Nigerian would experience a marked improvement
in his standard of living.
Nonetheless, in the same vein as concern with poverty alleviation was a derived
and not a direct objective, the strategies in the plan were not lucidly direct and
explicitly specific.
Generally, the priorities and strategies enunciated in virtually all the Plans
under reference show that agricultural production was always accorded the
highest priority (FRN) (1990:17); FRN (1981:37); FRN (1970:35) – although, the
Third Plan emphasized the mutual development of agriculture and industry for
balanced growth (FRN,1975:30). Even in the structural adjustment programme
document, agriculture was considered one of the critical sectors whose
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rehabilitation would be crucial to the success of the programme (FRN, 1986:8).
A concomitance of agricultural development, or its apanage, is rural development.
Against the background that the poor are preponderantly located in rural areas,
and are mainly engaged in agriculture, the accord of highest priority to agriculture
in the plan documents would suggest favourable disposition towards poverty
alleviation.
From the foregoing, two distinct approaches to poverty alleviation could
be said to have featured prominently in Nigeria’s national development plans and
planning. These are the economic growth strategy that presumes the trickling
down of the benefits of growth to the poor, and the strategy of rural/agricultural
development. Indeed, rural development could be viewed as having been central
to Nigeria’s poverty alleviation strategies. And the center -piece of the rural
development policy has been agricultural development, complemented by social
and economic infrastructure. For a long time now, the growth performance of the
country has not been satisfactory, with negative growth in the first half of the
1980s and very low growths since 1992 (an average of 2.5 per cent from 1992-
1999). Even in periods of economic growth, Nigerians did not experience
considerable or commensurate poverty reduction. In 1985-1992, there was a
slight increase in GDP and per capita income, and there was a slight drop in
aggregate poverty headcount level (from 46.3 to42.7 per cent), but inequality
worsene d and the core-poor did not share in the growth as the depth and severity
of poverty did not improve significantly. This suggests the need for a strategy of
growth with equity for poverty reduction.
In sum, within the framework of the National Development Plans, the
implicit thinking was that a positive relationship existed growth in the GDP and
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increased welfare for the general citizenry. And so, the approach to poverty
alleviation as expressed in the fundamental objectives of the Development Plans
did not involve policies and programmes which directly targeted the poor. The
poor were implicitly expected to benefit from the “trickle -down efforts” of the
overall process of development. But this has not been the case. And so growth
must be accompanied by a deliberate policy of targeted interventions.
II.2 Government Programmes and Policies Related to Poverty
In the light of the government’s concern for poverty reduction, numerous
policies and programmes have been designed at one time or another, if not to
meet the special needs of the poor, at least to reach them. The advent of the
Structural Adjustment Programme in1986 brought out more forcefully the need
for policies and programmes to alleviate poverty and provide safety nets for the
poor. This emphasis arose from an awareness of the unintended negative effects
of structural adjustment policies on the vulnerable groups in the society. While
structural adjustment had its salutary effects on economic growth, it lacked
emphasis on development and also accentuated socio-economic problems of
income inequality, unequal access to food, shelter, education, health and other
necessities of life. It indeed, aggravated the incidence of poverty among ma ny
vulnerable groups in the society.
As a result of the continuous deterioration of living conditions in the late
1980s, several poverty alleviation programmes came on board. They were
designed to impact positively on the poor. By the end of 1998, there were sixteen
poverty alleviation institutions in the country. In 1994, the Government set up a
broad-based Poverty Alleviation Programme Development Committee (PAPDC)
under the aegis of the aegis of the National Planning Commission. The primary
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objective of the PAPDC was to advise the government on the design, coordination
and implementation of poverty alleviation programmes. Its work contributed
immensely to the emergence of a new approach to the design and organisation of
poverty alleviation programmes culminating in the establishment in 1996 of the
Community Action Programme for Poverty Alleviation (CAPPA). CAPPA is a
community based approach which adopts a combination of social funds and social
action strategy. The CAPPA document drew largely from the past experience on
poverty reduction efforts in the country and attempts to ensure that the poor are
not only carried along in the design and implementation of poverty projects that
affect them but that the poor themselves actually formulate and manage the
poverty projects. Various agencies (Government, Donors and NGOs) involved in
poverty alleviation in the country have embraced the CAPPA strategy. Also, in
1996, a draft National Poverty Alleviation Policy document was produced by the
Government through the National Planning Commission. Its thrust is the
improvement in human welfare in the immediate and distant future.
Specifically, a number of government programmes initiated in the past,
have aimed at improving basic services, infrastructure and housing facilities for
the rural and urban population, extending access to credit farm inputs, and
creating employment. Most of the programmes were, however, not specifically
targeted towards the poor, though they affect them. There are specific multisector
programmes (water and sanitation, environment, etc) as well as sectorspecific
programmes in agriculture, health, education, transport, housing, finance,
industry/manufacturing and nutrition. (Box I contains some government
programmes related to poverty). Some achievements have been recorded by these
poverty-relation programmes in the areas of food crop production, agricultural
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and industrial extension services, primary health care, education enrolment, mass
transit programme and financial sector services through the People’s Bank of
Nigeria and Community Banks. However, the fact that the incidence of poverty
remains very high, the existence of the various programmes notwithstanding,
points to the ineffectiveness of the strategies and programmes. A number of
factors have contributed to the failure of past poverty-related programmes and
efforts. Some of them are:
(i) lack of targeting mechanisms for the poor and the fact that most of the
programmes do not focus directly on the poor.
(ii) Political and policy instability have resulted in frequent policy changes
and inconsistent implementation which in turn have prevented continuous
progress.
(iii) Inadequate coordination of the various programmes has resulted in each
institution carrying out its own activities with resultant duplication of
effort and inefficient use of limited resources. Overlapping functions
ultimately led to institutional rivalry and conflicts.
(iv) Severe budgetary, management and governance problems have afflicted
most of the programmes, resulting in facilities not being completed,
broken down and abandoned, unstaffed and equipped.
(v) Lack of accountability and transparency thereby making the programmes
to serve as conduit pipes for draining national resources.
(vi) Overextended scope of activities of most institutions, resulting in
resources being spread too thinly on too many activities. Examples are
DFRRI and Better Life Programmes which covered almost every sector
and overlapped with many other existing programmes.
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(vii) Inappropriate programme design reflecting lack of involvement of
beneficiaries in the formulation and implementation of programmes.
Consequently, beneficiaries were not motivated to identify themselves
sufficiently with the successful implementation of the programmes.
(viii) Absence of target setting for Ministries, Agencies and Programmes.
(ix) Absence of effective collaboration and complementation among the three
tiers of government.
(x) Absence of agreed poverty reduction agenda that can be used by all
concerned – Federal Government, State Governments, Local
Governments. NGOs, and the International Donor Community.
(xi) Most of the programmes lacked mechanisms for their sustainability.
Box 1
Some Government Programmes Related to Poverty
Multisectoral Programmes include: the National Directorate of Employment,
which consists of four main programmes: the Vocational Skills Development
Programme, the Special Public Works Programme, the Small Scale Enterprises
Programme, and the Agriculture Employment Programme; the Directorate of
Food, Roads and Rural Infrastructure, which supports mainly rural infrastructure
projects; and the Better Life Programme, which supports a multitude of
programmes targeted at women, including agriculture and extension services,
education and vocational training, cottage industries and food processing, primary
health care delivery and enlightenment/awareness and cooperatives. The last is
now replaced by Family Support Programme.
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BOX 1 CONTD.
Agriculture Sector Programmes include the Agriculture Development
Programmes; the National Agricultural Land Development Authority, the
Strategic grains Reserves Programme. The Programme for Accelerated Wheat
Production, as well as the development of artisanal fishery, small ruminant
production, pasture and grazing reserves. These programmes promote utilization
of land resources through subsidized land development, supply of farm inputs and
services and credit extension to farmers, and institutional support for produce
marketing cooperatives.
Health Sector Programmes include the primary Health Care Scheme, which
aims at providing at least one health centre in every local government; and the
Guinea-worm Eradication Programme, launched in 1988 with assistance of donor
agencies including UNICEF, which supports health interventions to control
diarrhea diseases, eradicate guinea-worm, and promote changes in knowledge,
attitudes and practices relating to water use, excreta disposal and general hygiene.
The effectiveness of the PHC programme was hampered by inadequate funding
from the LGAs, and lack of equipment, essential drugs, and trained manpower.
The Guinea-worm Eradication Programme succeeded in reducing the number of
reported guinea-worm cases from 650,000 in 1988 to 222,000 by the end of 1992.
In the Education Sector, the Nomadic Education Programme developed
curricula for nomadic education, trained nomadic teachers, and provided
infrastructure for the nomadic schools; additional programmes were targeted
towards girls education, women and children in exceptionally difficult
circumstances, and adult literacy.
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BOX 1 CONTD.
In the Transport Sector, the Federal Urban Mass Transit Progam was
established in 1988 to rescue the public transport system from imminent collapse.
New buses were put into public service and loan schemes helped cooperatives and
private operators acquire transport vehicles. However, the demand for public
transportation in many urban areas continues to outstrip supply.
In the Housing Sector, a Sites and Services Scheme commenced in 1987 to
increase the supply of land for residential development by all income groups. The
programme consists of site clearance, construction of concrete drains and culverts,
etc. However, shortage of funds resulted in non-payment of compensation to
former owners of assets in the acquired areas, and non-development of essential
infrastructure such as access roads, water, power supply, etc.
Financial Sector Programmes include a few initiatives begun in 1989/90: the
National Economic Reconstruction Fund which provide long-term loans at
concessionary interest rates to promote small and medium scale industrial
projects; the People’s Bank of Nigeria which extends credit to the poor who could
not have access to the credit facilities available in the commercial and merchant
banks; and the Community Banking Scheme which provides credit to small scale
producers on their own personal recognition.
Nutrition-Related Programmes consist of programmes aimed at improving food
security, prevention of micro-nutrient deficiencies in children and women,
promotion of exclusive breast-feeding, deworming of school children and
promotion of food quality and safety.
Manufacturing Sector Programme includes a Small-Scale Enterprises
Programme. This is designed to promote the growth of small-scale enterprises in
Nigeria. The programme involves government promotion of small-scale
industries through easier access to bank credit, artisan technology and the
provision of appropriate infrastructural facilities.
Source: Nigeria: National Planning Commission (1994 and 1995); World Bank
(1996).
Not only has the failure to ensure the successful implementation of the
various programmes and policies made the incidence of poverty to loom large, the
phenomenon has continued to spread and deepen. And very many factors have
tended to compound the poverty situation, among which are: slow economic
growth, economic mismanagement, infratructural deficiencies, weak political
commitment to poverty alleviation programmes and measures, and a host of
macroeconomic and sectoral problems such as inf lation, rising unemployment,
exchange rate depreciation, external debt overhang, etc (CBN, 1999:68-73).
These problems are also acknowledged by the government as enunciated by Aliu
(2001:4 -5) as follows:
(i) Poor macroeconomic and monetary policies resulting in low
economic growth rate and continuous downwards slide in the value
of naira from 1986;
(ii) dwindling performance of the manufacturing sector which has the
capacity to employ about 20 million people but currently employs
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only about 1.5 million by all the 2,750 registered members of the
Manufacturers Association of Nigeria (MAN);
(iii) increasing foreign debt overhang of almost US $30 billion,
requiring US $3.5 billion annually for servicing from an economy
earning just US$10-15 billion;
(iv) poor management of the nation’s resources, coupled with largescale
fraud and corruption, most of which has been siphoned out of
the country in hard currency; and
(v) poor execution of Government Programmes and projects especially
those aimed at the provision of social welfare services and those
aimed at the provision of economic infrastructure.
III. CURRENT EFFORTS AT POVERTY REDUCTION
The Government of President Olusegun Obasanjo, since inception in May,
1999, has expressed deep concern about the rising incidence of poverty in
Nigeria. The Government realized that if the worsening poverty situation
is not checked, the future of the nation would be doomed. In light of this,
the Government has introduced a number of progammes and measures
aimed at making a dent on poverty. Among the early activities of the
Government were the launching of the Universal Basic Education (UBE)
Programme, the Poverty Alleviation Programme and the constitution of
the Ahmed Joda Panel in 1999 and the Ango Abdullahi Committee in
