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‘AIDS: A Darwinian Event?’
by
Alan Whiteside1 & Alex de Waal2
The Centre for AIDS ResearchUniversity of Southampton 1. Director HEARD University of KwaZulu-Natal 2. Research Fellow, Global Equity Initiative, Harvard University
What do I mean?
Darwinian – that which results in change in our genetic, social, economic or psychological makeup
What do I mean?
Event – something we can measure as we look back or, in the case of AIDS, look forward
Examples
• The Black Death (see Barbara Tuchman ‘A Distant Mirror’)
• The extermination of colonial times – Tasmania
• Slavery?
• SMS texting with mobile phones?
What is AIDS?
HIV / AIDS an historical event – so what is our historical perspective
A candidate as a Darwinian
Event?
National trends in HIV prevalenceWomen attending Public Antenatal Clinics
0
5
10
15
20
25
30
35
40
45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
% H
IV p
osit
ive
Botswana
Namibia
South Africa
Swaziland
0
200000
400000
600000
800000
1000000
1200000
1995 2000 2005 2010 2015
year
num
ber o
f dea
ths
Other deaths AIDS Deaths
A model of future AIDS and non-AIDS deaths
0
10
20
30
40
50
6019
85
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
Mil
lio
ns
Tota
l po
pu
lati
on
0
1
2
3
4
5
6
7
8
9
Mil
lio
ns
Nu
mb
ers
HIV
, AID
S s
ick
and
HIV
dea
ths
Totalpopulation
Total HIV
TotalnumberAIDS sick
CumulativeHIVdeaths
Numbers infected, sick & dead ASSA2000
00001-E-47– 27 June 2000
Lifetime risk of AIDS death for 15Lifetime risk of AIDS death for 15--yearyear--old boys, old boys, assuming unchanged or halved risk of becoming assuming unchanged or halved risk of becoming
infected with HIV, selected countriesinfected with HIV, selected countries
Source: Zaba B, 2000 (unpublished data)
Current adult HIV prevalence rate
Burkina Faso
Cambodia
Côte d’Ivoire
Kenya
South AfricaZambia
Zimbabwe
Botswana
Burkina FasoCambodia
Côte d’Ivoire
Kenya
South AfricaZambia
Zimbabwe
Botswana
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0% 5% 10% 15% 20% 25% 30% 35% 40%
Ris
k of
dyi
ng o
f AID
S
current level of risk maintained
risk halved over next 15 years
Changing life expectancy in African countries with high and low HIV prevalence: 1950-2005
Source: UNAIDS, 2002. Report on the global HIV/AIDS epidemic
27Aug01 -Report I: Epidem’gy & Lit. p. 8
Households are becoming poorer
• Households will try to adapt.
• New forms of household.
• Coping & distress can both be found.
Assets will be sold.
• Households poorer
• Households disappear
Zambia5 year retrospective study of AIDS-
affected families(232 urban +101 rural)
Monthly disposable incomefell by >80%
Rakai, UgandaBicycles & radios in
houses with adult AIDS deathBike Radio
First vist 39 40Last visit 35 36
30
Demography
• Size (decrease, stabilise, grow more slowly)
• Structure male:female, dependency ratios
• orphans
Social/psychological
Selection by • Wealth • Skills• Ability or characteristics eg
artists or entrepreneurs
Wealth and HIV
1000 $
2000 $
3000 $
Per capita 1999
Adult HIV prevalence end 1999
Botswana
South Africa
Namibia
Swaziland
ZimbabweUganda
Cote d’Ivoire
Zambia10
10 20 30
Debswana Diamond Company (Pty) Ltd
HIV Prevalence by Job Band
30.9% 30.7%27.6%
19.3% 18.8%
0
5
10
15
20
25
30
35
A Band B Band C Band D Band F Band
% H
IV p
osi
tiv
e e
mp
loy
ee
s in
eac
h jo
b b
and
Some Populations Harder Hit than Others
*Above average deaths from AIDS(++ high impact, maybe higher numbers)
AIDSepidemic
Young women
Unemployed
Migrants, temp, contract workers
Drivers & mobile workers
Miners/hazardous occupations
Political leaders?
Newly prosperous
Soldiers
Sex workers
Teachers++
Some regions:KZN, Gauteng, Mpu’gaCaprivi – E&WBotswanaSwaziland, Lesotho
Dying*
orphans
Corridors & CrossroadsMaputoBeiraDurbanTrans-Kalahari?
Gov’t workers++
Short-term thinkers
Uncircumcised
AIDSepidemic
High income
Non-migrant families
Settled, long-termemployedTertiary education
Some regions:W. CapeN. CapeSn. NamibiaNorthern Prov.E. Cape
Grandparents
Surviving**
**Below average deaths from AIDS(the foundation of the future)
Long-term thinkers
Isolated areas
Chaste & faithful
Circumcised
Cohesive, candid societies
Intro.
Memetic evolution
Memes are replicable information in the brain.
• Circumcision• Risk taking• Funeral ceremonies• Nepotism and altruism
Is AIDS a Darwinian event?
Yes• Populations decline• Some groups
v.adversely affected• Memetic impact• Economic & social
effects
No• Pop. Decline limited• Epidemic isolated in
certain areas & groups
• The ‘dyers’ don’t matter
• The scale too short
Ozymandias
I met a traveler from an antique landWho said: Two vast and trunkless legs of stone
Stand in the desert. Near them, on the sand,Half sunk, a shattered visage lies, whose frown,And wrinkled lip, and sneer of cold command,Tell that its sculptor well those passions read,
Which yet survive, stamped on these lifeless things,The hand that mocked them, and the heart that fed,
And on the pedestal these words appear:"My name is Ozymandias, King of Kings:
Look upon my works, ye Mighty, and despair!"Nothing beside remains. Round the decayOf that colossal wreck, boundless and bareThe lone and level sands stretch far away.
Percy Bysshe Shelley1792-1822
No Man is an Island
No man is an island, entire of itself every man is a piece of the continent, a part of the main if a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friends or of thine own were any man's death diminishes me, because I am involved in mankind and therefore never send to know for whom the bell tolls it tolls for thee. -- John Donne
HIV/AIDS is an historical event!
A ‘history’ is being written.The responsibilityof historians provide: • ideas, • paradigms & • methodologies for understanding and
responding