CHAPTER ONE

INTRODUCTION

• BACKGROUND OF THE STUDY

HIV/AIDS is a global challenge that has threatened the very existence of the human race. In most countries the epidemic did not occur until the 1980s. At present, there is no country in the world without HIV cases (WHO 1995). The African continent is said to hold the vast majority of the world’s HIV infected population. It is estimated that in 2007, 33.0 million people living with HIV/AIDS, 22.0 million of them lived in sub-Saharan Africa (UNAIDS, 2008).

The Human Immunodeficiency Virus (HIV) which causes the Acquired Immune Deficiency Syndrome (AIDS) has spread more rapidly than most diseases in recent history, having social, cultural, economical and moral repercussions on individuals, families, communities and threatening foundations of entire societies. Over the years, the link between HIV/AIDS and impoverishment has grown and even stronger as the disease is infecting and affecting the younger generation who are the productive labour force of every economy. HIV infections are spreading quickly within the youth populations and what happens to them today will determine
what becomes of them and their communities in the future. An estimated 11.8 million young people aged 15–24 are living with HIV/AIDS, and half of all new infections, over 6,000 daily, are occurring among them. (The Joint United Nations Programme on HIV/AIDS, UNAIDS, 2003.)

The World Health Organization (WHO) has identified HIV/AIDS as one of the world’s first health emergency and an urgent threat to global public health. It reveals that HIV/AIDS is the worlds second widely spread communicable disease and the sixth common cause of death globally. About 65 million people have been affected and more than 25 million people have died of AIDS related causes. The situation is made even gloomier, with 29 million new infections estimated by 2020 if prevention and treatment are not accelerated.

The United Nations Millennium Development Goals (MDGs) report for 2006, states that several countries report success in reducing HIV infections. However, the overall infection rate is on the rise. Sub-Saharan Africa (SSA) remains the highest affected region.

The WHO (2004) has classified HIV/AIDS as the main cause of adult mortality in Africa. It affirms that about 3,1% and 3,9% of all male and female deaths respectively are caused by AIDS related diseases. In the same vein, UNAIDS (2006) fact sheet states that 63% of the global HIV/AIDS infections are in Africa, South of the Sahara with the prevalence rate highest among the age group 15-49 years. It is for which reason African heads of states declared AIDS as a state of emergency in the continent during the African development Forum (2000). This does not give a promising picture for the African Continent because this age group constitutes youths and adults who are the most active and productive and should be leading the process of development and social change. The international community has come to acknowledge that HIV/AIDS
is not only a health problem. It is a developmental disaster of alarming proportions which will affect development goals at the human, financial and material levels. According to UNAIDS (2008, 13) no disease in history has prompted a comparable mobilization of political, financial and human resources and no development challenge has led to such a strong leadership by communities and countries most heavily affected. By reducing life expectancy, increasing child mortality and proliferating the number of orphans, HIV/AIDS impoverishes individuals, communities and nations by eroding the capacities of socio-economic systems through losses of human resources which is the most important resource for meaningful and sustainable development.