2000. The immediate concern of the Panel/Committee was the
streamlining and rationalization of existing poverty alleviation institutions,
and the coordinated implementation and monitoring of relevant schemes
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and programmes. These culminated in the introduction early in 2001 of
the National Poverty Eradication Programme (NAPEP) and the
establishment of the National Poverty Eradication Council (NAPEC).
3.1 The Poverty Alleviation Programme (PAP)
This was an interim measure introduced early in 2000 to address the
problems of rising unemployment and crime wave, particularly among youths. It
was ultimately aimed at increasing the welfare of Nigerians. Essentially, the
primary objectives of PAP are three-fold:
· reduce the problem of unemployment and hence raise effective
demand in the economy;
· increase the productiveness of the economy; and
· drastically reduce the embarrassing crime wave in the society.
One could glean from government pronouncements that the
targets/components of the PAP include the following, among others:
· provide jobs for -200,000 unemployed;
· create a credit delivery system from which farmers would have
access to credit facilities;
· increase the adult literacy rate from 51 percent to 70 percent by
year 2003;
· shoot up health-care delivery system from its present 40 percent to
70 percent by year 2003
· increase the immunization of children from 40 percent to 100
percent;
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· raise rural water supply from the present 30 percent to 60 percent
and same for rural electrification;
· embark on training and settlement of at least 60 percent of tertiary
institutions’ graduates; and
· development of simple processes and small-scale industries.
To actualize the objectives of PAP, several measures were put forward in
the 2000 Budget as well as other policy documents such as:
· increase in the salary of public sector workers that has been
decimated over the past two decades;
· improving the supervisory capacity within the nation’s institutions;
· rationalization of organizations and methods within the system,
particularly that of the existing 16 poverty alleviation institutions
in Nigeria;
· encouraging and rewarding all deserving Nigerians for industry
and enterprise;
· substantial reduction of avenues for easy and illegitimate
acquisition of wealth; and
· the launching of Universal Basic Education Programme.
The orientation of the PAP is holistic in nature, and if properly planned
and managed could tame the menace of poverty in Nigeria. But inspite of the
broad feature of the programme, emphasis seemed to have placed more on the
creation of jobs through public work system. To this end, avenues were to be
provided for the gainful employment of 200,000 idle hands. This aspect of the
programme was designed to provide jobs for at least 5000 unemployed in each
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State. To actualize the programme, the Federal Government earmarked N10.0
billion, which was later raised to N17.0 billion by the Senate. No doubt, this
pointed to the Government’s commitment to the programme.
However, in implementation, the programme appeared to be ad-hoc in
orientation with little attention paid to the policy framework. The emphasis on
massive construction and other public work projects made it look like a one-off
affair rather than making it a revolving one.
The programme also paid little attention to the framework of allocation of
funds, sustainability aspect of the PAP and the needed collaborative arrangements
its success. The political connotation of the PAP served as an important threat to
the success of the programme. The programme was portrayed as the ruling
party’s programme and hence had met with resistance from the chief executives
of the states controlled by other political parties. This was quite noticeable in the
launching of the programme at the state level in February 2000.
Besides, the PAP also emphasized provision of credit to micro-enterprises
and trading to the exclusion of income and employment generating projects. The
programme also lacked appropriate framework for beneficiary targeting. The
timing and phasing of the direct labour (200,000 jobs) were not explicitly stated.
Yet, this aspect was very crucial to the suc cess of programme.
3.2 The National Poverty Eradication Programme (NAPEP)
Introduced early in 2001, NAPEP is the current Programme which
focuses on the provision of “strategies for the eradication of absolute poverty in
Nigeria” (FRN,2001:3) NAPEP is complemented by the National Poverty
Eradication Council (NAPEC) which is to coordinate the poverty-reduction-
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related activities of all the relevant Ministries, Parastatals and Agencies. It has the
mandate to ensure that the wide range of activities are centrally planned,
coordinated and complement one another so that the objectives of policy
continuity and sustainability are achieved.
Upon consideration of the Joda Panel and Abdullahi Committee Reports,
fourteen
(14) core poverty alleviation Ministries were identified as follows:
(i) Agriculture and Rural Development
(ii) Education
(iii) Water Resources
(iv) Industry
(v) Power and Steel
(vi) Employment, Labour and Productivity
(vii) Women Affairs and Youth Development
(viii) Health
(ix) Works and Housing
(x) Environment
(xi) Solid Minerals Development
(xii) Science and Technology
(xiii) Finance, and
(xiv) National Planning Commission
Similarly, thirty-seven (37) core poverty alleviation institutions,
agencies and programmes were identified. The poverty reduction-related
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activities of the relevant institutions under NAPEP have been classified
into four, namely:
176 CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
(i) Youth Empowerment Scheme (YES) which deals with capacity
acquisition, mandatory attachment, productivity improvement, credit
delivery, technology development and enterprise promotion;
(ii) Rural Infrastructure Development Scheme (RIDS) which deals
with the provision of potable and irrigation water, transport (rural and
urban), rural energy and power support;
(iii) Social Welfare Service Scheme (SOWESS) which deals with
special education, primary healthcare services, establishment and
maintenance of recreational centres, public awareness facilities, youth and
student hostel development, environmental protection facilities, food
security provisions, micro and macro credits delivery, rural
telecommunications facilities, provision of mass transit, and maintenance
culture; and
(iv) Natural Resource Development and Conservation Scheme (NRDCS)
Which deals with the harnessing of the agricultural, water, solid mineral
resources, conservation of land and space (beaches, reclaimed land, etc)
particularly for the convenient and effective utilisation by small-scale
operators and the immediate community.
In effect, the current poverty eradication programme of the country is
centered on youth empowerment, rural infrastructure development, provision of
social welfare services and natural resource development and conservation.
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Details about these are provided in the Blueprint for the schemes under the
National Poverty Eradication programme (as revised in June 2001). In the
attempt to overcome the inadequacies of provious programmes, the NAPEP
Blueprint has the following features (Aliu, 2001:12-13):
· it adopts the participatory bottom-up approach in programme implementation
and monitoring;
· it provides for rational framework which lays emphasis on appropriate and
sustainable institutional arrangement;
· it provides for pro-active and affirmative actions deliberately targeted at
women, youths, farmers and the disabled;
· it provides for inter-ministerial and inter-agency cooperation;
· it provides for the participation of all registered political parties, traditional
rulers, and the communities;
· it provides for technology acquisition and development particularly for
agriculture and industry;
· it provides for capacity building for existing skills acquisition and traning
centres;
· it provides for the provision of agricultural and industrial extension services to
rural areas;
· it provides for institutional development for marketing of agricultural and
industrial products; and
· it provides for integrated schemes for youth empowerment, development of
infrastructure, provision of social welfare services and exploitation of
natural resources.
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What becomes obvious from a careful consideration of the foregoing and
their elaborations in the blueprint is that much of the problems that attended
previous efforts have been sharply focussed upon following their identification.
Nonetheless, the statement of good intentions and enunciation of measures
towards poverty eradication are only necessary but not sufficient conditions. The
way forward is to recognise the problems and look beyond to operational and
incidental matters that may arise at the level of implementation vis-à-vis some
pertinent issues that may not have been adequately covered in the blueprint.
3.3 Poverty Reduction Strategy Paper (PRSP)
The government is currently preparing a Poverty Reduction Strategy Paper
(PRSP) under the supervision of the Economic Policy Coordinating Committee in
the Office of the Vice President. The PRSP is a document that will show the
commitment of the government in addressing poverty reduction. It will contain a
comprehensive poverty reduction plan and strategies to address it over a time
horizon. A National Core Team which was inaugurated in February, 2001, is
responsible for the technical preparation of the PRSP in two stages. The first
stage involves the preparation of an Interim-Poverty Reduction Strategy Paper (IPRSP),
which would dovetail into the second stage of preparing the full PRSP.
The I-PRSP was introduced to avoid delays in receiving international assistance
which donors have predicated on the production of a PRSP. The I-PRSP includes
a stocktaking of the country’s current mechanism for poverty reduction and a road
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map of how the country will develop its full PRSP. The I-PRSP was completed in
August 2001, thus paving way for the preparation of the PRSP.
IV. SOME PERTINENT ISSUES ON THE WAY FORWARD
Inspite of the expressed concerns of past governments and the plethora of
programmes and policies that have a bearing on poverty, the incidence and
scourge of poverty have worsened over the years. The factors which have
constrained the effectiveness of the programmes and policies have been
outlined already. Now, with the NAPEP being the centrepiece of the
Government’s efforts at poverty reduction what are the prospects of
achieving the international development goal of halving the incidence of
poverty by 2015? This question is pertinent against the background of the
Nigerian economy which is characterised by low economic growth, rapid
population growth, mismanagement of available resources and large-scale
corruption. Therefore, for NAPEP to make a meaningful dent on poverty,
there is the need for poverty reduction programmes to be implemented
within the framework of rapid economic growth with equity, controlled
population growth, sound economic management, and good governance,
among others. Some of these and other pertinent issues relating to poverty
reduction programmes are discussed briefly as follows:
(i) Broad-based Economic Growth with Equity
Rapid growth is important for poverty reduction. Therefore attention must
be focused on those macro and microeconomic policies and programmes which
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would ensure the rapid growth of the economic. Economic growth is crucial in
efforts aimed at conquering poverty as it would:
· Generate income earning opportunities for the poor, make job
creation possible, and thereby make use of their most abundant assetlabour;
· Produce additional resources for the government to use for social
programmes aimed at overcoming poverty; and
· Increase the incomes poor people receive as remuneration for their
labour.
However, economic growth alone is not sufficient for poverty reduction.
Therefore, growth must be accompanied by a deliberate policy of redistribution
and equity, promoted by participation. In this direction, broad-based growth that
involves the poor and generates employment is recognised to have a tremendous
impact on pove rty. In Nigeria, targeted efforts are required to induce broad-based
growth and provide social services and infrastructure aimed at reducing the depth
and severity of poverty of poverty across the country. Given the high incidence of
poverty in the country, the pursuit of rapid economic growth cannot be
overemphasised in the current and future efforts at poverty reduction. Indeed, for
a considerable decline in poverty, indications are that an economic growth rate of
7-8 per cent is required. And policies to foster growth would need to be
complemented by those aimed specifically at reducing poverty.
(ii) Targeting of Interventions
Considering the magnitude and profile of the magnitude and dimensions
of poverty in Nigeria, it would be clear that a sizable number of poor and
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disenfranchised people cannot participate directly in broad growth process. And
given the level of impoverishment, they may also not be able to have access and
use of the social and economic infrastructure provided to improve human capital.
It is therefore essential to provide targeted resource transfers and support to such
groups of people in rural and urban areas. The government can target the delivery
of some services and resources to reach poor areas and to communities living in
poverty, building on existing community-based organisations, civil society groups
and their activities where possible. Some element of targeting should also be
introduced in public expenditure, especially for social sector spending (health and
education) which touch the lives of the poor people than most of other public
expenditure.
(iii) Nature of Involvement of Beneficiaries
Experience from the past poverty alleviation programmes has shown the
inability to involve the people in their planning and implementation. However,
one of the main features of NAPEP is the adoption of the bottom-up approach to
programme implementation and monitoring (Aliu, 2001:12). But then, this tends
to give the indication that the bottom-up precludes the involvement of
beneficiaries in the identification in the identification of projects and programmes.
This is more so as “NAPEC is mandated to ensure that the wide range of activities
are centrally planned, coordinated and compleme nt one another so that the
objectives of policy continuity and sustainability are achieved” (FRN, 2001:5). If
the above indication is accurate, them there is the need to extend the bottom-up
concept to include direct participation of the benefiting communities in project
identification. Experience has shown that the non-involvement of such
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
communities is always a detraction from appropriateness of projects, as well as
their sustainability. This is because the top-down approach widely adopted in
project identification and selection has often led to beneficiaries not associating
themselves with such projects. Therefore, there should be sufficient participation
of the grassroot people in the identification and implementation of projects
affecting their lives. This will not only increase their commitment to such
programmes but will also de -emphasize the erstwhile perception of such
