As people age, infectious and nutritional disorders give way to chronic, degenerative and mental illnesses which become the leading causes of morbidity and mortality (Mujahid, 2006). Heart diseases, strokes, osteoporosis hearing and visual impairments, and trauma.
Also, regardless of the level mortality, all countries face rising numbers of disabled older persons which is a burden especially in Africa.
4.6 People Living with HIV/AIDS
The HIV/AIDS epidemic in Africa has been well documented. An estimated 28 million adults now live with HIV in sub-Saharan Africa (SSA only which is more than all other global regions combined. In 2006, SSA accounted for almost two-thirds (63 per cent) of people infected with HIV. Across the region, women bear a disproportional brunt of the AIDS burden both in terms of infection and the ones most likely to care for people infected. In SSA, on average, three women are HIV-infected for every two men. Among young people (15-24years) that ratio widens considerably, to three young women for every young man.
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69
Figure 4.8
Trends of PLWHA over the years
HIV epidemic in sub-Saharan Africa, 1985-2005 30
1985 1990 1995 2000 2005
B Number of people living with HIV
% mV prevalence, adult (15-49) This bar indicates the range around the estimate
Source: UNAIDS, 2006
PLWHA constitute a large excluded group. Over the years, the number of PLWHA has increased because of the treatment success. The establishment of National AIDS Councils in many African countries with HIV policies has generally looked at the material condi
tions. The number of people who received antiretroviral treatment in Central, East, South and West Africa, as a whole, significantly improved from 100,000 in 2003 to 1.3 million in 2006. The corresponding coverage of people who received treatment improved from 2 per cent in 2003 to 28 per cent in 2006. Although widening, coverage rate is still very low, the demand of those in need is great (UNECA 2008).
One of the significant contributions that undermine these policy responses is the problem associated with stigma and discrimination of HIV/AIDS patients, further exacerbated by the high representation of women, excluded in their own right. HIV/AIDS stigma and discrimination can result in being shunned by family, peers and the wider community;
poor treatment in healthcare and education settings; discrimination at the workplace;
psychological damage; and can negatively affect the success of testing and treatment. HIV/
AIDS stigma and discrimination affects not only persons living with HIV and AIDS but also affect those closely related to them such as orphans, care-givers and spouse who end up being excluded. At a personal level, research has shown that AIDS stigma has nega
tive effects on HIV test-seeking behavior, willingness to disclose HIV status, health care-seeking behavior, quality of health care received, and social support solicited and received.
This inaction results in the perpetuation of HIV/AIDS. Box 4.3 illustrates the exclusion experienced by PLWHA due to stigma and discrimination.
Placing Social Integration at the Centre of Africa's Development Agenda
Box 4.3
Ghana: HIV/AIDS victims
in many parts of Ghana HIV/AIDS patients are seen as being shameful. This perception of shame is often extended to individuals, families and communities. For example extended family members may disagree with their kin marrying someone infected, or even marrying somebody from a community with perceived high HIV prevalence.
Fear of this stigmatization prevents patients testing, or declaring their HIV positive status. Thus combating the problems of exclusion, stigma and discrimination-the relational aspects - are as important as medicai treatment, prevention and control.
Source: UNDP, 2007
Governments should now focus on the implications of the increasing number of PLWHA.
Besides addressing stigma and poverty issues, more attention should be placed on reinvig-orating prevention efforts including positive prevention or prevention with positive pro
grams because HIV has progressed into a chronic condition rather than a death sentence as was originally perceived. In addition, governments should think of long term policies and programmes for now the next generation of PLWHA i.e those who were born with HIV/AIDS and are now becoming parents themselves.
4.7 Internally-Displaced Persons
Internally-Displaced Persons (IDPs) in this report banks on the United Nations report.
Guiding Principles on Internal Displacement and defines IDPs as persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habit
ual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized State border.
According to Mooney (2005), "global statistics on internal displacement generally count only IDPs uprooted by conflict and human rights violations. Even in UNHCR, IDP and refugees populations are counted based on conflict which limits the numbers of IDPs to persons displaced by violence. It is therefore very difficult to get accurate figures for IDPs not only because populations are constantly fluctuating but because of the dynamics of returning and fleeing IDPs. Also, while the cases of IDPs in large camps such as those in Darfur, western Sudan, are relatively well-reported, development-induced IDPs often are not included in assessments. It is thus necessary to note that, most reported figures only include those displaced by conflict or natural disasters which are just indicative of the magnitude of the problem.
Hardly are development projects seen as causes of internal displacement, which often happens to poor, indigenous and marginalized groups, who are displaced without their consent. In some instances people are evicted without being given adequate compensation for resettlement especially in cases of foreign investment where allocated land belonging
The African Social Development Report 2009
to the poor is exploitive of natural resources including oil. Often, these evictions are car
ried out with violence and abuse of human rights and most of these companies do not have policies for social corporate responsibilities and do not provide social services and compensation for the displaced.
According to the Internal Displacement and Monitoring Center (IDMC), Countries with significant IDP populations in Africa include:
• The Central African Republic with approximately 197,000 IDPs due to the 2003 coup d'etat and the subsequent civil war.
• Chad with 178,000 IDPs due to the proximity to Darfur and the civil war in eastern Chad.
• The Democratic Republic of the Congo with 1,5 million IDPs due to the Second Congo War, mostly in the eastern provinces.
• Cote d'lvoire with about 709,000 IDPs due to the civil war, mostly in the western regions.
• Ethiopia with about 200,000 IDPs due to natural disasters, the Ethiopian-Eritrean War and the Ogaden conflict.
• Kenya with 250,000 - 400,000 IDPs due to the violence that rocked the country after the 2007 elections.
• Somalia with over a million IDPs due to the civil war.
• Sudan with 5-6 million IDPs due to decades of civil war in the south and the Darfur conflict in the west.
• Uganda with about 869,000 IDPs due to the insurgency of the Lord's Resistance Army.
• Zimbabwe with 560,000 - 960,000 IDPs due to political violence, major land reform and an economic collapse of the country.
IDPs in Africa have become an increasing social concern, often persecuted or under at
tack by their own governments, they are frequently in a more desperate situation and are twice the refugee number. When the International Displaced Monitoring Center (IDMC) monitored internal displacement in 19 African countries in 2008, there were an estimated 11.6 million IDPs in these countries, the lowest internal displacement figure in Africa in a decade but still nearly half of the world's total IDP population. Countries monitored include: Algeria, Angola, Burundi, Central African Republic (CAR), Chad, Cote d'lvoire, the Democratic Republic of the Congo (DRC), Eritrea, Ethiopia, Kenya, Liberia, Nigeria, Republic of the Congo, Rwanda, Senegal, Somalia, the Sudan, Uganda and Zimbabwe.
While the numbers of IDPs in some countries like Sierra Leone, Burundi and Liberia have decreased over the years (according to trend data- 1993- 2007), the number of IDPs is generally increasing across the continent, (see annex for trend data). The situation of the IDPs is more critical than refugees or asylum seekers because they are often ignored and hardly get any assistance from the varied stakeholders. Interventions are only
experi-Placing Social Integration at the Centre of Africa's Development Agenda
enced when situations become very critical in terms of lack of food, shelter and outright violence.
Figure 4.9
Trends of refugees, asylum-seekers, internally-displaced persons (IDPs), returnees (refugees and IDPs), stateless persons in Africa, 1997-2007
Refugees i DPs/Protected/Assisted —^— Statless persons Returned refugees —^— Refugees IDPs —•— Others
Source: UNHCR, database, 2007