Cameroon has a population of about 18,175.000 million, (WHO Cameroon, 2009). According to the 2008 country report for Cameroon submitted to the United Nations general Assembly Special Session (UNGASS), HIV adult prevalence stands at 5,5%. The number of people living with HIV/AIDS (PLHIV) is 543,295. The number of infections for those aged 15-24 years is 3,2%, 44.813 children aged 0-14 are living with HIV and children orphaned by AIDS related diseases amount to 305,000. Deaths related to AIDS infections are 43,632, (UNAIDS, 2008). These figures are based on the Demographic Health Survey (DHS) method. It includes sub groups like university students, commercial sex workers, long distance truck drivers among others and has been employed since 2004 as opposed to the sentinel surveillance method (counts from pregnant women who go for anti-natal care) which gave adult prevalence rates at 11% in previous year. This drop can also be explained by the fact that many people who were infected in the late 1990s and early 2000s have died of AIDS related diseases, since Antiretroviral therapy (ARV) drugs were very expensive in those years. Despite this drop in prevalence, new infections have been on the increase especially among the 15-24 age brackets. The WHO (2005) observes that young people in Cameroon are highly affected. Indeed, a third of Cameroonians infected are 15-29 years of age. This age group constitutes all Cameroonians who are in secondary school, high school, University, vocational schools, professional schools and those in active service. In their article, Mbanya, Martyn & Paul (2008, 2) state that the socio-economic impact of the disease is profound with growing numbers of sectors being affected, and high hospital bed occupancy rampant. They add that this results in overstretched medical personnel and extra burden to the health and education sectors where school teachers are reported to be unproductive on several counts and morbidity increasing from opportunistic infections. This of course, poses a major challenge to the socio-economic development of the country considering the fact that the age group below 15 makes up about 42% of the entire population (Population Reference Bureau, 2009). While the adult HIV prevalence in Cameroon is still one of the highest in the Central African Sub-Region it can be described as relatively lower compared to other countries in SSA particularly in the South and Eastern African Countries. This, however, does not imply that Cameroon should be complacent while the younger generation is engulfed by the AIDS pandemic. .

In recent years, the government of Cameroon has been quite committed in the fight against HIV/AIDS and has declared HIV/AIDS a health emergency and a priority programme for the Poverty Reduction Strategy Paper (PRSP). A National Aids Control Committee (NACC) was instituted in 1998, to coordinate all activities geared towards prevention, treatment and care of PLHIV. It also monitors the spread of the pandemic and controls the finances that are allocated to all stakeholders in the fight against HIV/AIDS. ARV drugs have been subsidized over the years beginning with a 53% subsidy in 2002. Cameroon also developed national treatment guidelines and a multi-sectoral plan for decentralizing the provision of ARV drugs in 2004-2005 in collaboration with the NACC and WHO, (WHO, 2005). Early in 2007 the distribution of ARV drugs was declared free by the government, as a result of subsidies from the Association Esther France and drugs for opportunistic infections from the Clinton Foundation HIV/AIDS Initiative (CHAI). Mbanya, Martyn & Paul (2008, 5) state that the Government of Cameroon has achieved quite a lot in its strategic plans towards curbing the spread of HIV. These interventions have been very timely to reduce the impact and especially the social burden on people infected and affected by HIV/AIDS. The 2008 progress report by the NACC reveals that 50,005 patients are on treatment, thus representing 55% of patients eligible for treatment. This represents 9,8% of the total number of people living with HIV/AIDS (NACC, 2008). The National Strategic AIDS Plan (2006-2010) addresses the full range of HIV/AIDS strategies, including care, prevention, support and treatment. The government is committed to promoting universal access to treatment, prevention and voluntary testing and counselling (VTC) centres have been integrated into all, regional and district hospitals in all ten regions of the country. Recent global reports from UNAIDS still confirm that young people aged 15–24 account for 45% of all new HIV infections in adults, and many young people still lack accurate and complete information on how to avoid exposure to the virus. It emphasizes that preventing new infections is the key to reversing this epidemic. (UNAIDS 2008, 96.)

Despite all these interventions it has been observed that prevalence among the 15-24 years old is staggering, and they still remain the highest risk group in Cameroon. In fact, children infected and affected by HIV/AIDS are more likely to drop out of school at some point in time. The entire school systems are themselves affected by HIV/AIDS, 95% of HIV positive teachers have difficulties with punctuality in school and 73% of them affirm that they have to stop lessons from time to time when they are not physically fit. Up to 67% of students living with HIV face similar problems. (UNESCO Cameroon, 2007.) These circumstances make it difficult for students to have a decent education. The Paranoid situation created by this pandemic is putting the entire educational systems and the society at large under pressure. The education system must be supported through prevention, for education is the major driver of economic and social development. Indeed, countries education sectors have a strong potential to make a difference in the fight against HIV/AIDS (Bundy 2002, 7). Prevention and coping strategies can only be ensured through education for it is true that with the current state of scientific knowledge and development, the only protection available to society is through education (Kelly 2004, 38).