programmes as conduit pipes for national cake sharing, which they feel is
responsible for their poverty. It also promotes empowerment on project
management as well as its sustainability.
(iv)Political Allegiance and Continuity of Programmes, Projects and Services
The communiqué and syndicate reports of the first retreat for Executive
Governors and State Coordinators of the NAPEP, June 24-25, 2001, issued under
the aegis of the Presidency, raised some very crucial issues. Paragraph 7 of the
communiqué states the following:
Discussion at both the Plenary Sessions and Syndicate Groups were frank,
and devoid of political, tribal or religious colourations, in a free and relaxed
atmosphere where the sole goal of all participants was to evolve lasting strategies
to eradicate a problem which, participants argreed, respects no political, ethnic or
religious boundaries. Participants expressed full support and commitment for the
programme but urged that everything be done to avoid its derailment either
through partisan considerations, corruption or other malpractices which militated
against the success of previous programmes (emphasis ours).
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
Similarly, the third resolution/recommendation of syndicate Group A at
the retreat read: That NAPEP should not be limited to the life span of any
particular Government or Administration in power but should be sustained to
elicit desired objective and impact.
These remarks bring to the fore the issues and problems associated with
political culture and the politicisation of programmes and projects. The foreging
paragraph 7 of the communiqué under reference accurately underlines the fact of
poverty not recognising political boundaries. However, the Nigerian reality point
to the fact that political differences could be a strong factor in the accentuation of
poverty in particular areas. This arises when relevant schemes and programmes
are resisted in some regions/zones or states simply because of the perceived
advantages the implementation could confer on some political parties. For
instance, there were reports of the Nigerian Peoples Party (NPP) government in
old Anambra State refusing the construction of Federal roads in the State because
the rival National Party of Nigeria (NPN) could make it a campaign issue.
Similarly, in year 2000, there were reports that the Alliance for Democracy (AD)
Governors of South-West Zone were apprehensive that the People’s Democratic
Party (PDP) at the Centre might have conceived of the PAP for strategic political
gains. Indeed, there were allegations of the AD Governors working against the
PAP in order to frustrate the PDP Federal Government.
The point to stress is that poverty is too critical an issue that everyone,
irrespective of party affiliation and leaning, should be deeply concerned about its
eradication. The idea of sabotaging a scheme simply because it was initiated by a
rival political party/group should not arise. It is only with such a spirit that a
scheme could live beyond its initiators-a factor that is pertinent to the
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
sustainability and continuity of services. Perhaps, consideration could be given to
making poverty alleviation an explicit constitutional matter in view of the fact that
no one administration can meaningfully bind its successor to its programmes.
This also reinforces the need to give expression to poverty alleviation objectives
in national development plans with the strategies consolidated into the nation's
overall development/policy management framework.
(v) Good Governance, Transparency, Accountability and Social
Responsibility
Corruption is generally acknowledged as having adversely affected
previous poverty alleviation efforts in Nigeria. Corruption is one of the aspects of
bad governance. The anti-corruption crusade of the present administration is
expected to have favourable implications for poverty alleviation if successfully
carried through. The communiqué earlier referred to has as one of the imperatives
for success of the NAPEP “ensuring that corruption and other sharp practices at
any stage of the programme are not condoned but severely punished”.
The manifestations and problems associated with corruption have various
dimensions. Among these are project substitution, plan distortion,
misrepresentation of project finances, diversion of resources to uses to which they
were not meant, even conversion of public funds to private uses, etc. The effect
of corruption is both direct and indirect on poverty increase. On the hand, the
indirect effect follows from the reduction or misapplication of resources which
penalizes growth rate and growth potential. When growth rates are lowered, there
will be no outputs and incomes to redistribute. So poverty could escalate. One
the other hand, the direct effect is that the poor are denied resources and access to
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
facilities that could have been provided through judicious application of the
siphoned/diverted resources.
A related problem is that lack of social responsibility manifest in the
vandalisation or wilful destruction of facilities that benefit the poor. It is expected
that the bottom-up approach to project identification with attendant association of
beneficiaries with the projects, will minimise vandalisation. But beyond that it is
crucially necessary that efforts and resources are committed to security of
provisions. Finally, in order to ensure transparency and accountability in the
management of poverty reduction programmes and projects, all the stakeholders
should be involved in the monitoring and evaluation of such projects.
v. CONCLUSION
The embarassing paradox of poverty in the midst of plenty in Nigeria
suggests the compelling need for a single -minded pursuit of the objective of
poverty reduction and its eventual elimination. To this end, there is the need for
an agreed poverty reduction agenda that can be used by all stakeholders – Federal
Government, State Government, Local Governments, NGOs and the International
Donor Community. There is also the need for strong political commitment to the
poverty reduction goal, as well as a depoliticisation of poverty alleviation
programmes and projects. Very importantly, in order to make a meaningful dent
on poverty it is crucial for poverty reduction programmes and measures to be
implemented within the framework of rapid broad-based economic growth with
equity, controlled population growth, sound economic management and good
governance, among others. Finally, it is important to give expression to poverty
alleviation objectives in national development plans with the strategies and
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
measures integrated into the country’s overall development/policy management
framework.
REFERENCES
Abdullahi, M. Yahoo (1993) The Design and Management of poverty Alleviation
projects in Africa. Washington, D. C.: Economic Development Institute
of the World Bank.
Aliu, A. (2001), National Poverty Eradication Programme (NAPEP):
Completion, Implementation, Coordination and Monitoring, NAPEP
Secretariat, Abuja, April.
Besley, Timothy (1996), “Political Economy of Alleviating Poverty: Theory and
Institutions”, in M. Bruno and B. Pleskovic (eds), proceedings of the
Annual World Bank Conference on Development Economics, The World
Bank Washington, D.C.
Central Bank of Nigeria, Research Department (1999) Nigeria’s development
Prospects: Poverty Assessment and Alleviation Study (Abuja: CBN).
Fajingbesi, A.A. and E.O. Uga (2001a), “Plans, Programmes and Poverty
Alleviation Strategies in Nigeria”, in Integration of poverty Alleviation
Strategies into plans and programmes in Nigeria, NCEMA, Ibadan.
FRN (2001), National Poverty Eradication Programme (NAPEP): A Blueprint for
the Schemes, NAPEP Secretariat, Abuja, June.
NCEMA (1995), Integration of Poverty Alleviation Strategies into Plans and
Programmes of Nigeria, Report of a National Workshop, Kaduna and
Ibadan, November – December.
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
Nigeria. National Planning Commission (1995), “Community Action Programme
for Poverty Alleviation (CAPPA)”, Lagos.
Nigeria. National Planning Commission (1994), Government Policies and
Programmes to Reach the Poor”, Background paper to poverty
Assessment Studies (January).
Nigeria. Federal Ministry of Finance (2000)./ “Nigeria: CG Poverty Reduction
Paper”. Background paper for Consultative Group Meeting.
Obadan, M.I. (1996) “Analytical Framework for poverty Reduction: Issue of
Economic Growth Versus Other Strategies”, Proceedings of the 1996
Annual Conference of the Niger ia Economic Society (Ibadan: NES).
Obadan, M. I. (1996) “Poverty in Nigeria: Characteristics, Alleviation Strategies
and Programmes”, NCEMA Analysis Series, Vol. 2, No. 2.
Okowa, W.J. (1987), “Urban Bias in Nigerian Development Planning”, The
Nigeria Jour nal of Economic and Social Studies, Vol. 29 (1), March.
Okumadewa, F. (1996) “Nigeria: Poverty Reducing Growth Strategies and
Options”. Proceedings of the CBN/World Bank Collaborative Study
Workshop on “Nigeria: Prospects for Development”. (Abuja: CBN).
Olayemi, J.K. (1995), “A Survey of Approaches to Poverty Alleviation”. A
Paper Presented at the NCEMA National Workshop on Integration of
Poverty Alleviation Strategies into Plans and Programmes in Nigeria,
Ibadan, Nov. 27 – Dec. I.
The Presidency (2001), “Communique and Syndicate Groups Reports of the first
Retreat for Executive Governors and State Coordinators of the National
Poverty Eradication Programme (NAPEP)”, Abuja, June 22 – 24.
CBN ECONOMIC FINANCIAL REVIEW, VOL. 39 N0. 4
Ukpong, S.J. (1996), “Putting People First: New Directions for Eradicating
Poverty”, A Paper Presented at the National Dialogue/Workshop on
Agenda for Sustainable Human Development in Nigeria, Organized by the UNDP
in port-Harcourt, 3-5 May.
World Bank (1996), Nigeria, Poverty in the Midst of Plenty: The challenge of
Growth with Inclusion. Washington, D.C.: World Bank.
World Bank (1993), Poverty Reduction Handbook Washington, D.C.: The
International Bank for Reconstruction and Development.
World Bank (1995), Advancing Social Development. Washington, D.C.: The
International Bank for Reconstruction and Development.
World Bank (1995), “Distribution and Growth: Complements, Not
Compromises”. Policy Research Bulletin, vol. 6, No. 3 (May-July).]]> Thu, 23 Oct 2008 07:31:00 EDT http://ellahster.tigblog.org/post/507205 4.95 8.31666674.958.3166667 http://ellahster.tigblog.org/post/238761
HIV Positive Women, Poverty
and Gender Inequality
THE INTERNATIONAL COMMUNITY OF WOMEN LIVING WITH HIV/AIDS (ICW)
• New infections among women are
increasing at a faster rate than new
infections among men.
• In sub-Saharan Africa HIV positive
women out number HIV positive men.
(UNAIDS 2003)
• Many women, especially in rural sub-
Saharan Africa, define poverty as
their prime concern above all others,
including the risk or reality of HIV.
(Wallace 2004)
Gender inequalities in personal
relationships, in the community, within the
workforce, and in political circles affect
women all over the world. Inequalities
increase women’s vulnerability to poverty
and vice-versa: both impact harshly on our
ability to enjoy full human rights. Gender
inequality and poverty not only increase the
risk of HIV but also leave women more
vulnerable than men to its impact. Shortterm
survival needs force women to develop
a range of coping strategies with varying
implications for our long-term health and
well being. With increasing HIV related ill
health and stigma we may be unable to
make choices to improve both the health and
happiness of ourselves and our families.
Moreover, even when women (HIV positive
and HIV negative) know the risks, we may
not be in a position to practise safer sex.
In my opinion, the problems of positive
women are much like those affecting women
in general. The main one is that more
women on the planet lack power.(ICW
European contact from Spain quoted in
O’Sullivan 2000)
Sex refers to the biological
characteristics that categorise someone
as either female or male; whereas
gender refers to the socially created
ideas and practices of what it is to be
female or male. (Baden and Reeves
2000)
Livelihoods
Clearly the need for financial support or a
livelihood is important for all women.
However, an HIV positive diagnosis
compounds the problems women face in
finding and keeping work. HIV positive
women who sell goods may find that people
avoid their stall or shop, women farmers
may lose access to land, and employers have
been known to fire people after an HIV
positive diagnosis, sometimes after
compulsory testing.
At the same time that I got AIDS, I had my
job and they wanted to drive me out. I knew
but I did not accept it because I did not want
to quit my job. They forced me to have blood
taken. Eventually, they drove me to live in
this house for AIDS people.(Participant of
Thailand Voices and Choices 2003).
I felt like I was falling into a huge abyss
because I knew what was going to happen at
work. And so it was – they sacked me as
soon as they found out and most of my so
called friends turned their back on me. […]
My dream, what I was – a nurse known by
all, with prestige, loved by everyone – had
gone. I fell into a depression and forgot
everyone in the world.(Participant from
Mexico in Voces Positivas, ICW 2004)
2
HIV Positive Women, Poverty
and Gender Inequality
3
Many women, including HIV positive women,
also work in the informal sector. The
informal sector may provide flexible
opportunities to earn a living. However,
when informal sector workers or family
members are ill they do not get paid for the
work they miss. Moreover, stigma and
gender inequality combine to make it
difficult to obtain resources and customers
for small businesses.
I tried to do a local business but it ended
because of stigma. I started selling food, but
because people knew my status they did not
buy them. […] because they were things to be
eaten people thought they would catch HIV.
(Participant of Kampala conference, 20031)
Personal relationships
Gender inequality and discrimination against
women living with HIV hits personal
relationships too. When HIV positive women
face abuse from partners and other relatives
we are often even less able than other
women to assert ourselves. For many of us
there may be no possibility of practising safe
sex – even if we are aware of the risks. This
is especially true for young women who lack
the protection of elders and the power and
confidence to negotiate safer sex.
Our culture makes it difficult to rescue
women. They do what the husband or
partner says. They are not autonomous. If he
says no, then it is no.(Mexican participant,
Voces Positivas)
Our unequal status within families and society
means that we are often blamed for ‘bringing
HIV into the family’. Poverty and inequality
means that we are unable to avoid the bad
treatment that comes with this blame.
Losing two babies also made my partner
worried. Up to this time he had been denying
that he might be infected. He started to
question how he could be HIV positive and
began to blame me for bringing HIV to his
life. It did not stop there. He went to his
family and told them about my HIV status
but neglected to tell them that he was HIV
positive too. He warned them that if anything
happened to him I would be responsible.
(Personal testimony, South African positive
young woman, 2003)
Many women fear violence, the loss of
access to assets, children and homes. This is
particularly the case if we are HIV positive
and after the death of our husbands.
I know women in Papua New Guinea who
husbands have died and whose in-laws have
broken into their homes. I know women who
have lost custody of their children, who have
lost the pots and pans they use to cook food
for their children.(ICW member from Asia
Pacific, ICW 2001)
In some societies we find that even though
we may be legally entitled to own property in
our own name, in practice we can only gain
rights to land and other assets through men
(usually husbands or fathers).
We suffer, especially us widows. When
our husband passes away, you can be
tortured by the husband’s relatives. They
can throw you out, they can remove
everything from you. (Participant of
Kampala Conference, 2003)
1 11th International Conference of HIV Positive People,
Kampala, Uganda, October 2003.
4
Even if we know our rights, we rarely have
access to independent legal support. Those
women who do get support, for instance
from a women’s law group or community
leader, can often face increased anger and
ostracism from relatives. A village head in
Birchenough Bridge, Zimbabwe, stopped the
in-laws of an HIV positive widow with six
children from driving her out. He said they
had no right to do so when there were so
many children. However, this left the in-laws
bitter and angry and so the woman felt that
there was no one to help her when she was
sick (ICW 2002).
After the loss of a breadwinner, HIV
positive women in certain social situations
are faced with having to find an income, or
secure financial and social security through
another relationship. Young women
especially face strong pressure to marry
older men to secure financial and social
security, leaving them with little power to
negotiate healthy sexual relationships. Such
pressure to seek new livelihoods or maintain
existing ones is intensified by their own ill
health and the ill health and care of other
relatives, including children.
My father was the first one to die […], my
mother gave birth to a healthy baby, but she
also got sick. […] As I was the eldest
daughter, I was the one who took over all the
duties of looking after the family including
my mother and the baby. The baby was like
mine and when my mother died I became the
breadwinner. As my father had left no
pension I had to find ways to look after the
family. I had three brothers and one sister.
[…] When my young sister was three years,
she also became sick and died. There was no
other way to find money. I started to have sex
with anyone who could give me money. It was
not easy for me but I had to do it because I
had to find food for my brothers. All the
relatives did not want to help us. (Participant
of Zimbabwe Voices and Choices, ICW 2002)
Coping strategies
Sex work may be the only possible economic
option available to many women.
Yes we can stop sex for money, but what are
we going to do to have our needs fulfilled,
such as clothes? The problem is lack of
employment. (Young woman Malawi,
Welbourn 2002)
There are some women whose family knows
what kind of work they do but people who
come from the country generally don’t tell.
But when they work for a long time and keep
giving money to the family – to build a house,
buy the land, pay off debts, when their
siblings don’t have to go to school in torn
clothing any more – then they’ll tell the family
about their work. They’ll tell them bit by bit,
so it doesn’t come as a huge shock. And they
might say, please try to be economical at
home because now you know the kind of
work we have to do to get this money.
(Thai interviewee, ICW 2001)
Women who are involved in
sex work generally face
greater discrimination.
Women who are involved in sex work
generally face greater discrimination than
other women because of social ideals about
what makes a ‘good’ woman. Such
discrimination can come from women and
men, both HIV positive and negative.
Women, young and older, HIV positive and HIV
negative, may have to use sex to ensure the
smooth running of other livelihood strategies,
such as having to offer sex to officials in
exchange for being allowed to trade goods.
Unfortunately, in some societies, women who
act independently and move around more
than their peers are labelled as immoral by
our communities, making our efforts to earn
a secure living even harder.
Border jumping is very risky because if the
police get hold of you, you probably have to
offer sex. These days when you tell someone
that you are a vendor who sells from one
country to another it’s almost the same as
saying you sleep with people. (Participant of
Zimbabwe Voices and Choices review workshop)
Investing in the future?
Poverty and gender inequality also limit our
access to health care and nutritious food
which is not only needed to maintain good
general health but also affects the possibility
of taking up anti-retrovirals (ARVs).
I wanted to tell young people that this
disease is very expensive. For sure the way
it is expensive is that I have many diseases;
tuberculosis, sexually transmitted
infections, coming on and off.
(Participant of Kampala conference)
Now we have ARVs in Kenya, but if people
don’t have anything to eat, it’s letting them
down and causes more problems.
(ICW interview, Kenya, June 2004)
Impacts of poverty on children include
having to withdraw them from school to help
in the home or with income generating
activities or because there is not enough
money to pay school costs. This is likely to
affect girls more than boys as often less
value is placed on their education.
The only problem as a single woman is that I
do not have a [waged] job, I rent a house, at
least I have my business because this
disease needs medicine, proper food as well
as school fees for my three year old son.
(Participant of Kampala conference)
Yet poverty makes claiming our rights to
equality, safe and secure livelihoods and
good health almost impossible. If we cannot
even afford to feed ourselves how can we
afford to travel to the places where decisions
are made about our lives?
5
Vision Paper 3 >>>
If we can not afford to feed
ourselves how can we afford
to travel to the places where
decisions are made about
our lives.
ICW Call for Action
ICW recognises that gender inequality and
poverty both need to be tackled for HIV
positive women and their families to thrive.
We call for the following:
Support for women’s groups:
• Support women’s organisations already
campaigning for better access to land,
property ownership and inheritance rights.
• Support self-help and support groups – as
they often help women discover livelihood
opportunities as well as providing space to
explore and challenge gender inequality.
Economic rights:
• Conduct research into the effectiveness of
income generating activities and what
specific factors support their success.
• Support strategies designed to increase
women’s financial independence, such as
micro-credit schemes; financial support
for carers unable to work and to keep
children in education.
• Support the resource, training and capacitybuilding
needs of income generating
groups, for instance, management training
and how to access resources to invest in
equipment and transport.
Workplace policies:
• Involve HIV positive people in workplace
policy development and implementation.
Policies that promote the retention and
employment of HIV positive staff, including
women, and ensure that benefits to staff
include a range of appropriate care and
support, which is not just drug specific.
• Develop a proactive awareness throughout
the whole management and staff body,
from top to bottom, of the way in which
HIV and gender affects all our lives.
Law Reform:
• Review ownership and inheritance laws and
promote advocacy work with both women
and men at the community level to take
note of the impact these laws have on HIV
positive women, men and their families.
Work with men:
• Challenge violent and abusive behaviour,
to encourage them to recognise that their
roles are also governed by gender
stereotypes and that gender inequities
harm them too.
• Create environments that enable men to
support their partners. This includes
media campaigns, one-on-one counselling,
male peer support groups, and
community-wide life-skills programmes.
Examples of work on gender equality
and poverty
Developing a shared understanding of
inequality
Creacion Positiva is an organisation based in
Barcelona, Spain, that works on HIV/AIDS
from a gender perspective. By considering
the different ways that women and men are
affected by gender in all areas of life
Creacion Positiva is able to address the
complexity of behaviours, ideas, emotions
and feelings related to HIV infection. This
organisation offers a space for reflection,
support and activism.
For more information contact: tel: +34 93431
4548, email: creacionpositiva@eresmas.net.
6
The Indian Railroad is the
world’s third largest employer,
with over 1.5 million staff.
Challenging negative stereotypes
The Gender AIDS Forum (GAF) and ICW
hosted a National Summit - Confronting
marginalisation in the context of HIV/AIDS in
Durban, South Africa, 7-8 August 2003.
The aim of the summit was to bring together
women and men from marginalised groups
such as sex workers, lesbian, gay, bisexual,
and transgendered women and men,
refugees, prisoners, and women and men
living with HIV to discuss the realities of
their lives. Participants created a national
advocacy agenda for action on gender and
HIV/AIDS in South Africa (Ewing 2003 -
report available on ICW website).
Raising awareness among community
members
The Stepping Stones training programme on
gendered, and inter-generational,
communication and relationship skills for all
community members, has enabled both
older and younger male and female
participants, in Africa, Asia and beyond, to
work together to reduce household quarrels,
increase male involvement in sharing of
household tasks and expenditure, write wills
to increase the chances of widows’
inheritance, reduce and outlaw gender
violence, increase respect and support for
HIV positive neighbours, reduce numbers of
sexual partners and increase condom use
within and outside marriage.
(www.steppingstonesfeedback.org)
Income generating activities
Yolanda Zaldivar, an ICW member, describes
an income generating project in Honduras:
The project proposal was approved. I only
asked for 2000 Lempira and for that amount
for 11 women. First we approached
cooperatives. Unfortunately, none of them
accepted us because we were HIV positive
but then one said, yes, come over. We all
went and explained who we were, and the
manager accepted us and explained how to
be a part of the cooperative. The women put
1000 Lempira in the co-op and took away
1000. Each then one decided what she was
going to do with her share. One decided to
sell vegetables, the other decided to set up a
mini pulperia. When they needed more
money we negotiated with the donors and
received 3000 lempira more. Once there
were 20 children in our group who were not
studying because of lack of resources. This
year, all are in schools.
Now we have developed a second project to
train women as machinists to make more
school uniforms for orphaned children. In
the factories they ask you for an HIV test and
if it is positive you don’t get the job. So, in
our group we said, ‘Let’s show them that if
they trust us PWAs, we can do good work.’
We wrote to UNICEF, who approved the
project and are now paying for the premises.
It is amazing. In our factory there will be
only positive women. We are going to show
the world that we can succeed. The people
of Puerto Cortes are impressed, and they
are supporting us.(ICW 2004)
Work place policies
As a result of an initiative by UNIFEM and
the Vijaywada division of the Indian Railways,
Gender and HIV/AIDS education has been
introduced into the curriculum of all the
Indian Railway schools. Building upon the
existing curriculum on sex education and
HIV/AIDS prevention, the introduction of a
section on gender and sexuality aims to
encourage young people to question existing
gender stereotypes, enable young women to
negotiate safer sex and promote male sexual
responsibility. The Indian Railroad is the
world’s third largest employer, with over 1.5
million staff and an extensive infrastructure
including schools, hospitals and training
colleges. (Source: www.unifem.org.au)
7
Vision Paper 3 >>>
design and print ds print I redesign 020 8805 9585
References
Ewing, 2003, Confronting Marginalisation in
the Context of HIV/AIDS, report of the National
Summit, Durban, South Africa 7-8 August
2003, GAF/ICW
ICW, 2004, ICW NewsIssue 25, London:
International Community of Women Living with
HIV/AIDS (ICW)
ICW, 2002, Positive Women: Voices and
Choices,London: International Community of
Women Living with HIV/AIDS (ICW)
ICW, 2001, ICW NewsIssue 19, London:
International Community of Women Living with
HIV/AIDS (ICW)
Reeves, H., Baden, S. 2000, Gender and
Development Concepts and Definitions,
BRIDGE, Institute of Development Studies (IDS)
O’Sullivan, Sue, 2000, ‘Uniting Across
Boundaries: HIV positive women in global
perspective’,Agenda No.44
UNAIDS, 2003, AIDS Epidemic Update 2003,
Geneva: UNAIDS
Wallace, Tina, 2004, Inform, Inspire,
Encourage: A guide to producing effective
HIV/AIDS materials,London: ActionAid
International
Welbourn, Alice, 2002, ‘Gender, sex and HIV:
how to address issues that no one wants to
hear about, in Cornwall, Andrea and Welbourn,
Alice, 2002, Realising Rights: Transforming
Approaches to Sexual and Reproductive Wellbeing,
London: Zed Press
ICW research programmes and workshops
mentioned in this Vision Paper
Voices Choices Zimbabwe, 2002, and Voices
and Choices Thailand, 2003
A project led by positive women to explore the
impact of HIV on their sexual behaviour, well
being and reproductive rights, and to promote
improvements in policy and practise.
Voces Positivas – process of empowerment
and training for HIV positive women from
Central America and the Caribbean, 2003.
ICW Vision Papers (2004) have been written
for HIV positive members and our supporters
to use when advocating and organising around
ICW’s visions, aims, and objectives. In them
you will learn what ICW’s positions are and be
able to represent ICW well at any meetings or
in any groups you attend, or if you are asked in
any circumstances to explain what ICW stands
for. They are meant as an aid to your own work
and can be used creatively. ICW welcomes your
feedback and evaluation of its vision papers.
Please tell us how you have been able to use
them. We’d love to hear from you.
This Vision Paper on gender inequality and
poverty one of five ICW Vision Papers. This
series outlines ICW’s position on: access to
care and treatment; participation and policy
making, gender equity and poverty; human
rights; and HIV positive young women. They
are available in English, Spanish and French.
ICW is very grateful to The Joint United Nations
Programme on HIV/AIDS (UNAIDS) for funding
this series. We would also like to thank Novib,
Positive Action and Comic Relief for core
funding.
The International Community of Women
Living with HIV/AIDS (ICW), a registered UK
charity, is the only international network run
for and by HIV positive women. ICW was
founded in response to the desperate lack of
support, information and services available to
women living with HIV worldwide and the need
for these women to have influence and input
on policy development.
All HIV positive women can join ICW for free.
Just contact us – details below.
International Community of Women
Living with HIV/AIDS (ICW)
Unit 6, Building 1
Canonbury Yard
190a New North Road
London N1 7BJ
UNITED KINGDOM
Tel +44 20 7704 0606
Fax +44 20 7704 8070
Email info@icw.org
URL www.icw.org
ICW is the convening agency for the treatment
and care arm of the Global Coalition on
Women and AIDS.
ICW is registered in the UK as a company
limited by guarantee with charitable status.
Company No 2987247
Registered charity No 1045331]]> Thu, 02 Aug 2007 13:37:00 EDT http://ellahster.tigblog.org/post/238761 4.95 8.31666674.958.3166667 http://ellahster.tigblog.org/post/238759
THE HISTORY OF HIV UP TO 1986


Mid-1970's-1980 history

We do not know how many people developed AIDS in the 1970s, or indeed in the years before. Neither do we know, and we probably never will know, where the AIDS virus HIV originated (see our origins page for some theories). But what we do know is:

"The dominant feature of this first period was silence, for the human immunodeficiency virus (HIV) was unknown and transmission was not accompanied by signs or symptoms salient enough to be noticed. While rare, sporadic case reports of AIDS and sero-archaeological studies have documented human infections with HIV prior to 1970, available data suggest that the current pandemic started in the mid- to late 1970s. By 1980, HIV had spread to at least five continents (North America, South America, Europe, Africa and Australia). During this period of silence, spread was unchecked by awareness or any preventive action and approximately 100,000-300,000 persons may have been infected."

- Jonathan Mann -1
1981 History

Kaposi's Sarcoma (KS) was a rare form of relatively benign cancer that tended to occur in older people. But by March 1981 at least eight cases of a more aggressive form of KS had occurred amongst young gay men in New York.2

At about the same time there was an increase, in both California and New York, in the number of cases of a rare lung infection Pneumocystis carinii pneumonia (PCP)3. In April this increase in PCP was noticed at the Centers for Disease Control (CDC) in Atlanta. A drug technician, Sandra Ford, noticed a high number of requests for the drug pentamine, used in the treatment of PCP:

"A doctor was treating a gay man in his 20s who had pneumonia. Two weeks later, he called to ask for a refill of a rare drug that I handled. This was unusual - nobody ever asked for a refill. Patients usually were cured in one 10-day treatment or they died"

- Sandra Ford for Newsweek -4

In June, the CDC published a report about the occurrence, without identifiable cause, of PCP in five men in Los Angeles5. This report is sometimes referred to as the "beginning" of AIDS, but it might be more accurate to describe it as the beginning of the general awareness of AIDS in the USA.

A few days later, following these reports of PCP and other rare life-threatening opportunistic infections, the CDC formed a Task Force on Kaposi's Sarcoma and Opportunistic Infections (KSOI).6


Dr. Conant and Dr Volverg discussing

Kaposi's Sarcoma. Circa 1981

Around this time a number of theories were developed about the possible cause of these opportunistic infections and cancers. Early theories included infection with cytomegalovirus, the use of amyl nitrite or butyl nitrate "poppers", and "immune overload".7 8 9

Because there was so little known about the transmission of what seemed to be a new disease, there was concern about contagion, and whether the disease could by passed on by people who had no apparent signs or symptoms.10 Knowledge about the disease was changing so quickly that certain assumptions made at this time were shown to be unfounded just a few months later. For example, in July 1981 Dr Curran of the CDC was reported as follows:

"Dr. Curran said there was no apparent danger to non homosexuals from contagion. 'The best evidence against contagion', he said, 'is that no cases have been reported to date outside the homosexual community or in women'"

- The New York Times -11

Just five months later, in December 1981, it was clear that the disease affected other population groups, when the first cases of PCP were reported in injecting drug users.12 At the same time the first case of AIDS was documented in the UK.13
1982 History

The disease still did not have a name, with different groups referring to it in different ways. The CDC generally referred to it by reference to the diseases that were occurring, for example lymphadenopathy (swollen glands), although on some occasions they referred to it as KSOI, the name already given to the CDC task force.14 15

In contrast some still linked the disease to its initial occurrence in gay men, with a letter in The Lancet calling it "gay compromise syndrome".16 Others called it GRID (gay-related immune deficiency), AID (acquired immunodeficiency disease), "gay cancer" or "community-acquired immune dysfunction".17 18

In June a report of a group of cases amongst gay men in Southern California suggested that the disease might be caused by an infectious agent that was sexually transmitted.19

By the beginning of July a total of 452 cases, from 23 states, had been reported to the CDC.20

Later that month the first reports appeared that the disease was occurring in Haitians, as well as haemophiliacs.21 22 This news soon led to speculation that the epidemic might have orignated in Haiti, and caused some parents to withdraw their children from haemophiliac camps.23


The occurence of the disease in non-homosexuals meant that names such as GRID were redundant. The acronym AIDS was suggested at a meeting in Washington, D.C., in July.24 By August this name was being used in newspapers and scientific journals.25 26 27 AIDS (Acquired Immune Deficiency Syndrome) was first properly defined by the CDC in September.28

An anagram of AIDS, SIDA, was created for use in French and Spanish.29 Doctors thought AIDS was an appropriate name because people acquired the condition rather than inherited it; because it resulted in a deficiency within the immune system; and because it was a syndrome, with a number of manifestations, rather than a single disease.30

Still very little was known about transmission and public anxiety continued to grow.

"It is frightening because no one knows what's causing it, said a 28-year old law student who went to the St. Mark's Clinic in Greenwich Village last week complaining of swollen glands, thought to be one early symptom of the disease. Every week a new theory comes out about how you're going to spread it."

- The New York Times -31

By 1982 a number of AIDS specific voluntary organisations had been set up in the USA. They included the San Francisco AIDS Foundation (SFAF), AIDS Project Los Angeles (APLA), and Gay Men's health Crisis (GMHC).32 In November 1982 the first AIDS organisation, the "Terry Higgins Trust" (later known as the Terrence Higgins Trust), was formally established in the UK, and by this time a number of AIDS organisations were already producing safer sex advice for gay men.33 34

In December a 20-month old child who had received multiple transfusions of blood and blood products died from infections related to AIDS.35 This case provided clearer evidence that AIDS was caused by an infectious agent, and it also caused additional concerns about the safety of the blood supply. Also in December, the CDC reported the first cases of possible mother to child transmission of AIDS.36

By the end of 1982 many more people were taking notice of this new disease, as it was clearer that a much wider group of people was going to be affected.

"When it began turning up in children and transfusion recipients, that was a turning point in terms of public perception. Up until then it was entirely a gay epidemic, and it was easy for the average person to say 'So what?' Now everyone could relate."

- Harold Jaffe of the CDC for newsweek -37

It was also becoming clear that AIDS was not a disease that just occurred in the USA. Throughout 1982 there were separate reports of the disease occurring in a number of European countries.38

Meanwhile in Uganda, doctors were seeing the first cases of a new, fatal wasting disease. This illness soon became known locally as 'slim'.39
1983 History

In January, reports of AIDS among women with no other risk factors suggested the disease might be passed on through heterosexual sex.40

At about the same time the CDC convened a meeting to consider how the transmission of AIDS could be prevented, and in particular to consider the newly emerged evidence that AIDS might be spread through blood clotting factor and through blood transfusions. As James Curran, the head of the CDC task force, said:

"The sense of urgency is greatest for haemophiliacs. The risk for others [who receive blood products] now appears small, but is unknown."41

The risk for haemophiliacs was so great because the blood concentrate that some haemophiliacs used exposed them to the blood of up to 5,000 individual blood donors.

In March, the CDC stated that,

"persons who may be considered at increased risk of AIDS include those with symptoms and signs suggestive of AIDS; sexual partners of AIDS patients; sexually active homosexual or bisexual men with multiple partners; Haitian entrants to the United States; present or past abusers of IV drugs; patients with hemophilia; and sexual partners of individuals at increased risk for AIDS."

The same report also said,

"each group contains many persons who probably have little risk of acquiring AIDS... Very little is known about risk factors for Haitians with AIDS."42

Nevertheless, the inclusion of Hatians as a risk group caused much controversy. Haitian Americans complained of stigmatisation, officials accused the CDC of racism, and Haiti suffered a serious blow to its tourism industry.43 44 Before long people were talking colloquially of a "4-H Club" at risk of AIDS: homosexuals, haemophiliacs, heroin addicts and Haitians.45 46 Some people substituted hookers for haemophiliacs.47

In the UK there were public concerns about the blood supply with references in newspapers to "killer blood".48 The media more generally started to take notice of AIDS, with the screening of a TV Horizon programme, "The Killer in the Village", and a number of newspaper articles on the subject of the "gay plague".49 50

In May 1983, doctors at the Institute Pasteur in France reported that they had isolated a new virus, which they suggested might be the cause of AIDS.51 Little notice was taken of this announcement at the time, but a sample of the virus was sent to the CDC.52 A few months later the virus was named lymphadenopathy-associated virus or LAV, patents were applied for, and a sample of LAV was sent to the National Cancer Institute.53

But whilst progress was being made by scientists there was at the same time increasing concern about transmission, and not just in relation to the blood supply. A report of AIDS occurring in children suggested quite incorrectly the possibility of casual household transmission.54

AIDS transmission became a major issue in San Francisco, where the Police Department equipped patrol officers with special masks and gloves for use when dealing with what the police called "a suspected AIDS patient".

"The officers were concerned that they could bring the bug home and their whole family could get AIDS."

- The New York Times -55

And in New York:

"landlords have evicted individuals with AIDS" and "the Social Security Administration is interviewing patients by phone rather than face to face."

- Dr David Spencer, Commisioner of Health, New York City -56

There was considerable fear about AIDS in many other countries as well:

"In many parts of the world there is anxiety, bafflement, a sense that something has to be done - although no one knows what."

- The New York Times -57

As anxiety continued, the CDC tried to provide reassurance that children with AIDS had probably acquired it from their mothers and that casual transmission did not occur:

"The cause of AIDS is unknown, but it seems most likely to be caused by an agent transmitted by intimate sexual contact, through contaminated needles, or, less commonly, by percutaneous inoculation of infectious blood or blood products. No evidence suggests transmission of AIDS by airborne spread. The failure to identify cases among friends relatives, and co-workers of AIDS patients provides further evidence that casual contact offers little or no risk... the occurrence in young infants suggests transmission from an affected mother to a susceptible infant before, during, or shortly after birth."58

Reports from Europe suggested that two rather separate AIDS epidemics were occurring. In the UK, West Germany and Denmark, the majority of people with AIDS were homosexual, and many had a history of sex with American nationals. However in France and Belgium AIDS was occurring mainly in people from Central Africa or those with links to the area.59

Examples of this second epidemic included a number of previously healthy African patients who were hospitalised in Belgium with opportunistic infections (such as PCP and cryptosporidosis), Kaposi's sarcoma, or other AIDS-like illnesses. All of these Africans had immune deficiency similar to that of American AIDS patients. However they had no history of blood transfusion, homosexuality, or intravenous drug abuse.60 In light of such reports, European and American scientists set out to discover more about the occurrence of AIDS in Central Africa.

By this time, doctors working in parts of Zambia and Zaire had already noticed the emergence of a very aggressive form of Kaposi's sarcoma. This cancer was endemic in Central Africa, but previously it had progressed very slowly and responded well to treatment, whereas the new cases looked very different and were often fatal.61 62

In September the CDC published their first set of recommended precautions for health-care workers and allied professionals designed to prevent "AIDS transmission".63 In the UK, people who might be particularly susceptible to AIDS were asked not to donate blood.64

In October, the first European World Health Organisation (WHO) meeting was held in Denmark. At the meeting it was reported that there had been 2,803 AIDS cases in the USA.65

That meeting was followed in November by the first meeting to assess the global AIDS situation. This was the start of global surveillance by the WHO and it was reported that AIDS was present in the U.S.A., Canada, fifteen European countries, Haiti and Zaire as well as in seven Latin American countries. There were also cases reported from Australia and two suspected cases in Japan.66

By the end of the year the number of AIDS cases in the USA had risen to 3,064 and of these 1,292 had died.67
1984 History

At the CDC researchers had been continuing to investigate the cause of AIDS through a study of the sexual contacts of homosexual men in Los Angeles and New York. They identified a man as the link between a number of different cases and they named him "patient O" for "Out of California".68 The research appeared to confirm that AIDS was a transmittable disease, and the co-operation of "patient O" contributed to the study.69

However a problem arose when other people read the scientific paper.

"I called this guy Patient O... But my colleagues read it as Patient Zero."

- Darrow for Newsweek -70

And so in March 1984 the myth of Patient Zero began.71 See 1987 for more information about Patient Zero.

Just one month later, on April 22nd, Dr Mason of the CDC was reported as saying:

"I believe we have the cause of AIDS."

He was referring to the French virus, LAV, and he was basing his opinion on the findings made in the preceding weeks by the researchers at the Pasteur Institute who had discovered the virus the previous year.72


Margaret Heckler

Just one day later, on April 23rd, the United States Health and Human Services Secretary Margaret Heckler announced that Dr. Robert Gallo of the National Cancer Institute had isolated the virus which caused AIDS, that it was named HTLV-III, and that there would soon be a commercially available test able to detect the virus with "essentially 100 percent certainty". It was a dramatic and optimistic announcement that also included:

"We hope to have a vaccine [against AIDS] ready for testing in about two years."

And it concluded with:

"yet another terrible disease is about to yield to patience, persistence and outright genius".73 74

The same day patent applications were filed covering Gallo's work, but there was clearly a possibility that LAV and HTLV-III were the same virus.75 76 The scientific papers regarding Gallo's discovery of HTLV-III were published on 4th May.77 By 17th May, private companies were already applying to the Department of Health Human Services for licences to develop a commercial test, which would detect evidence of the virus in blood, a test which it had already been said would be used to screen the entire supply of donated blood in the USA.78 79

Meanwhile there continued to be concern about the public health aspects of AIDS. This was particularly the case in San Francisco where all the gay bath houses and private sex clubs were closed. Some gay men regarded the closures as an attack on their civil rights. But Mervyn Silverman, Director of the San Francisco Department of Public Health stated the public health view as follows:


Dr Robert Gallo

"There are certain places where things are allowed and certain places where they are not. You can't have sex at the McDonald's. You generally cannot have sex in the pews of a church or in a synagogue. People don't feel their civil liberties are being in any way abrogated because of that."80

Researchers who had visited Central Africa in late 1983 reported they had identified 26 patients with AIDS in Kigali, Rwanda, and 38 in Kinshasa, Zaire. The Rwandan study concluded that, "an association of an urban environment, a relatively high income, and heterosexual promiscuity could be a risk factor for AIDS in Africa".81 The Zairian study found there to be a "strong indication of heterosexual transmission".82

In light of these findings the Zairian Department of Public Health, in collaboration with American and European scientists, launched a national AIDS research programme called Projet SIDA.83

By the end of 1984, there had been 7,699 AIDS cases and 3,665 AIDS deaths in the USA, and 762 cases had been reported in Europe.84 85 In the UK there had been 108 cases and 46 deaths.86
1985 History

In January 1985 a number of more detailed reports were published concerning LAV and HTLV-III, and by March it was clear that the viruses were the same.87 The same month the U.S Food and Drug Administration (FDA) licensed, for commercial production, the first blood test for AIDS. The test would reveal the presence of antibodies to HTLV-III/LAV, and it was announced that anyone who had antibodies in their blood would not in future be allowed to donate blood.88

There were a number of social and ethical issues, as well as certain medical matters, that had to be considered before the new test could be used even to ensure the safety of the blood supply. And even more aspects needed to be considered before the test could be more widely used. Concern particularly centred on issues of confidentiality and the meaning of a positive test result.89 90

"Richard Dunne, director of the Gay Men's Health Crisis, said that the group would not object to the wider availability of the procedure provided that certain safeguards were assured: informed consent, good counselling and confidentiality, 'which means anonymity,' he said. He stressed that the city must prevent insurance companies, employers, schools and others from gaining access to test results."

- The New York Times -91

The first small-scale needle and syringe exchange project had been started in 1984 in Amsterdam, the Netherlands, but more projects were started in 1985 as a result of growing concerns about HTLV-III/LAV.92

In April more than 2000 people attended the first international Conference on AIDS held in Atlanta. Three major topics of discussion were the new HTLV-III/LAV test, the situation with regard to AIDS internationally, and the extent of heterosexual transmission.93


"Some experts are sceptical that AIDS will spread as rapidly among heterosexuals as it has among homosexuals. Yet other experts, taking their cues from data emerging from preliminary studies from Africa showing equal sex distribution among males and females, are less sure."

- The New York Times -94

Immediately after the conference, the World Health Organization (WHO) organized an international meeting to consider the AIDS pandemic and to initiate concerted worldwide action.95

Meanwhile in many countries there was a separate "epidemic of fear" and prejudice.96

In the UK tabloid press, AIDS gained many headlines and caused alarm among the public. In some newspapers, the prejudice was obvious. The haemophiliacs were seen as the "innocent victims" of AIDS whereas gays and drug-users were seen as having brought the disease upon themselves.97 The fear of AIDS caused firemen to ban the kiss of life, and caused holidaymakers to cut their holiday short for fear of contracting AIDS from an HTLV-III positive passenger on the Queen Elizabeth 2.98 99 A 9-year old HTLV-III positive haemophiliac was allowed to attend the local school, but some of the pupils where kept home by anxious parents.100


In the US, it was feared that drinking communion wine from a common cup could transmit AIDS, and Ryan White, a 13-year old haemophiliac with AIDS, was barred from school.101 102

"In 1985, at 13, Ryan White became a symbol of the intolerance that is inflicted on AIDS victims. Once it became known that White, a haemophiliac, had contracted the disease from a tainted blood transfusion, school officials banned him from classes."

- Time Magazine -103

The CDC removed Haitians from their list of AIDS risk groups, in light of information that suggested both heterosexual contact and exposure to contaminated needles played a role in transmission.104

On September 17th, President Reagan publicly mentioned AIDS for the first time, when he was asked about AIDS funding at a press conference. At the same press conference he was also asked a question whether he would send his children if they were younger to school with a child who has AIDS.

"It is true that some medical sources had said that this cannot be communicated in any way other than the ones we already know and which would not involve a child being in the school. And yet medicine has not come forth unequivocally and said, 'This we know for a fact, that it is safe.' And until they do, I think we just have to do the best we can with this problem. I can understand both sides of it."

- Ronald W. Reagan -105

Drugs such as ribavirin, thought to be active against HTLV-III/LAV, were being smuggled from Mexico into the USA.106

The actor Rock Hudson died of AIDS on October 3rd 1985. He was the first major public figure known to have died of AIDS.107

All UK blood transfusion centres began routine testing of all blood donations for HTLV-III/LAV in October.108

For the Global Surveillance of AIDS, the WHO had initially used the definition of AIDS as developed in the USA in 1982. But this definition was difficult to use in developing countries where there was a lack of sophisticated laboratory tests. So in order to help with the surveillance of AIDS, particularly in Africa, a new WHO definition was adopted in October. This definition of AIDS became known as the Bangui definition.109

Towards the end of the year, Western scientists became much more aware of the "slim disease" that had become increasingly common in South West Uganda since 1982. Studies found that most cases were among promiscuous heterosexuals, the majority of whom tested positive for antibodies to HTLV-III/LAV. The site and timing of the first reported cases suggested that the disease arose in neighbouring Tanzania. Some scientists who studied slim concluded:

"Although slim disease resembles AIDS in many ways, it seems to be a new entity."110

However, others thought differently:

"[Evidence] suggests that slim disease cannot be distinguished from AIDS and ARC [AIDS related complex] by extreme weight loss and diarrhoea. Thus slim disease may not be a new syndrome but simply identical with AIDS as seen in Africa."111

In December 1985, the Pasteur Institute filed a lawsuit against the National Cancer Institute to claim a share of the royalties from the NCI's patented AIDS test.112

During the year, knowledge of transmission routes was to change again, when the first report appeared of the transmission of the virus from mother to child through breast feeding.113 The first case of AIDS was also reported in China, and AIDS had as a result been reported in every region in the world.114

By the end of 1985, 20,303 cases of AIDS had been reported to the World Health Organisation.115 In the USA 15,948 cases of AIDS had been reported,116 and in the UK 275 cases.117
1986 History

The first UK needle exchange scheme started in Dundee in February.118

In the UK, the government launched, in March, the first public information campaign on AIDS, with the slogan "Don't Aid AIDS". There were a series of advertisements in national newspapers.119

There was still at this time disagreement about the name of the virus.

"The name of the virus had itself become a political football as the French insisted on LAV (lymphadenopathy-associated virus), while Gallo's group used HTLV-3 (human T-cell lymphotropic virus, type 3)."

- Time Magazine -120

In May 1986, the International Committee on the Taxonomy of Viruses ruled that both names should be dropped and the dispute solved by a new name, HIV (Human Immunodeficiency Virus).121

At the opening speech of the International Conference in Paris, held from 23rd to 25th June 1986, Dr H Mahler, the Director of WHO, announced that as many as 10 million people worldwide could already be infected with HIV.122

In August, the USA Federal Government accused an employer of illegal discrimination against a person with AIDS for the first time. A hospital had dismissed a nurse and refused to offer him an alternative job. This was seen as a violation of his civil rights.123

In September there was dramatic progress in the provision of medical treatment for AIDS, when early results of clinical tests showed that a drug called azidothymidine (AZT) slowed down the attack of HIV. AZT was first synthesised in 1964 as a possible anticancer drug but it proved ineffective.

The AZT clinical trial divided patients into two groups: one received AZT and the other received placebo, or dummy drugs. At the end of six months, only one patient in the AZT group was dead, whilst there were 19 deaths among the placebo group. The clinical trial was stopped early, because it was thought to be unethical to deny the patients of the placebo groups a better chance of survival.124


"The announcement set off a flurry of excitement and controversy. AIDS hotlines and doctors' offices were flooded with calls, community leaders warned about undue optimism, and doctors debated the ethical and medical issues raised by the early cancellation of the AZT study."

- Time Magazine -125

In the United States, the Surgeon General's Report on AIDS was published. The report was the Government's first major statement on what the nation should do to prevent the spread of AIDS. The "unusually explicit" report urged parents and schools to start "frank, open discussions" about AIDS.126

By this time, scientists had accumulated enough evidence to form an overview of AIDS in Africa. Studies of medical records showed there had been marked increases in a number of AIDS-related conditions during the late 1970s and early 1980s. In particular:
Slim disease in Kinshasa, Zaire (late 1970s)
Slim disease in Uganda and Tanzania (early 1980s)
Esophagel candidiasis in Rwanda (from 1983)
Aggressive Kaposi's sarcoma in Kinshasa, Zaire (early 1980s)
Aggressive Kaposi's sarcoma in Zambia and Uganda (from 1982 and 1983)
Crypotococcal meningitis in Kinshasa, Zaire (late 1970s to early 1980s).

In conclusion:

"These studies suggested that while isolated cases of AIDS may have occurred in Africa earlier, it was probably rare until the late 1970's and early 1980's, a pattern similar to that in the United States and Haiti."127

As in developed countries, AIDS in Africa was found to primarily affect young and middle-aged people, especially those who were unmarried. The sex and age distributions were seen to reflect other sexually transmitted diseases, and the major transmission routes had been identified:

"Available data suggest that heterosexual activity, blood transfusions, vertical transmission from mother to infant, and probably frequent exposure to unsterilized needles account for the spread of HIV infection and AIDS in Africa."128

HIV and AIDS had also been detected in India, among sex workers in the southern state of Tamil Nadu, igniting fears that the disease would soon spread across the subcontinent. In response, the Indian government decided to increase the number of HIV testing centres and improve the screening of blood donations.129

By the end of the year, 85 countries had reported 38,401 cases of AIDS to the World Health Organisation. By region these were: Africa 2,323, Americas 31,741, Asia 84, Europe 3,858, and Oceania 395.130
Further reading


There are four other history of AIDS pages:
History of AIDS from 1987 to 1992
History of AIDS from 1993 to 1997
History of AIDS from 1998 to 2002
History of AIDS from 2003 - onwards

This page was written by Annabel Kanabus and Jenni Fredriksson.
References
Mann J. M (1989) 'AIDS: A worldwide pandemic', in Current topics in AIDS, volume 2, edited by Gottlieb M.S., Jeffries D.J., Mildvan D., Pinching, A.J., Quinn T.C., John Wiley Sons
Hymes, K.B., Greene, J. B., Marcus, A., et al. (1981) 'Kaposi's sarcoma in homosexual men: A report of eight cases', Lancet 2:598-600
MMWR Weekly (1981) ' Kaposi's Sarcoma and Pneumocystis Pneumonia among Homosexual Men- New York City and California', July 4,30 (4); 305-308
Daniel McGinn, 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive
MMWR Weekly (1981) 'Pneumocystis Pneumonia- Los Angeles', June 5, 30 (21); 1-3
'The AIDS epidemic in San Francisco: The medical response, 1981-1984', Volume I, an oral history conducted in 1992-1993, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1995
Gottlieb M.S., Schroff R., Schanker H.M., et al. (1981) 'Pneumocystis carinii pneumonia and mucosal candidiasis in previously healthy homosexual men: evidence of a new acquired cellular immunodeficiency', The New England Journal of Medicine 305:1425-31.
Goedert J.J., Neuland C.Y., Wallen W.C., (1982) 'Amyl Nitrite may alter T lymphocytes in homosexual men',the Lancet 1:412-6
Shearer G.M., Hurtenbach U. (1982) 'Is sperm immunosuppressive in homosexuals and vasectomized men?' Immunology Today 3 153-154
Darrow, W.W (1991) 'AIDS: Socioepidemiologic responses to an epidemic', in 'AIDS and the social sciences, common threads', edited by Ulack, R. and Skinner, W.F., 1991,The University Press of Kentucky
Altman, L.K, (1981) 'Rare cancer seen in 41 Homosexuals', the New York Times, July 3
Masur H., Michelis M.A., Greene J.B., Onorato I., Stouwe R.A., Holzman R.S., Wormser G., Brettman L., Lange M., Murray H.W. and Cunnigham-Rundles S. (1981) 'An Outbreak of community acquired Pneumocystis carinii pneumonia: initial manifestation of cellular immune dysfunction' (1981), The New England Journal Of Medicine, vol 305:1431-1438, December 10, Number 24,
Dubois, R.M., Braitwaite, M.A., Mikhail, J.R. et al., (1981) 'Primary Pneumocystis Carinii and Cytomegalovirus Infections', the Lancet, ii, 1339
MMWR Weekly (1982) 'Epidemiologic Notes and Reports Persistent, Generalized Lymphadenopathy among Homosexual Males', May 21, 31(19); 249-51
MMWR Weekly (1982) 'Diffuse, Undifferentiated Non-Hodgkins Lymphoma among Homosexual Males- United States', June 4,31(21); 277-9
Brennan, R.O. and Durack, D.T., (1981) 'Gay compromise syndrome', the Lancet, 2 1338-1339:
Altman, L.K. (1982) 'New homosexual disorder worries officials', the New York Times, May 11
The Washington Blade (1982) 'Gay cancer focus of hearing', April 16
MMWR weekly (1882) 'A Cluster of Kaposi's sarcoma and Pneumocystis carinii Pneumonia among homosexual male residents of Los Angles and Orange counties, California', June 18/31 (23); 305-7
CDC (1982) ' Kaposi's Sarcoma (KS), Pneumocystis Carinii Pneumonia (PCP), and Other Opportunistic Infections (01): Cases Reported to CDC as of July 8'
MMWR Weekly (1982) 'Opportunistic infections and Kaposi's Sarcoma among Haitians in the United States', July 9,31 (26); 353-4,360-1
MMWR Weekly (1982) 'Epidemiologic notes and Reports Pneumocystis carinii Pneumonia among persons with hemophilia A', July 16, 31(27); 365-7,).
McKeown P. (1982) ''Gay Plague' Baffling Medical Detectives', Philadelphia Daily News, August 9
Time (2003) 'A Name for the Plague', March 30
Marx J.L. (1982) 'New disease baffles medical community', Science, August 13
Herman R. (1982) 'A Disease's spread provokes anxiety', the New York Times, August 8
McKeown P. (1982) ''Gay Plague' Baffling Medical Detectives', Philadelphia Daily News, August 9
MMWR Weekly (1982) 'Current Trends Update on Acquired Immune Deficiency Syndrome (AIDS)- United States', September 24, 31(37); 507-508, 513-514,
Direction Generale De La Sante (1982) 'Syndrome d'immuno-depression acquise', Bull. Epid. Hebd., no. 50 (1982b)
Connor S. and Kingman S. (1988) 'The search for the virus, the scientific discovery of AIDS and the quest for a cure', Penguin Books, p.14
Herman R. (1982) 'A Disease's spread provokes anxiety', the New York Times, August 8
About SFAF, www.sfaf.org/aboutsfaf; About APLA, www.apla.org/apla/about/about.html; About GMHC, www.gmhc.org/aboutus/gmhc.html
Berridge V., (1996), 'AIDS in the UK, the making of policy' 1981-1994, Oxford University Press
For example: Bay Area physicians for human rights leaflet on Kaposi's Sarcoma, GMHC health recommendation brochure.
MMWR Weekly (1982) 'Epidemiologic Notes and Reports Possible Transfusion-Associated Acquired Immune Deficiency Syndrome, AIDS- California', December 10, 31 (48); 652-4
MMWR Weekly (1982) 'Unexplained Immunodeficiency and Opportunistic Infections in Infants- New York, New Jersey, California', December 17,31 (49); 665-667
McGinn D. 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive,
For example: Vilaseca , J. et al. (1982) 'Kaposi's sarcoma and Toxoplasma gondi brain abscess in a Spanish homosexual', The Lancet 1, 572; Rozenbaum, W., et al. (1982) 'Multiple opportunistic infection in a male homosexual in France', The Lancet 1,572-573; Francioli, P., et al. 'Syndrome de deficience immunitaire acquise, infections opportunists et homosexualite. Presentation de trios cas observes en Suisse', (1982) Schweiz. Med. Wschr. 112, 1682-1687
Serwadda D, Mugerwa RD, Sewankambo NK, et al (1985) 'Slim disease: a new disease in Uganda and its association with HTLV-III infection', the Lancet, 2:849-52
MMWR Weekly (1983) 'Epidemiologic notes and reports immunodeficiency among female sexual partners of males with Acquired Immune Deficiency Syndrome (AIDS) - New York' (1983), January 7, 31(52);697-8
Marx J.L. (1983) 'Health officials seek ways to halt AIDS', Science, 21 January
MMWR Weekly (1983) 'Current trends prevention of Acquired Immune Deficiency Syndrome (AIDS): Report of Inter-Agency Recommendations', March 4, 32(8);101-3
Altman L. K. (1983) 'Debate Grows on U.S. Listing Of Haitians in AIDS Category', New York Times, July 31
Simons M. (1983) 'For Haiti's Tourism, the Stigma of AIDS is Fatal', New York Times, November 29
Callen M. (1983) 'Remarks to the New York Congressional Delegation', May 28
Goldstein A. (1983) 'AIDS Fear Hits Gay Populace Doctors: More Deaths Likely', Miami Herald, June 12
Black D. (1986) 'The Plague Years', Chapter 3 Part 12
Mail on Sunday (1983) May 1
Vass. A. (1986) 'AIDS: A Plague in Us', Venus Academica, p.25
For Example Daily Telegraph (1983) "Gay Plague" May Lead to Blood Ban on Homosexuals', May 2, and Daily Mirror (1983) 'Alert over "Gay Plague"', May 2
Barre-Sinoussi F. , Chermann J-C., Rey F., Nugeyre M.T., Chamaret S., Gruest J., Dauguet C., Axler-Blin C., Brun-Vezinet F., Rouzioux C., Rozenbaum W., and Montagnier L. (1983), 'Isolation of a T-Lymphotropic retrovirus from a patient at risk for Acquired Immune Deficiency Syndrome (AIDS)', Science, May 20
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.28
Connor S. and Kingman S. (1988), 'The search for the virus, the scientific discovery of AIDS and the quest for a cure' Penguin Books, p.35
Oleske J., et al. (1983), 'Immune Deficiency Syndrome in children', Journal of American Medicine Association, 249 (17), 2345-2349
New York Times (1983)'San Francisco Seeks to Combat Fear of AIDS', May 22
Enlow, R.(1984), 'Special session', in Acquired Immune Deficiency Syndrome, Annals of the New York Academy of Science, Volume 437, edited by Selikoff I.J, Teirstein A.S. and Hirschman S.Z., The New York Academy of Sciences, p.291
Altman L.K. (1983) 'Concern over AIDS grows internationally', the New York Times, May 24
MMWR Weekly (1983) 'Current Trends Acquired Immunodeficiency Syndrome (AIDS) Update - United States', June 24, 32 (24); 309-11
Weller I., Crawford D.H., Iliescu V., MacLennan K., Sutherland S., Tedder R.S., and Adler M.W. (1984) 'Homosexual men in London: Lymphadenopathy, immune status, and Epstein-Barr virus infection ', Annals of the New York Academy of Science, Volume 437, edited by Selikoff I.J, Teirstein A.S. and Hirschman S.Z., The New York Academy of Sciences, p.248-249
Clumeck N, Sonnet J, et al (1984) 'Acquired immunodeficiency syndrome in African patients', New England Journal of Medicine, 23;310(8):492-7
Bayley A.C. (1984) 'Aggressive Kaposi's sarcoma in Zambia, 1983', the Lancet 1:1318-20
Coker R, Wood PB (1986) 'Changing patterns of Kaposi's sarcoma in N.E. Zaire', Trans R Soc Trop Med Hyg., 1986;80(6):965-6
MMWR Weekly (1983) 'Acquired Immunodeficiency Syndrome (AIDS): Precautions for Health-Care Workers and Allied Professionals', September 2, 32 (34); 450-1
Gunson H H, (1986) 'The blood transfusion service in the UK', in Proceedings of the AIDS Conference 1986, edited by Jones P., Intercept, p.91-100
MMWR Weekly (1983) 'International Notes Acquired Immunodeficiency Syndrome (AIDS) - Europe', November 25, 32 (46); 610-1
WHO (1983) 'Acquired Immune Deficiency Syndrome Emergencies', Report of a WHO Meeting, Geneva, 22-25, November
AIDS Activity Center For Infectious Diseases Centers For Disease Control (1983) 'Acquired Immunodeficiency Syndrome (AIDS) weekly surveillance report- United States', December 22
Darrow, W.W (1991) 'AIDS: socioepidemiologic responses to an epidemic', in 'AIDS and the social sciences, common threads', edited by Ulack, R. and Skinner, W.F., 1991,The University Press of Kentucky
Auerbach D.M., Darrow, W.W., Jaffe, H.W, and J.W Curran (1984)'Cluster of cases of the acquired Immune Deficiency Syndrome-patients linked by sexual contact' ,American Journal of Medicine, 76, 487-492
McGinn D. 'MSNBC: AIDS at 20: Anatomy of a Plague; an Oral History', Newsweek Web Exclusive,
The Associated Press (1984), 'U.S. Medical study singles out a man who carried AIDS', the New York Times, March 27
Altman L.K. (1984) 'Federal official says he believes cause of AIDS has been found', the New York Times, April 22
Heckler, M. M. Secretary, U.S. Department of Health and Human services, Washington DC, Statement regarding AIDS, April 23, 1984
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.29
Culliton B.J. (1984), 'Crash development of AIDS test nears goal', Science, September 14
Altman L.K. (1984), 'New U.S. report names virus that may cause AIDS', the New York Times, April 24
Marx J.L. (1984), 'Strong new candidate for AIDS agent', Science, May 4
Culliton B.J. (1984), 'Five firms with the right stuff', Science, September 14
Office of Technology Assessment (1985) 'Review of the Public Health Service's Response to AIDS', U.S. Congress, Washington DC., February, p.29
'The AIDS Epidemic in San Francisco: the medical response, 1981-1984', Volume I, an oral history conducted in 1992-1993, Regional Oral History Office, The Bancroft Library, University of California, Berkeley, 1995
Van de Perre, P, Rouvroy D., Lepage, P et. al. (1984) 'Acquired Immunodeficiency Syndrome in Rwanda', the Lancet 2:62-5
Piot P, Quinn T.C., Taelman H. et al. (1984), 'Acquired Immunodeficiency Syndrome in a heterosexual population in Zaire', the Lancet 2:65-69
Mann J., Kapita B., Colebunders R. et al. (1986), 'Natural history of Human Immunodeficiency Virus Infection in Zaire', the Lancet, 2, 707-709
AIDS Activity, Center For Infectious Diseases, Centers For Disease Control (1984)'Acquired Immunodeficiency Syndrome (AIDS), Weekly Surveillance Report- United States', December 31
MMWR Weekly (1985) 'International Notes Update: Acquired Immunodeficiency Syndrome Europe', 34(11);147-150 March 22,
Department of Health Social Security (1985) 'Acquired Immune Deficiency Syndrome, general information for doctors', May
Marx J.L. (1985), 'A virus by any other name�', Science, March 22
'Pear R. (1985), 'AIDS blood test to be available in 2 to 6 weeks', the New York Times, March 3
Krieger N. and Appleman R (1986), 'The politics of AIDS', Frontline Pamphlets, the Institute for Social and Economic Studies, p.25
Gunson H. H. (1986) 'The blood transfusion service in the UK', in Proceedings of the AIDS Conference 1986, edited by Jones P., Intercept, p.91-100
Eckholm E. (1985) 'City, in shift, to make blood test for AIDS virus more widely available', the New York Times, December 23
National Institute on Drug Abuse (1988) 'Needle sharing among intravenous drug abusers: national and international perspectives', Research Monograph Series 80
Patton C. (1985) 'Sex and germs, the politics of AIDS', South End Press, Boston, p.37
Altman L.K. (1985) 'The Doctor's world: AIDS data pour in as studies proliferate', the New York Times, April 23
Mann , J. M (1989) 'AIDS: A worldwide pandemic', in Current topics in AIDS, Volume 2, edited by Gottlieb M.S., Jeffries D.F., Mildvan D., Pinching A.J., Quinn T.C., R.A. John Wiley Sons
Boffey P.M. (1985) 'U.S. counters public fears AIDS', the New York Times, September 20
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Brunt M. (1985) 'Ban on deadly kiss of life', Sunday Mirror, February 17
Sunday People (1985) 'Scandal of AIDS cover-up on QE2', February 17
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Berger J. (1985) 'Communion-Cup fear addressed' , the New York Times, September 13
Levine J. (1986) 'AIDS: prejudice and progress', Time Magazine, September 8,
Time Magazine (1990) 'American notes voices, the 'miracle' of Ryan White', April 23
MMWR Weekly (1985) 'Current Trends Update: Acquired Immunodeficiency Syndrome -- United States', May 10
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Arno P.S. and Feiden K.L. (1992) 'Against the odds: the story of AIDS development, politics and profits', HarperCollins Publishers and Palazzolo J. and Baker R. (1988) 'Antivirals for HIV infection', Bulletin of experimental treatments for AIDS (BETA), No.2, November
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Bureau of Hygiene Tropical Diseases (1986) 'AIDS newsletter' Issue 1 January 30th
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Bureau of Hygiene Tropical Diseases (1986) 'AIDS newsletter' Issue 1 January 30
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Bureau of Hygiene Tropical Diseases (1986) 'AIDS newsletter' Issue 4, March 25
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Fischl M. A., Richman D. D., Grieco M. H., Gottlieb M. S., Volberding P. A., Laskin O. L., Leedom J. M., Groopman J. E., Mildvan D., Schooley R. T., et al. (1987)''The Efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex, a double-blind, placebo-controlled trial', The New England Journal Of Medicine, Vol. 317: 185-191, Number 4
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08/18/2005


UN Millennium Development Goal #5

Childbirth remains an unnecessarily dangerous and life-threatening risk for women throughout the developing world. Every year, twelve million women are permanently disabled and between 500,000 and 600,000 die from treatable complications during childbirth because of lack of access to proper pre-and post-natal care – accounting for nearly 1,600 maternal deaths per day. Ninety-nine percent of all maternal deaths occur in developing countries – specifically in Asia and sub-Saharan Africa where poverty is most prevalent. One in every sixteen women in sub-Saharan Africa dies of pregnancy-related causes; in the developed world, only one woman in every 2,800 is at risk of maternal death. Almost all of the women who die in developing countries during childbirth would still be alive if they had pre- and post-natal care, access to a skilled midwife or doctor in childbirth and effective emergency care for obstetric emergencies. Additionally, improved access to contraceptives could further help in reducing maternal mortality by allowing women to plan their families

As contraceptives are often difficult to get reliably in developing countries